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High unmet need for diabetes diagnosis, care across sub-Saharan Africa
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Health systems in sub-Saharan Africa fail to identify the majority of patients with diabetes, and a large unmet need for diabetes counseling and treatment remains, according to an analysis of population-based surveys.
“The burden of diabetes and overweight/obesity are very substantial in the sub-Saharan African countries included in this piece, but much of the need for diagnosis, lifestyle counseling and treatment is not being met by the current systems of care,” Jennifer Manne-Goehler, MD, DSc, a resident in medicine at Beth Israel Deaconess Medical Center, clinical fellow at Harvard Medical School and research fellow at the Harvard T.H. Chan School of Public Health, told Endocrine Today. “In particular, younger and less educated people with diabetes in this region are most in need of these health services.”
Manne-Goehler and colleagues analyzed individual-level data from nationally representative population-based surveys conducted between 2005 and 2015 across 12 countries in sub-Saharan Africa, including Benin, Comoros, Guinea, Kenya, Liberia, Mozambique, Seychelles, Tanzania, Togo and Uganda (n = 38,311; mean age, 39 years; 58% women; 57% currently employed). Most included surveys used in the WHO Stepwise Approach to Surveillance (STEPS) method, an instrument for collecting data on noncommunicable diseases in WHO member countries. Researchers assessed self-reported data to quantify the met and unmet needs for screening and diagnosis of diabetes. Three measures were defined: patients with overweight or obesity having ever received a blood glucose measurement; individuals defined as having diabetes ever having received a blood glucose measurement; and individuals defined as having diabetes having been told by a health care provider about diabetes diagnosis, a measure of awareness of diagnosis.
Among respondents categorized as having diabetes, researchers quantified the met need for four dimensions of care: ever having received counseling to lose weight, ever having received counseling to exercise, use of oral drugs for diabetes management and use of insulin for treating diabetes.
Across the 12 surveys analyzed, single-country diabetes prevalence ranged from 2% in Mozambique to 14% in the Seychelles; median prevalence in the region was 5%. Among respondents aged 55 to 64 years, median prevalence of diabetes was 9%. Across surveys, a median of 27% of respondents had overweight or obesity; among those, a median of 22% reported ever having received a blood glucose test. Among respondents with diabetes, a median of 36% self-reported receiving a blood glucose test; a median of 27% reported being told of their diabetes diagnosis.
Responses also suggested an unmet need for care. A median of 15% of respondents reported that they were counseled by a health care provider to lose weight; 15% reported that they received counseling regarding exercise. A median of 25% of respondents reported the use of oral diabetes drugs; 11% reporting using insulin.
“Our analysis of pooled, individual-level data across 12 nationally representative population-based surveys shows strikingly high levels of unmet need across several key indicators of diabetes diagnosis and care,” the researchers wrote. “Taking the median of country means as a summary statistic, among all people with diabetes, only a third reported having ever received a blood sugar measurement and only a third recalled being diagnosed as having diabetes. Similarly, only small proportions of overweight or obese people reported being screened for diabetes, despite their high risk for the disease.”
The researchers noted that, although the target population and cost-effectiveness of blood glucose screenings for previously undetected diabetes in sub-Saharan Africa is under debate, patients with overweight or obesity should be considered a “key group” for targeted diabetes screening interventions.
“The clinical implications of this work are great for providers in the sub-Saharan African region, in terms of the need for more awareness of the burden of diabetes and more robust care provision,” Manne-Goehler said. “There is a dearth of population-based, empirical data from low- and middle-income countries about many aspects of diabetes, so this is a key research gap. In addition, further investigation is needed to understand levels and correlates of diabetes control in this region and how this epidemic interacts with other noncommunicable disease epidemics, such as hypertension and hyperlipidemia, and infectious epidemics, such as HIV/AIDS, both from a clinical and health-systems perspective.” – by Regina Schaffer
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Jen nifer Manne-Goehler, MD, DSc, can be reached at the Harvard H.T. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115; email: jmanne@post.harvard.edu.
Disclosure: Manne-Goehler reports no relevant financial disclosures.
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