Diabetes: The Hidden Pandemic and its Impact on Sub-saharan Africa

This 40-page briefing document was produced to increase the understanding of diabetes in sub-Saharan Africa through epidemiological evidence, health economic analyses, and examples of best practice for diabetes care and prevention. It was produced as part of the Changing Diabetes Barometer, supported by Novo Nordisk, an initiative designed to give healthcare providers and policymakers critical information to measure progress and drive change in diabetes. According to the document, along with data and care initiatives, preventive educational programmes are needed to empower and raise awareness of the impact of lifestyle; particularly for the younger generation. Providing knowledge to healthcare professionals, and the skill to inspire effective self-care in their patients, is also a vital part of the solution.

The document states that up to 80% of cases of type 2 diabetes can be prevented, and even once diabetes has set in, many serious diabetes complications can be prevented or delayed. Giving people the information to understand the importance of a healthy lifestyle can help them to avoid developing impaired glucose tolerance or diabetes. Even if diagnosed with diabetes, helping people to manage their diabetes with lifestyle advice and medication helps to delay or prevent disabling complications. Preventive actions have been shown to be cost-effective for low- and middle-income countries care for these as well. Although it faces very great problems in offering adequate healthcare for people with diabetes, sub-Saharan Africa is already showing examples of good practice that are beginning to address the problems. Sharing information and ideas about approaches that are working is one of the most positive options for the future. The document highlights the following case studies related to raising awareness:

• A World Diabetes Foundation project has provided information about diabetes and its risk factors to the general population in Mali and has also provided extra training in diabetes awareness and diagnosis to 50 healthcare professionals and 50 diabetes and nutrition educators. These people are active in information and education on a local basis and are estimated to have reached over 400,000 people, as well as providing individual nutritional advice to 100,000 people with diabetes. In addition, diabetes has been publicised through radio and television programmes and through information shared with traditional chiefs.
• A community and school outreach programme was implemented in Tanzania to improve diabetes prevention by integrating schools, communities and health facilities in diabetes prevention. This programme trains primary-school teachers to perform physical measurements as used in the screening of people at high risk of developing diabetes. The teachers use this knowledge to train their students, who perform these measurements at home among their family members. These results will then be followed up with healthcare providers to ensure counselling and care for those in need.
• A twinning programme in Mozambique allowed the Diabetes UK association to work with the Mozambique Diabetes Association towards development of the first comprehensive plan in sub-Saharan Africa to address non-communicable diseases (NCDs). The collaboration also enabled extra training in diabetes care for 265 health workers, public awareness events in the context of World Diabetes Day, and the development of appropriate materials for patient education. The project resulted in significant strengthening of the Mozambique association and raised the profile of diabetes and other NCDs from their former low priority; improvements were made with only modest costs.
• A diabetes education programme implemented in Kenya improved the understanding of diabetes among healthcare staff and created public awareness on diabetes prevention, control and risk factors. To improve diabetes care in Kenya, new diabetes clinics were set up and existing diabetes clinics re-equipped. The Ministry of Health is responsible for providing all equipment, facilities, medication, general practitioners and nurses for the clinics, along with further training and retraining of professional healthcare providers. To create public awareness of diabetes and its risk factors, public information meetings, press conferences and exhibitions were held. The programme resulted in 118,767 people being screened for diabetes, of whom 12,627 had diabetes. Diabetes management training was given to 682 doctors, 2,091 nurses, 813 paramedics, 380 dieticians, and 4,023 lay educators.

The evidence gathered in the book led to the following recommendations being put forth for discussion at the Diabetes Leadership Forum Africa 2010:

• National diabetes programmes should be developed to enable integrated planning, training, services and supervision.
• More research should be undertaken on the prevalence of diabetes, its complications, and effective interventions in order to provide an evidence base of country-specific data to inform the development of national priorities and policies.
• Health systems should be strengthened, with a move towards systems that can detect and treat multiple diseases rather than focusing on a few conditions.
• Supply chains, buildings, and personnel should offer combined care for multiple chronic conditions such as HIV, diabetes, and respiratory and cardiovascular diseases; and so could support systems offering peer-to-peer education for improved treatment compliance and psychosocial well-being.
• Information and education initiatives to improve diabetes awareness in the general population are vital, particularly, in the areas of detection of type 1 diabetes in children and of women’s health and gestational diabetes.
• Opportunistic screening for diabetes, carried out when people are seeking treatment for other conditions, would improve early detection and treatment of diabetes.