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Current Issues International Health and Diabetes
Diabetes in Sub-Saharan Africa – Overview of a Looming Health Challenge
Felix K Assah
1
and Jean-Claude Mbanya
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 recognised 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 since 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 programmes.
Keywords
Diabetes, sub-Saharan Africa, epidemiology, morbidity, mortality, cost of diabetes care, diabetes control programme
Disclosure: The authors have no conflicts of interest to declare.
Received: 4 May 2009 Accepted: 16 July 2009
Correspondence: Felix K Assah, 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 Prevalence, Risk Factors and Trends
societies. This statement would be rather inappropriate today as it is There is a dearth of good-quality epidemiological data on diabetes
known that most of the world’s diabetes patients live in developing prevalence, incidence and trends on the African continent. The
countries. In absolute numbers, most of these people live in China difficulty is even more critical when trying to extricate the separate
and India. However, the burden of diabetes in sub-Saharan Africa rates of type 1 or type 2 diabetes. Only a handful of studies have
(SSA) is already substantial, and continues to increase at a very rapid described the epidemiology of type 1 diabetes in an African population,
rate: current predictions estimate that the number of people living and of these only a couple are from SSA.
4
Due to limitations in study
with diabetes on the continent will almost double over the next 20 methods and design, many of these studies do not provide reliable
years.
1
This is not good news for a continent that has been the hardest population estimates, in addition to the fact that these estimates may
hit by the HIV/AIDS pandemic and that currently is home to about 70% include cases of malnutrition-related diabetes or ketosis-prone
of the billion poorest people of the world.
2
diabetes
5
due to diagnostic constraints. Notwithstanding, the
International Diabetes Federation (IDF) estimates that there were a
The increasing prevalence of diabetes and other non-communicable total of almost 38,000 prevalent cases of type 1 diabetes in SSA in
diseases in Africa is a result of an epidemiological transition driven 2007, which was higher than those in South and Central America or the
by rapid urbanisation of communities. Urbanisation brings with it a Western Pacific region of the IDF despite the fact that these regions
nutritional transition from traditional natural foods to processed had a much higher denominator population than SSA.
1
The peak age of
energy-dense foods, as well as a substantial reduction in physical occurrence of type 1 diabetes has been reported to be much later in
activity levels due to mechanisation of work and transport. These Africans (22–23 years) compared with Caucasians (12–13 years).
6
changes have led to an increasing level of obesity in young adults Current estimates of the prevalence of type 2 diabetes in Africa from
and adults, which is driving the surge in diabetes. The the IDF
1
are based on data from only a handful of countries. In 2007,
epidemiological transition Africa is currently undergoing is not there were an estimated 10.4 million people living with diabetes in
exactly the same as that which most western countries went Africa, with this number expected to increase to 18.7 million by 2025 –
through: the transition in Africa is following a delayed model
3
an 80% increase (see Figure 1). This projection may be a conservative
characterised by high fertility and high but reducing mortality, estimate, even considering the effect HIV/AIDS is going to have on
resulting in a double demographic disease pattern. This means that reducing the size of the adult population that is at greatest risk of
the low-income economies of most African countries and their developing diabetes, since with increasing access to antiretroviral
strained healthcare systems have to grapple with the burden of chemotherapy the region would probably witness an increase in
infections, underweight and chronic malnutrition in children and people developing antiretroviral therapy (ART)-induced glucose
obesity and cardiovascular diseases in adults. intolerance. Our data in Cameroonian adults based on two cross-
© TOUCH BRIEFINGS 2009 13
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