AFRICA: Diabetes - deadly, underfunded and unidentified

Friday, March 6, 2009

Even though diabetes is as lethal as HIV/AIDS and cases in Africa have nearly doubled to more than seven million within the past 15 years, according to the International Diabetes Federation, the illness receives scant attention from donors or governments in Africa.

Diabetes, which the UN World Health Organization says causes about six percent of deaths worldwide every year, is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.

Nutritionist Stéphane Besançon, director of the non-profit Malian Association to Control Diabetes, told IRIN that urbanisation, sedentarisation, affordable motor transport, food imports and industrialisation have taken their toll on Malians’ health.

“With cheaper motorbikes, people simply walk less. Artisanal oil that used to be made through drip processes are now produced and imported en masse, which has had a negative effect on diets.”

In the category of internal medicine, diabetes is the second leading cause of hospitalisation after HIV/AIDS in Mali and the reason behind 40 percent of all visits according to the Health Ministry, based on the most recent data from 1996. Bescançon said diabetes data is hard to find and that the government is conducting a nationwide survey to update these figures.

Besançon said some cultural factors heighten risk, such as eating out of a communal bowl, which discourages portion control, and perceptions of obesity as a sign of beauty and prestige.

Double burden

International Diabetes Federation’s (IDF) director for Africa, Alieu Gaye, told IRIN the continent is forced to confront chronic disease while it also battles the world’s largest share of infectious diseases.

“Countries have not crossed infectious diseases off their agenda and along come chronic diseases," Gaye told IRIN. "But with these diseases, there is no funding, no attention and often no diagnoses.”

WHO estimates that by 2025 the largest increase in diabetes cases will be in developing countries, with a projected 75 percent of the world’s diabetics. But at least half of those with diabetes have not been diagnosed, which leaves many other health complications also undiagnosed, according to IDF.

Diabetes is responsible for 60 percent of amputations in the developing world, according to WHO. In addition to foot disease, diabetes can cause blindness, heart disease – the world’s number-one killer – kidney failure and loss of feeling in the limbs.

In a 2004 study by the Malian Association to Control Diabetes, diabetes patients with complications paid more than US$160 for their care every month, or $60 if they did not have complications. “Without donor or government subsidies, patients pay out-of-pocket or simply do not continue life-saving treatment,” said Besançon.

Employed Malians earned on average a little over $41 per month in 2007, according to the World Bank.

Recent studies in Mali and Mozambique showed that a person requiring insulin for survival would die within less than one year, according to IDF. In Zambia, the average is 11 years.

IDF’s Gaye told IRIN most attention in the developing world is focused on infectious diseases while chronic diseases like heart disease, hypertension and diabetes are mistakenly considered “rich-country” concerns.

Without donor money, poor governments are unlikely to pay more attention to diabetes, said NGO director Besançon. “It is no secret governments will promote whatever health programmes donors are willing to fund. Donor funds determine governments’ priorities.”

Donors have given almost $12 billion since 2001 to The Global Fund to Fight AIDS, Tuberculosis and Malaria.

Diabetes and other chronic non-communicable diseases are rarely singled out for donor or policy attention, according to a 2004 medical journal study though they are the leading cause of mortality worldwide, according to WHO.

Who gets saved?

In 2006 African Union and WHO spearheaded the African Diabetes Declaration and Strategy, which Gaye said has raised awareness but not significant funds.

Besançon questioned subsidising health care for one disease and not another. “An HIV patient has his treatments covered, but not a diabetic patient. The patient who is saved from HIV may very well die of diabetes.”

IDF’s Gaye said preliminary studies on HIV/AIDS patients have shown that malnutrition and other side effects can make patients susceptible to diabetes.

Besançon said injecting money to wipe out one particular disease minimises the connection between illnesses. “It creates an ethical problem for medical practitioners who are able to save the life of a patient with a particular pathology but not another.

“The question is not how to raise more money or to create a duelling Global Fund, but rather how to redistribute support to the overall health system in which deadly disease complications are treated equally.”