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Diabetes in Sub-Saharan Africa – Overview of a Looming Health Challenge
jointly issued a Diabetes Declaration and Strategy for Africa.
46
The Declaration and Strategy for Africa
46
is a starting point that should be
declaration is a call to action for governments of African countries and used by the different countries of the region to bring diabetes to the
all partners and stakeholders in diabetes to prevent diabetes and related forefront, and at the same time to facilitate the adoption of a structured
non-communicable diseases and to improve quality of life and reduce and holistic approach to establishing a diabetes control programme. n
morbidity and premature mortality from diabetes (see ‘The Diabetes
Declaration for Africa – Call to Action’, opposite).
Felix K Assah is a doctoral student at the Medical
Research Council Epidemiology Unit in Cambridge. His
Conclusion current research is looking at objectively measured
Diabetes is an emerging public health problem in SSA that must be
physical activity patterns and metabolic health in urban
and rural Cameroon. Dr Assah qualified from the
addressed and contained. Its current burden may not confer it a high
Faculty of Medicine and Biomedical Sciences of the
ranking in the list of health problems of this poor continent. However, it University of Yaoundé I in Cameroon.
would be counterintuitive to wait for diabetes to move up the list of
priorities before appropriate action is taken.
Jean-Claude Mbanya is a Professor of Medicine and
Diabetes research and care in Africa will need to build on the current
Endocrinology in the Faculty of Medicine and
Biomedical Sciences at the University of Yaoundé I in
knowledge and technologies available from other parts of the world.
Cameroon. He is President Elect of the International
However, a direct transposition may not be a realistic or pragmatic plan
Diabetes Federation (IDF). Professor Mbanya has
since these models will have to be re-moulded into the specificities of
worked extensively in Africa and worldwide on
advocacy for diabetes. His research has focused on the
the African context. Country-specific data on the burden of the disease
epidemiology and public health aspects of diabetes in
are urgently required, together with a clear understanding of the extent
Cameroon and Africa.
of national policies for the prevention and care of diabetes. The Diabetes
1. IDF, Diabetes Atlas, International Diabetes Federation, 2007. 16. Bourne LT, Lambert EV, Steyn K, Where does the black developing nation, Int J Low Extrem Wounds, 2008;7(2):93–8.
Available at: www.eatlas.idf.org/ population of South Africa stand on the nutrition 31. Danaei G, Lawes CM, Vander HS, et al., Global and regional
2. Collier P, The Bottom Billion: Why the Poorest Countries are Failing transition?, Public Health Nutr, 2002;5(1A):157–62. mortality from ischaemic heart disease and stroke
and What Can Be Done About It, New York: Oxford University 17. Mennen LI, Jackson M, Sharma S, et al., Habitual diet in attributable to higher-than-optimum blood glucose
Press, 2007. four populations of African origin: a descriptive paper on concentration: comparative risk assessment, Lancet,
3. Omran AR, The epidemiologic transition: a theory of the nutrient intakes in rural and urban Cameroon, Jamaica 2006;368(9548):1651–9.
epidemiology of population change. 1971, Milbank Q, and Caribbean migrants in Britain, Public Health Nutr, 32. Kalk WJ, Joffe BI, Differences in coronary heart disease
2005;83(4):731–57. 2001;4(3):765–72. prevalence and risk factors in African and White patients
4. Majaliwa ES, Elusiyan BE, Adesiyun OO, et al., Type 1 18. Abubakari AR, Lauder W, Agyemang C, et al., Prevalence with type 2 diabetes, Diabetes Res Clin Pract, 2007;77(1):
diabetes mellitus in the African population: epidemiology and time trends in obesity among adult West African 107–12.
and management challenges, Acta Biomed, 2008;79(3): populations: a meta-analysis, Obes Rev, 2008;9(4):297–311. 33. Kirigia JM, Sambo HB, Sambo LG, Barry SP, Economic
255–9. 19. Christensen DL, Eis J, Hansen AW, et al., Obesity and burden of diabetes mellitus in the WHO African region,
5. Sobngwi E, Mauvais-Jarvis F, Vexiau P, et al., Diabetes in regional fat distribution in Kenyan populations: impact of BMC Int Health Hum Rights, 2009;9(1):6.
Africans. Part 2: Ketosis-prone atypical diabetes mellitus, ethnicity and urbanization, Ann Hum Biol, 2008;35(2):232–49. 34. kossou-Zinsou SY , Amedegnato MD, Direct cost of
Diabetes Metab, 2002;28(1):5–12. 20. Fezeu LK, Assah FK, Balkau B, et al., Ten-year changes in hospitalized care in diabetic patients in Lome (Togo),
6. Kalk WJ, Huddle KR, Raal FJ, The age of onset and sex central obesity and BMI in rural and urban Cameroon, Diabetes Metab, 2001;27(6):709–10.
distribution of insulin-dependent diabetes mellitus in Obesity (Silver Spring), 2008;16(5):1144–7. 35. Chale SS, Swai AB, Mujinja PG, McLarty DG, Must diabetes
Africans in South Africa, Postgrad Med J, 1993;69(813):552–6. 21. Wild S, Roglic G, Green A, et al., Global prevalence of be a fatal disease in Africa? Study of costs of treatment,
7. Mbanya JC, Kengne AP, Assah F, Diabetes care in Africa, diabetes: estimates for the year 2000 and projections for BMJ, 1992;304(6836):1215–18.
Lancet, 2006;368(9548):1628–9. 2030, Diabetes Care, 2004;27(5):1047–53. 36. Elrayah H, Eltom M, Bedri A, et al., Economic burden on
8. Mbanya JC, Ngogang J, Salah JN, et al., Prevalence of 22. Garrett J, Ruel MT, The coexistence of child undernutrition families of childhood type 1 diabetes in urban Sudan,
NIDDM and impaired glucose tolerance in a rural and an and maternal overweight: prevalence, hypotheses, and Diabetes Res Clin Pract, 2005;70(2):159–65.
urban population in Cameroon, Diabetologia, 1997;40(7): programme and policy implications, Matern Child Nutr, 37. Njamnshi A, Hiag AB, Mbanya J-C, From research to policy:
824–9. 2005;1(3):185–96. the development of a national diabetes programme in
9. Aspray TJ, Mugusi F, Rashid S, et al., Rural and urban 23. Health of Populations in Transition (HoPiT) Research Cameroon, Diabetes Voice, 2006;51(3):18–21.
differences in diabetes prevalence in Tanzania: the role of Group – Cameroon, Cameroon Burden of Diabetes 38. Ramaiya K, Tanzania and diabetes—a model for
obesity, physical inactivity and urban living, Trans R Soc Trop (CamBoD) Project: Baseline Survey Report, 2004, developing countries?, BMJ, 2005;330(7492):679.
Med Hyg, 2000;94(6):637–44. Yaoundé, Cameroon. 39. Daniels A, Biesma R, Otten J, et al., Ambivalence of
10. Sobngwi E, Mbanya JC, Unwin NC, et al., Exposure over 24. Gill G, Gebrekidan A, English P, et al., Diabetic primary health care professionals towards the South
the life course to an urban environment and its relation complications and glycaemic control in remote North African guidelines for hypertension and diabetes, S Afr
with obesity, diabetes, and hypertension in rural and Africa, QJM, 2008;101(10):793–8. Med J, 2000;90(12):1206–11.
urban Cameroon, Int J Epidemiol, 2004;33(4):769–76. 25. Dehayem YM, Kengne AP, Choukem SP, et al., The 40. Gill GV, Price C, Shandu D, et al., An effective system of
11. Levitt NS, Katzenellenbogen JM, Bradshaw D, et al., The spectrum of coma among people with diabetes in nurse-led diabetes care in rural Africa, Diabet Med,
prevalence and identification of risk factors for NIDDM in Cameroon: an appraisal of the implications and 2008;25(5):606–11.
urban Africans in Cape Town, South Africa, Diabetes Care, challenges at the Yaounde Central Hospital, Ann Trop Med 41. Beran D, Yudkin JS, Diabetes care in sub-Saharan Africa,
1993;16(4):601–7. Parasitol, 2008;102(1):73–8. Lancet, 2006;368(9548):1689–95.
12. Sobngwi E, Mbanya JCN, Unwin NC, et al., Physical activity 26. Rolfe M, Ephraim GG, Lincoln DC, Huddle KR, 42. Whiting DR, Hayes L, Unwin NC, Diabetes in Africa.
and its relationship with obesity, hypertension and Hyperosmolar non-ketotic diabetic coma as a cause of Challenges to health care for diabetes in Africa,
diabetes in urban and rural Cameroon, Int J Obes, emergency hyperglycaemic admission to Baragwanath J Cardiovasc Risk, 2003;10(2):103–10.
2002;26(7):1009–16. Hospital, S Afr Med J, 1995;85(3):173–6. 43. Awah PK, Unwin N, Phillimore P, Cure or control:
13. Mbalilaki JA, Hellenius ML, Masesa Z, et al., Physical 27. Toure NO, Dia KY, Diatta A, et al., Tuberculosis and complying with biomedical regime of diabetes in
activity and blood lipids in rural and urban Tanzanians, diabetes, Rev Mal Respir, 2007;24(7):869–75. Cameroon, BMC Health Serv Res, 2008;8:43.
Nutr Metab Cardiovasc Dis, 2007;17(5):344–8. 28. Gill GV, Mbanya JC, Ramaiya KL, Tesfaye S, A sub-Saharan 44. Bradley HA, Puoane T, Prevention of hypertension and
14. Levitt NS, Steyn K, Lambert EV, et al., Modifiable risk African perspective of diabetes, Diabetologia, 2009;52(1): diabetes in an urban setting in South Africa: participatory
factors for Type 2 diabetes mellitus in a peri-urban 8–16. action research with community health workers, Ethn Dis,
community in South Africa, Diabet Med, 1999;16(11):946–50. 29. Mbanya JC, Sobngwi E. Diabetes in Africa. Diabetes 2007;17(1):49–54.
15. World Health Organization, STEPwise approach to chronic microvascular and macrovascular disease in Africa, 45. United Nations, World Diabetes Day, A/RES/61/225, 2006.
disease risk factor surveillance, World Health J Cardiovasc Risk, 2003;10(2):97–102. 46. IDF Africa, Diabetes Declaration and Strategy for Africa.
Organization, 2009. Available at: www.who.int/chp/steps/ 30. Ogbera OA, Osa E, Edo A, Chukwum E, Common clinical International Diabetes Federation. Available at:
reports/en/index.html features of diabetic foot ulcers: perspectives from a www.idf.org/
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