Abstract
In sub-Saharan countries, Non-communicable Chronic Diseases (NCDs), including diabetes, are on the rise. Glycated hemoglobin (HbA1c) is a Point Of Care (POC) diagnostic tool for diabetic monitoring that is unavailable in many resource-constrained environments worldwide. Theoretically, HbA1c measurement is practical in these settings because fasting is not required, the test is not generally repeated before 120 days and travel time for multiple appointments is reduced. To improve diabetes management of patients and the provider’s ability to manage chronic diabetes, two HbA1c monitoring machines were used to determine the effectiveness and feasibility of HbA1c in diabetes management in two hospital locations in Tanzania. A follow-up team returned to the sites to determine the use of the HbA1c machines in the treatment of diabetes and introduced the use of Point Of Care (POC) HbA1c machines. Interviews were conducted with diabetic participants (n = 4) regarding their diabetes management experiences. Though short-term change had mixed success, the long-term impact on the management of diabetes is unknown. Cultural influences and access issues had a significant impact on the usefulness of the HbA1c machines for monitoring diabetes in rural northern Tanzania. A greater understanding of these factors is needed in order to creatively address these barriers. The Tanzania HbA1c project functions as a case study at a population level through which to examine the complexities of diabetes management in a resource-constrained environment.
Highlights
Tanzania is a country in the midst of epidemiological transition
Non-Communicable Disease (NCDs) were once considered rare in low income countries like Tanzania but since the 1980s they have been on the rise (Kolling et al, 2010)
NCDs are disproportionately represented in Low-and Middle-Income Countries (LMICs), with 80% of the 415 million individuals living with diabetes worldwide residing in LMICs (Ndayisaba et al, 2017)
Summary
Tanzania is a country in the midst of epidemiological transition. Tuberculosis, malaria, lower respiratory infections and HIV are leading causes of death; Non-Communicable Disease (NCDs) such as ischemic heart disease, diabetes and stroke are becoming more prevalent (CDC, 2019). NCDs were once considered rare in low income countries like Tanzania but since the 1980s they have been on the rise (Kolling et al, 2010). NCDs are disproportionately represented in Low-and Middle-Income Countries (LMICs), with 80% of the 415 million individuals living with diabetes worldwide residing in LMICs (Ndayisaba et al, 2017). Regardless of the variation, diabetes in Tanzania is a growing problem, one that a low-resource country with a double disease burden is poorly equipped to handle
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