1 / 58

DIABETES IN SUB-SAHARAN AFRICA

DIABETES IN SUB-SAHARAN AFRICA. Dr Kaushik Ramaiya. 38.2 44.2 16%. 25.0 39.7 59%. 81.8 156.1 91%. 18.2 35.9 97%. 13.6 26.9 98%. 1.1 1.7 59%. 10.4 19.7 88%. GLOBAL PROJECTIONS FOR THE DIABETES EPIDEMIC: 2003-2025 (millions). World 2003 = 189 million

mira
Download Presentation

DIABETES IN SUB-SAHARAN AFRICA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DIABETES IN SUB-SAHARANAFRICA Dr Kaushik Ramaiya

  2. 38.2 44.2 16% 25.0 39.7 59% 81.8 156.1 91% 18.2 35.9 97% 13.6 26.9 98% 1.1 1.7 59% 10.4 19.7 88% GLOBAL PROJECTIONS FOR THE DIABETES EPIDEMIC: 2003-2025 (millions) World 2003 = 189 million 2025 = 324 million Increase 72%

  3. Deaths by broad cause group and WHO region Noncommunicable conditions % 75 Injuries Communicable diseases, maternal and perinatal conditions and nutritional deficiencies 50 25 EMR SEAR WPR EUR AFR AMR

  4. RISK FACTORS • NON MODIFIABLE • Age • Ethnicity/predisposition • MODIFIABLE • Obesity • Urbanization • Physical inactivity • Change in dietary habits Age Prevalence of diabetes by age group in a population of Cameroon Mbanya JC et al

  5. RISK FACTORS • NON MODIFIABLE • Age • Predisposition • MODIFIABLE • Obesity • Urbanization • Physical inactivity • Change in dietary habits Sobngwi E, et al. Int J Obes 2002 Obesity

  6. RISK FACTORS • NON MODIFIABLE • Age • Predisposition • MODIFIABLE • Obesity • Urbanization • Physical inactivity • Change in dietary habits Childhood Obesity

  7. Prevalence of Systolic, Diastolic and Both (Systolic and Diastolic) Hypertension in the Three School Settings %

  8. Prevalence of Obesity in the three school settings %

  9. RISK FACTORS • NON MODIFIABLE • Age • Predisposition • MODIFIABLE • Obesity • Urbanization • Physical Inactivity • Change in dietary habits Average percentage annual increase in urban and rural populations, 1995-2000

  10. RISK FACTORS • NON MODIFIABLE • Age • Predisposition • MODIFIABLE • Obesity • Urbanization • Physical Inactivity • Change in dietary habits Physical Inactivity Daily walking time in a sample of 2465 urban and rural Cameroonians (Sobngwi E, et al Int J Obes 2002)

  11. TYPE 1 DIABETES:INCIDENCE INCIDENCE/100,000 of Type 1 diabetes in Sudan (El Amin et al.)

  12. Type 1 DM in Africa- Clinical characteristics of Type 1 diabetes in Africa Patients

  13. Type 2 DM in Africa • Data • increasing but limited • Not rare • low in rural areas • moderate in rural and urban areas with development • high in urban areas • Urban > Rural • IGT • early stage of epidemic • Increasing in same population • Ethnicity • Modifiable risk factors

  14. SUMMARY OF CURRENT PREVALENCE OF TYPE 2 DIABETES • Rural Sub Saharan Africa 1 – 3.5% • Urban Sub Saharan Africa 3 – 7.7% • Republic of South Africa 4.8 – 8.0% • Maghrebian countries 6.3 – 9.3% • Indian origin populations 8.6 – 13.3%

  15. Acute complications of diabetes: • Diabetic ketoacidosis • Hyperosmolar non-ketotic coma • Hypoglycaemia

  16. Diabetic ketoacidosis • Common emergency • High mortality 25% in Tanzania, 33% in Kenya • Contributing factors: • Lack of insulin availability • Delay in diagnosis • Misdiagnosis • Economics • Poor healthcare system • infections

  17. Hyperosmolar non-ketotic coma: • Complication of type 2 diabetes • Less common • Accounts for about 10% of all hyperglycaemic emergencies (Zouvanis et al, 1987) • Contributing factors: • Infections • Non-compliance • First presentation • Mortality high – 44% - studies from South Africa (Rolfe et al, 1995) – patients usually elderly and have other major illness

  18. Hypoglycaemia • Serious complication of OHA therapy • In South Africa (Gill & Huddle,1993) 33% of cases associated with sulphonylurea treatment • Other precipitating causes: • Missed meal (36%) • Alcohol (22%) • GI upset (20%) • Inappropriate treatment

  19. Microvascular complications of diabetes RETINOPATHY

  20. RETINOPATHY • In South Africa, at diagnosis, 21-25% of type 2 diabetes and 9.5% of type 1 diabetes haveretinopathy(Kalk et al,1997). • ? Genetic predisposition – africans more affected • Poor/inadequate access to healh care leading to inadequate control of blood glucose and blood pressure.

  21. Microvascular complications of diabetes NEPHROPATHY *microabuminuria

  22. NEPHROPATHY • Diabetes contributes to 35% of all patients admitted to dialysis unit (Diallo et al,1997) • In South African series, 50% of all causes of mortality in type 1 diabetes was due to renal failure (Gill, Huddle & Rolfe, 1995)

  23. Microvascular complications of diabetes NEUROPATHY

  24. NEUROPATHY • Prevalence varies widely depending on method used. • Poor glycaemic control and inadequate foot care are risk factors for diabetic foot.

  25. MACROVASCULAR COMPLICATIONS OF DIABETES

  26. Diabetes - Clinical course • ETHIOPIA Causes of death in 100 Ethiopian diabetic patients 1976 - 1983. • At death:- 45 % of patients below age 50 years 46 % below 10 years of diabetic duration • Causes of death:- Metabolic 47 % Renal Failure 26 % Infective 12 % Cirrhosis 10 % Stroke 8 % Other 12 % Not known 15 % • Lester FT. Ethiopian Med J 1984; 2: 61-68

  27. Diabetes - Clinical CourseSouth Africa

  28. Clinical course of DiabetesTanzania (Dar es Salaam)

  29. AWARENESS AND MANAGEMENT OF DIABETES: The Cameroon Diabetes Study 2004 75% of all the known cases of diabetes were treated Only 27% of the treated cases were controlled by medical treatment

  30. Patients knowledge of diabetes 60 50 % Knowledge 40 Medicine 30 Diet Complications 20 Total 10 0

  31. Insulin / OHA costs • Tanzania (1989-90):- • Average annual direct cost of diabetes care US $ 287.00 IRDM US $ 103.00 NIDDM • Purchase of insulin accounted for US $ 156.00 (68.2%) of the average annual outpatient costs for IRDM. • OHA accounted for US $ 29.30 (42.5%) of the average annual outpatient costs for NIDDM. Chale SS et al. For Med J 1992; 304: 1215-8

  32. Costs of treatment • In Cameroon (Nkegoum, 2002) in the year 2001: • Average direct medical cost of treating a patient with diabetes was USD 489. • 56% -hospital admission • 33.5% - anti-diabetic drugs • 5.5% -laboratory tests • 4.5% on consultation fee.

  33. The increasing burden of T2D is against a background of decreasing resources Therefore primary prevention must be the cornerstone of policies aiming to tackle diabetes in Africa Country level: Time for a national diabetes program Regional level: Time for an African Diabetes Declaration

  34. The increasing burden of T2D is against a background of decreasing resources Therefore primary prevention must be the cornerstone of policies aiming to tackle diabetes in Africa Country level: Time for a national diabetes program Regional level: Time for an African Diabetes Declaration

  35. Prevention StrategiesProblems in Africa • Mortality • Poorly skilled or inadequate providers • Delay - attention • Drugs – availability - affordability • Complications •  awareness •  facilities– detection - monitoring • economics

  36. Barriers to Quality care • Irregular supply of medicines (including insulin) • Inadequate health-care infrastructure and disproportionate distribution of the facilities • Affordability • Lack of adequate training and retraining of health care providers • Lack of education to the people living with diabetes & their families • Differing government priorities

  37. NATIONAL RESPONSE

  38. Primary prevention: • Diet • Physical activity • Maintaining ideal body weight • Life-style modification

  39. LIFE STYLE GUIDANCE • Advice on:- EXERCISE DIET SMOKING

  40. CHANGE IN GLUCOSE TOLERANCE

  41. Secondary Prevention

  42. Prevalence (%) of diabetes in different communities in Tanzania % Mara 0.6 Kilimanjaro 0.7 Morogoro 0.8 1.0 - 5.0 Urban Africans (Dar es Salaam) African nuns (Dar es Salaam) 4.3 Ithna-asheri Asians (Dar es Salaam) 8.8 Hindu Asians (Dar es Salaam) 9.8 10.0 African Priests (Dar es Salaam) Bohra Asians ({Dar es Salaam) 11.0 African Executives 12.0

  43. MULTI-SECTORAL PARTNERSHIP Tanzania Diabetes Association Ministry of Health Donors World Diabetes Foundation Novo Nordisk Fund Raising Dr Zolli – Venice,Italy NN World Partnership Project Curriculum development Training Capacity building- tools Establishment of Association Branches Monitoring & Evaluation Supply & logistics system Human resources Clinic space “Seed” funding SUSTAINABLE QUALITY DIABETES SERVICE

  44. Tanzania

  45. Community awareness

More Related