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Current Issues International Health and Diabetes
Diabetes in Sub-Saharan Africa—Overview of a Looming Health Challenge
Felix K Assah, MD, MPhil
1
and Jean-Claude Mbanya, MD, PhD, FRCP
2
1. Doctoral Student, MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge;
2. Professor of Medicine and Endocrinology, Department of Internal Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I
Abstract
The number of people living with diabetes in the world is increasing rapidly. Most of the increase will occur in developing countries such as those in
sub-Saharan Africa. Diabetes is currently recognized as a real and imminent threat to social and economic development globally and is set to be a
major public health challenge in the 21st century. In sub-Saharan Africa, the challenge posed by diabetes is even more overwhelming as diabetes
will have to share scarce resources with infections and malnutrition. Even worse, diabetes still has to gain sufficient political and social recognition
in order to warrant aggressive national policies for prevention and treatment. In this article we present an overview of the burden of diabetes in
sub-Saharan Africa and the specificities of care and control, and highlight the importance of developing effective national diabetes programs.
Keywords
Diabetes, sub-Saharan Africa, epidemiology, morbidity, mortality, cost of diabetes care, diabetes control program
Disclosure: The authors have no conflicts of interest to declare.
Received: May 4, 2009 Accepted: July 16, 2009
Correspondence: Felix K Assah, MD, MPhil, MRC Epidemiology Unit, Institute of Metabolic Science, Box 285, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 0QQ, UK.
E: felix.assah@mrc-epid.cam.ac.uk
A few decades ago, diabetes was considered a disease of affluent underweight, and chronic malnutrition in children and obesity and
societies. This statement would be rather inappropriate today as it is cardiovascular diseases in adults.
known that most of the world’s patients with diabetes live in developing
countries. In absolute numbers, most of these people live in China and Prevalence, Risk Factors, and Trends
India. However, the burden of diabetes in sub-Saharan Africa (SSA) is There is a dearth of good-quality epidemiological data on diabetes
already substantial, and continues to increase at a very rapid rate: prevalence, incidence, and trends on the African continent. The
current predictions estimate that the number of people living with difficulty is even more critical when trying to extricate the separate
diabetes on the continent will almost double over the next 20 years.
1
rates of type 1 or type 2 diabetes. Only a handful of studies have
This is not good news for a continent that has been the hardest hit by described the epidemiology of type 1 diabetes in an African population,
the HIV/AIDS pandemic and that currently is home to about 70% of the and of these only a couple are from SSA.
4
Due to limitations in study
billion poorest people of the world.
2
methods and design, many of these studies do not provide reliable
population estimates, in addition to the fact that these estimates
The increasing prevalence of diabetes and other non-communicable may include cases of malnutrition-related diabetes or ketosis-
diseases in Africa is a result of an epidemiological transition driven prone diabetes
5
due to diagnostic constraints. Notwithstanding, the
by rapid urbanization of communities. Urbanization brings with it a International Diabetes Federation (IDF) estimates that there were a total
nutritional transition from traditional natural foods to processed energy- of almost 38,000 prevalent cases of type 1 diabetes in SSA in 2007,
dense foods, as well as a substantial reduction in physical activity levels which was higher than those in South and Central America or the
due to mechanization of work and transport. These changes have led to Western Pacific region of the IDF despite the fact that these regions had
an increasing level of obesity in young adults and adults, which is driving a much higher denominator population than SSA.
1
The peak age at
the surge in diabetes. The epidemiological transition Africa is currently occurrence of type 1 diabetes has been reported to be much later in
undergoing is not exactly the same as that which most developed Africans (22–23 years) compared with Caucasians (12–13 years).
6
countries went through: the transition in Africa is following a delayed Current estimates of the prevalence of type 2 diabetes in Africa from
model
3
characterized by high fertility and high but reducing mortality, the IDF
1
are based on data from only a handful of countries. In 2007,
resulting in a double demographic disease pattern. This means that the there were an estimated 10.4 million people living with diabetes in
low-income economies of most African countries and their strained Africa, with this number expected to increase to 18.7 million by 2025—
healthcare systems have to grapple with the burden of infections, an 80% increase (see Figure 1). This projection may be a conservative
© TOUCH BRIEFINGS 2009 15
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