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A disease of affluence in Africa: People suffering from diabetes lack access to diagnosis and care

Research using data from twelve countries in sub-Saharan Africa show that most people suffering from diabetes remain undiagnosed and do not receive adequate care. In particular the young and people with low educational attainment are commonly unaware that they suffer from diabetes. Health systems structures and prevention approaches are lacking to successfully combat diabetes in sub-Saharan Africa. Researchers around Prof. Dr. Dr. Till Bärnighausen, Humboldt Professor and Director of the Institute of Public Health in the Faculty of Medicine at the University of Heidelberg, publish their findings in the journal The Lancet Diabetes & Endocrinology

Blood tests and health systems data on more than 38,000 people in twelve countries in sub-Saharan Africa were analyzed by a research team around Prof. Dr. Dr. Till Bärnighausen, Alexander von Humboldt University Professor and Director of the Institute of Public Health at the University of Heidelberg. The study was just published in the The Lancet Diabetes & Endocrinology. The findings are alarming: diabetes, a so-called “disease of affluence, is widespread in sub-Saharan Africa. About five percent of adults in the countries included in the study are affected with the disease, with large cross-country variations. About two thirds of diabetic patients are unaware that they suffer from the disease. In particular the young and people with low educational attainment typically do not know that they have diabetes.

The study further shows that diabetes diagnosis and prevention and treatment interventions are rarely available in sub-Saharan Africa. Only one third of diabetes patients – and only one quarter of the overweight or obese population, which faces a high risk of diabetes – have ever received a blood sugar test to screen for diabetes.  Less than half of diabetes patients ever received lifestyle counseling – and only about one quarter ever received treatment.  

Just as in high-income countries, diabetes represents a major challenge for health systems in sub-Saharan Africa. In recent years, health policy on the sub-continent has been focused on fighting AIDS, tuberculosis and malaria. These efforts have led to major successes. “Now, health systems in Africa need to be equipped to successfully prevent and treat the lifestyle diseases adiposity, diabetes and high blood pressure”, says Professor Bärnighausen. The findings of the study demonstrate that there is great potential to improve health through prevention, diagnosis and treatment of diabetes, in particular among the young and people with low educational attainment. “We are currently discussing our findings with research colleagues, representatives of diabetes societies and politicians in Africa. If it were possible to ensure that more patients received effective diabetes prevention and treatment, the costs of the diseases would likely decrease and the economic consequences of the sequelae of the diseases could be averted”, explains Dr. Jennifer Manne-Goehler, the first author of the study.

Strengthening health systems

In order to build better health systems in sub-Saharan Africa, more and better data are needed. For the study at hand, the researchers utilized data from nationally-representative surveys in 12 countries in sub-Saharan Africa, which were carried out between 2005 and 2015, including, for instance, in Kenya, Tanzania, Uganda, and Benin. “We included only datasets that were nationally representative. However, the quality of these data is variable across countries. We have to take data quality into account in our analyses and interpretations”, explains Bärnighausen.  In future work, the research team in Heidelberg, Africa and the US will analyze datasets from further countries in Africa, as well as Asia and Latin America. The team will carry out similar analyses focusing on high blood pressure and high cholesterol levels. “First, we need to understand, how disease risks and health systems access vary across population groups in different world regions. Then, we can develop locally appropriate and sustainable approaches to improve health systems.” This research is likely to lead to a wide variety of long-term benefits, according to Bärnighausen: „Strong health systems that meet important health care needs, such as diabetes care, can contribute to political stability and can prevent migration.”

The Institute of Public Health has focused on improving health in low- and middle-income countries for over 50 years. Building on this expertise, it will be expanded into an institute for global health research over the coming years.


Manne-Goehler J, Rifat A, Stokes A, Goehler A, Houinato D, Houehanou C, Hambou M, Mbenza B, Sobngwi E, Balde N, Mwangi J, Gathecha G, Ngugi P, Wesseh C, Damesceno A, Lunet N, Bovet P, Labadarios D, Zuma K, Mayige M, Kagaruki G, Ramaiya K, Agoudavi K, Guwatudde D, Bahendeka S, Mutungi G, Geldsetzer P, Levitt N, Salomon J, Yudkin J, Vollmer S, Bärnighausen T (2016). Unmet need for diabetes care in sub-Saharan Africa: individual pooled analysis in 12 countries. Lancet Diabetes & Endocrinology
Opens external link in new windowhttp://dx.doi.org/10.1016/S2213-8587(16)30181-4

Shabbar Jaffar (2016): Diabetes and other non-communicable diseases in Africa: a potential disaster in the waiting. The Lancet Diabetes & Endocrinology
Opens external link in new windowhttp://dx.doi.org/10.1016/S2213-8587(16)30216-9


Prof. Dr. Dr. Till Bärnighausen
Institute of Public Health
Faculty of Medicine, Universityh of Heidelberg
E-Mail: Opens window for sending emailtill.baernighausen@uni-heidelberg.de
Telefon: 06221 56-5637
Mobile: 01621377448


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