Abstract
BackgroundAlthough the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done.MethodsTo ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008–2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770 matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age. We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing for statistical significance using two-stage multivariable hurdle models.FindingsDMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times more medications than MCs (all p<0.001). DMs used an estimated 3.44 inpatient days per person per year, made 10.72 outpatient visits per person per year (excluding traditional healers), and were taking an average of 2.49 prescribed medicines when interviewed.ConclusionsIn Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought to be minor problems for health systems and patients in Africa, our data demonstrate the opposite.
Highlights
The large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas
In Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China
[15] The International Diabetes Management Practices study (IDMPS) recruited a stratified random sample of physicians experienced in insulin therapy from various continents including one Sub-Saharan African country, the Republic of South Africa, in 2006–2007
Summary
The large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. Chale et al interviewed 464 patients with diabetes at Muhimbili Medical Center in Dar es Salaam, Tanzania in 1989–90 and found that insulin and oral medicines accounted for most their costs of medical care, in part because the salaries of physicians and nurses at that time were extremely low. [13] Despite the low salaries, annual perpatient expenditures for diabetes treatment exceeded Tanzania’s 1989 national income per capita, exceeded per capita spending on health by nearly 20-fold, [14] and accounted for 30.8% of total expenditures by the hospitals outpatient department. Micro- and macro-vascular complications as well as level of glycaemic control were positively correlated to hospitalization [16]
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