Readiness of Sub-Saharan Africa Healthcare Systems for the New Pandemic, Diabetes: A Systematic Review.

Bernardo Nuche-Berenguer,Linda E Kupfer

doi:10.1155/2018/9262395

Abstract

Background Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Objective We conducted a systematic review of literature to determine the capacity of SSA health systems to manage diabetes. Methodology We used three different databases (Embase, Scopus, and PubMed) to search for studies, published from 2004 to 2017, on diabetes care in SSA. Results Fifty-five articles met the inclusion criteria, covering the different aspects related to diabetes care such as availability of drugs and diagnostic tools, the capacity of healthcare workers, and the integration of diabetes care into HIV and TB platforms. Conclusion Although chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy. We identified pilot projects to enhance these capacities. The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming pandemic in diabetes. Nonetheless, much more work needs to be done to address the health system-wide deficiencies in diabetes care. More research is also needed to determine how to integrate diabetes care into the healthcare system in SSA.

Highlights

While the international community is certainly aware of subSaharan Africa (SSA) problems caused by malnutrition and HIV and other infectious diseases, awareness of the increasing burden of chronic noncommunicable diseases (NCDs) such as diabetes is still low [1,2,3]
A title or title and abstract screening of the initial 3186 articles narrowed these down to 318 articles for full text review; 55 articles remained that met the eligibility criteria by including evaluation of different aspects on health system performance, interventions devoted to the improvement of diabetes care, and some mention of the integration of diabetes care in other disease care platforms
Based on the study questions, nine areas related to diabetes and healthcare systems emerged from the analysis: (1) capacity to diagnose diabetes; (2) access to medicines for diabetic patients; (3) capacity of healthcare workers; (4) pilot experiences designed to optimize the effectiveness of healthcare workers’ capacity; (5) pilot experiences for increasing patients’ adherence to treatment (Table 1); (6) existence of electronic medical records; (7) provision of national guidelines for diabetes care; and (8) integration of diabetes care into HIV and TB platforms (Table 2)

Summary

Introduction

While the international community is certainly aware of subSaharan Africa (SSA) problems caused by malnutrition and HIV and other infectious diseases, awareness of the increasing burden of chronic noncommunicable diseases (NCDs) such as diabetes is still low [1,2,3]. In 2014, 20 million people in SSA had diabetes and 523,000 died because of this disease or conditions related to it, with 76% of them under the age of 60 [4]. The prediction is that for the year 2035, 41.5 million people in SSA will have diabetes [4]. This increase is much higher than in any other region in the world [4]. Effective health systems are needed to care for the coming surge of diabetics in sub-Saharan Africa (SSA). Chronic care health systems in SSA have developed significantly in the last decade, the capacity for managing diabetes remains in its infancy.

Methods

Results

Discussion

Conclusion