Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries
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Date
2016
Journal Title
Journal ISSN
Volume Title
Publisher
The lancet Diabetes & endocrinology
Abstract
Despite widespread recognition that the burden of diabetes is rapidly growing in many countries in
sub-Saharan Africa, nationally representative estimates of unmet need for diabetes diagnosis and care are in short
supply for the region. We use national population-based survey data to quantify diabetes prevalence and met and
unmet need for diabetes diagnosis and care in 12 countries in sub-Saharan Africa. We further estimate demographic
and economic gradients of met need for diabetes diagnosis and care.
Methods We did a pooled analysis of individual-level data from nationally representative population-based surveys
that met the following inclusion criteria: the data were collected during 2005–15; the data were made available at the
individual level; a biomarker for diabetes was available in the dataset; and the dataset included information on use of
core health services for diabetes diagnosis and care. We fi rst quantifi ed the population in need of diabetes diagnosis
and care by estimating the prevalence of diabetes across the surveys; we also quantifi ed the prevalence of overweight
and obesity, as a major risk factor for diabetes and an indicator of need for diabetes screening. Second, we determined
the level of met need for diabetes diagnosis, preventive counselling, and treatment in both the diabetic and the
overweight and obese population. Finally, we did survey fi xed-eff ects regressions to establish the demographic and
economic gradients of met need for diabetes diagnosis, counselling, and treatment.
Findings We pooled data from 12 nationally representative population-based surveys in sub-Saharan Africa, representing
38 311 individuals with a biomarker measurement for diabetes. Across the surveys, the median prevalence of diabetes
was 5% (range 2–14) and the median prevalence of overweight or obesity was 27% (range 16–68). We estimated seven
measures of met need for diabetes-related care across the 12 surveys: (1) percentage of the overweight or obese
population who received a blood glucose measurement (median 22% [IQR 11–37]); and percentage of the diabetic
population who reported that they (2) had ever received a blood glucose measurement (median 36% [IQR 27–63]);
(3) had ever been told that they had diabetes (median 27% [IQR 22–51]); (4) had ever been counselled to lose weight
(median 15% [IQR 13–23]); (5) had ever been counselled to exercise (median 15% [IQR 11–30]); (6) were using oral
diabetes drugs (median 25% [IQR 18–42]); and (7) were using insulin (median 11% [IQR 6–13]). Compared with those
aged 15–39 years, the adjusted odds of met need for diabetes diagnosis (measures 1–3) were 2·22 to 3·53 (40–54 years)
and 3·82 to 5·01 (≥55 years) times higher. The adjusted odds of met need for diabetes diagnosis also increased
consistently with educational attainment and were between 3·07 and 4·56 higher for the group with 8 years or more of
education than for the group with less than 1 year of education. Finally, need for diabetes care was signifi cantly more
likely to be met (measures 4–7) in the oldest age and highest educational groups.
Interpretation Diabetes has already reached high levels of prevalence in several countries in sub-Saharan Africa. Large
proportions of need for diabetes diagnosis and care in the region remain unmet, but the patterns of unmet need vary
widely across the countries in our sample. Novel health policies and programmes are urgently needed to increase
awareness of diabetes and to expand coverage of preventive counselling, diagnosis, and linkage to diabetes care.
Because the probability of met need for diabetes diagnosis and care consistently increases with age and educational
attainment, policy makers should pay particular attention to improved access to diabetes services for young adults
and people with low educational attainment.
Description
Keywords
Diabetes diagnosis, Care, Sub-Saharan Africa, Individual data
Citation
Manne-Goehler, J., Atun, R., Stokes, A., Goehler, A., Houinato, D., Houehanou, C., ... & Bärnighausen, T. (2016). Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries. The lancet Diabetes & endocrinology , 4 (11), 903-912. http://dx.doi.org/10.1016/