REPORT ON DIABETES i

Transcription

1 AFRICAN UNION UNION AFRICAINE UNIÃO AFRICANA AU CONFERENCE OF MINISTERS OF HEALTH (CAMH6) Sixth Ordinary Session, April 2013, Addis Ababa, ETHIOPIA CAMH/Exp/6(VI) iv THEME: The Impact of Non-Communicable Diseases (NCDs) and Neglected Tropical Diseases (NTDs) on Development in Africa. REPORT ON DIABETES i

2 P a g e 1 BACKGROUND A- Definition: 1. Diabetes mellitus is a chronic disease whose global spread has given it the characteristics of a pandemic. Diabetes is defined by a chronic elevated level of blood glucose. There are two main types of diabetes. Type 1 diabetes is caused by an absolute lack of insulin. Without insulin, Type 1 diabetes is rapidly fatal. The most frequent form is Type 2 diabetes which represents more than 85% of the cases, and is linked to excessive weight and physical inactivity. Diabetes is 5-10 times more prevalent in obese people than in people with normal weight.[1]. Other forms are specific diabetes and gestational diabetes (5%). 2. The disease presents with metabolic anomalies characterized by chronic hyperglycaemia, resulting from defective secretion of insulin and/or defective action of insulin(insulin resistance) or both. It is confirmed with a random venous plasma glucose higher than 2g/l (11.1 mmol), or fasting glycaemia that is higher than 1.26g/l (7.0 mmol/l) at two tests, or a fasting glycaemia higher than 2g/l (11.1 mmol) 2 hours after a glucose intake. 3. Diabetes is serious due to its complications, namely: cardiovascular ailments, cerebral vascular accidents, renal insufficiency, blindness, sexual impotence and gangrene of the feet leading to amputation. B- Epidemiology: 4. Diabetes mellitus is no longer rare in Africa. Over the past few decades, Diabetes mellitus has emerged as an important non communicable disease (NCD) in sub-saharan Africa. In 2010, mortality attributable to diabetes in sub-saharan Africa is estimated, at 6% of total mortality. 1;2;3 The STEPS survey undertaken in many African countries reported diabetes prevalence based on fasting blood glucose concentration, ranging from 3 to 15%. 4 The Seychelles and Mauritius have some of the highest rates of diabetes in the Region. Previously undiagnosed diabetes in Africa is in the order of 60% to 80% in cases diagnosed in Cameroon, Ghana and Tanzania. The rate of limb amputations varies from 1.4% to 6.7% of diabetic foot cases. 5. The factors that affect the onset of diabetes are well-known. They comprise nonmodifiable and modifiable factors. The non-modifiable factors include old age (over 45 years of age), heredity (direct collateral) and the causes of diabetes in pregnancy. The modifiable factors are obesity, physical inactivity and excessive alcohol consumption Motala AA, Omar MAK, Pirie FJ. Epidemiology of diabetes in Africa. In: Ekoe J-M, Rewers M, Williams R, Zimmet P, eds. The epidemiology of diabetes mellitus (2nd edn). Chichester: Wiley, 2008: Levitt NS. Diabetes in Africa: epidemiology, management and health care challenges. Heart 2008; 4: World Health Organization. Diabetes programme. Geneva: WHO; Mendis S et al. Barriers to management of cardiovascular risk in a low-resource setting using hypertension as an entry point. J Hypertens. 2004; 22:59-64.

3 P a g e 2 6. Africa, which faces the dual burden of communicable and non-communicable diseases, is witnessing changes in traditional lifestyles that have disrupted feeding patterns. This in turn leads to physical inactivity that promotes obesity. The emerging Type 2 diabetes observed in children and adolescents is linked to obesity. In the Region, vulnerability to diabetes among the age groups exposes them to complications and premature deaths. It causes a decline in productivity, with an economic cost, which added to the cost of treating other types of diabetes (Type 1 and diabetes in pregnancy), constitutes an additional burden for the already weakened health systems. 7. Sub-Saharan Africa is undergoing the fastest rate of urbanization worldwide, with an average annual rate of change in number of urban dwellers of more than 3%. Currently, more than a third of the population of sub-saharan Africa lives in urban areas. This proportion is predicted to increase to 45% by This rapid urbanization in sub-saharan Africa has been suggested as a major determinant of the rising burden of diabetes and other cardiovascular diseases. Findings of many studies have shown clearly a positive rural urban gradient in prevalence of diabetes and its risk factors, particularly obesity. Urban residence is associated with a two to five times increased risk of diabetes or impaired fasting glycaemia. 8. In most African communities, delivery of diabetes care is integrated into the overall national health-care structure. The idea of a specialized diabetes care centre and team is a novelty and, where available, limited funding renders it non-functional. A major challenge faced by diabetes patients in Africa is the lack of constant access to antidiabetic drugs, especially insulin, at affordable cost, leading to underuse and avoidable metabolic complications. For many of the NCDs described access to affordable essential drugs is essential for management and prevention of complications. For example despite being on the WHO model essential medicines list, insulin is neither sufficiently available nor accessible to people with diabetes in the developing world. Syringes, oral hypoglycaemics and blood glucose monitoring equipment, including refill strips, are also unavailable to many. C- Economic costs: 9. The emergence of diabetes in African countries and its ensuing heavy burden of morbidity and premature mortality result in additional socioeconomic costs, in terms of both medical care and loss of human resources. Studies estimate the direct cost of diabetes care per affected individual at about 25% of gross national income per head for the 12 richest countries, and almost 125% of gross national income per head for the 34 poorest countries. The total cost (direct and indirect costs) of diabetes per person with the disease in these poor countries is more than double the gross national income per head. 10. Late diagnosis of diabetes coupled with inequalities in access to major antidiabetes drugs (including insulin, a drug declared by WHO as essential for treatment of the disease) leads to early presentation of diabetic complications and premature deaths. Indeed, agents such as generic glucose-lowering drugs and antihypertensive treatments should be funded

4 P a g e 3 just as drugs for HIV/AIDS are, along with support for delivery mechanisms and chronic disease education and care models. D- Issues and Challenges: 11. Limited political commitment to diabetes and NCD prevention and control in the Region, because NCDs are underappreciated as development issues and underestimated as diseases with profound economic effects. Insufficiency of recent and comprehensive data. Accurate data on diabetes and NCDs morbidity and mortality in Africa are scarce and generally based on hospital data and estimates. Recording of diabetes and NCDs cases in most resource-challenged countries is hampered by the weakness of health systems in general and national health information systems in particular. Population-based databases are scarce or generate poor-quality data. 12. Heavy economic and psychosocial burden. NCDs diagnosed at advanced stages of the diseases when complications are already installed with devastating physical, psychological and social impact on patients, their families and the community. 13. Weak health systems with inadequate human and other resources to undertake interventions for primary, secondary and tertiary prevention of diabetes. Lack of collaboration and coordination of interventions. Collaboration between the various stakeholders is inadequate and the rare initiatives taken lack coordination. All stakeholders, namely communities, health professionals, Member States and partners, should therefore work together to overcome these obstacles and effectively fight against diabetes and NCDs. E- Way Forward: 14. The way forward is based on a number of global and regional initiatives which have been undertaken to address diabetes and NCDs. They include Resolutions WHA53.17 on the Prevention and control of non-communicable diseases and WHA61.14 on Prevention and control of non-communicable diseases: implementation of the global strategy; Regional committee resolution AFR/RC57/7 on the Regional strategy for diabetes prevention and control (2007), the report of the WHO Commission on Social Determinants of Health (2008); the Ouagadougou Declaration on Primary Health Care And Health Systems in Africa (2008); the Libreville Declaration on Health and Environment (2008); the Nairobi Call to Action for Health Promotion (2009); the Mauritius Call for Action on Diabetes, Cardiovascular Diseases and NCDs (2009). 15. Heads of State and Government should provide leadership, through the participation of the public sector in partnership with civil society organizations, the private sector and communities, in diabetes and NCDs prevention and control. The Heads of State and Government should also promote good governance to prevent conflict and disruption of health services.

5 P a g e National health information systems should be strengthened and standardized to generate disaggregated data on NCDs, their risk factors and determinants and monitor their magnitude, trends and impact. 17. National health systems should be oriented towards the promotion and support of healthy lifestyles by individuals, families and communities within the primary health care context in order to effectively respond to complex social, cultural and behavioural issues associated with diabetes and NCDs. 18. Health systems should be strengthened with appropriate attention to inter alia: health financing; training; retention of the health workforce; procurement and distribution of medicines, vaccines, medical supplies and equipment; improving infrastructure; and, evidence-based and cost- effective service delivery for diabetes and NCDs. There is need to advocate for the integration of health in all policies across sectors in order to address NCD risk factors and determinants. 19. The management of communicable diseases in many countries including global health initiatives can provide ample opportunities to accelerate prevention and control of NCDs. Such opportunities should be identified and harnessed to address integrated care in the context of primary health care and health systems strengthening Partnerships, alliances and networks bringing together national, regional and global players including academic and research institutions, public and private sectors and civil society organizations should be encouraged and supported in order to collaborate in NCD prevention and control and to conduct innovative research relevant to the African context. 20. Financial resources that are commensurate with the burden of diabetes and NCDs should be allocated from the national budgets to support primary prevention and case management using the primary health care approach and establish sustainable innovative and new financing mechanisms at national and international levels.