In sub-Saharan Africa, children with type 1 diabetes die in childhood, said Nigerian diabetes expert Biyi Adesina. That was certainly true until recently. Now, growing awareness of the condition across the region has enabled many children with type 1 diabetes, who depend on daily insulin injections, to live until their first and second birthdays.
But Adesina told DW that a diagnosis is only half the battle. (Read this also | Widely used diabetes and weight loss drugs linked to increased risk of colon paralysis: Study,
In Nigeria’s private healthcare system, the majority of the population is uninsured. Medications for non-communicable diseases – such as insulin – are often out-of-pocket costs for patients or their parents.
Parents cannot afford diabetes treatment for their children
A month’s dose of insulin costs 15,000 Nigerian naira – half the monthly minimum wage of 30,000 Nigerian naira ($20, €18). Depending on the person’s situation, he or she may need up to three doses per month.
Adesina said parents of children with type 1 diabetes don’t know what to do. They have to feed their other children and themselves.
“Sometimes parents prefer that [their children] “We hear young people say, ‘My parents would like me to die so I won’t be a burden.’ They can’t afford insulin,” he said.
This is a common story of diabetes, both types 1 and 2, in sub-Saharan Africa.
Although doctors know how to diagnose and treat non-communicable diseases, no infrastructure exists to ensure patients get the expensive care they need.
Statistics show that people with diabetes in sub-Saharan Africa are dying needlessly
The number of diabetes cases in sub-Saharan Africa has increased tenfold since the year 2000, mainly due to globalization and industrialization in the region.
Adesina said that unlike 20 years ago, people are now driving cars, holding sedentary jobs and eating more junk food, which is cheap and ubiquitous in many countries, including Nigeria.
Diabetes caused more than 416,100 deaths in sub-Saharan Africa in 2021, according to data from the International Diabetes Federation.
World Health Organisation data show that in the same year in the African region, about 410,000 people died from HIV/AIDS-related diseases, about 365,000 from tuberculosis and 580,000 from malaria.
In an article published by The Lancet medical journal, health experts projected that noncommunicable diseases, including diabetes, and particularly type 2 diabetes, will overtake “communicable, maternal, neonatal and nutritional diseases combined” as the leading cause of death in sub-Saharan Africa by 2023.
These statistics and estimates provide just a glimpse of the scale of the problem. Diabetes is highly underdiagnosed in sub-Saharan Africa – doctors estimate that about 50% of cases go undocumented.
Hospitals seen as ‘last resort’ in Nigeria
Adesina knows this problem well. He told DW that he chose to specialize in diabetes medicine because his family has a history of the disease.
He said when he was a child, his grandfather had a large wound on his leg that wouldn’t heal — “for years and years.” He remembers looking at the wound at age 10 and wondering what it could be.
Now she knows why her grandfather’s foot never healed. He had diabetic foot, one of the most common symptoms of diabetes in sub-Saharan Africa.
He said it is common for Nigerians to view wounds or foot ulcers as a spiritual attack, as his grandfather suffered. “The hospital is always a last resort,” Adesina said.
“This is the traditional belief,” he said. “Oh, it was a spiritual attack against you, which is why you have an ulcer on your foot that won’t heal… so instead of going to the hospital, people start looking for alternatives to counter the spiritual attack.”
Adesina said that only when all home remedies fail do patients seek treatment in a hospital. But by then, the infection is so severe that amputation is the only option.
Diabetes is the leading cause of foot amputation in sub-Saharan Africa.
Private healthcare is too expensive for many people
However, experts believe that many people cannot afford the necessary health care.
While most sub-Saharan Africans can access HIV medications, malaria antiretroviral therapy, and TB vaccines for free, they have to pay out-of-pocket for care related to noncommunicable diseases such as diabetes or high blood pressure.
The result is that people put off treatment until it’s too late, or don’t seek treatment at all, said Felicia Anuma, a professor of medicine/endocrinology and diabetology at the University of Abuja in Nigeria.
And even when they do receive a proper diagnosis, patients often can’t afford the medications they need to recover. People with type 2 diabetes often have other health problems and need multiple medications to stay stable, Anuma told DW.
For example, he said, a poor patient suffering from diabetes, hypertension and dyslipidemia may need six medicines to stay healthy, but can actually afford only two.
“The patient will likely choose the two drugs he can afford,” Anuma said, adding that when these drugs run out, the patient may not have enough money to get his prescription refilled immediately.
Anuma said, “The blood sugar level goes up and down, the blood pressure also goes up and down.” After a long period of such inconsistent treatment, she asked, “What do you expect?”
“Complications and untimely death,” he said, answering his own question. “Can you imagine?”
