Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa

Abstract

Background: Although 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.

Methods: To 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.

Findings: DMs 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.

Conclusions: 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. 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.

Conflict of interest statement

Competing Interests: Before retirement in 11/09 J. Brown led or could have led studies funded by research contracts with Novo Nordisk, GSK, Takeda Pharmaceuticals North America, Eli Lilly, and Merck. J. Brown had no consulting or other paid or unpaid arrangements with these or other actual or potential commercial funders. Starting in 2002 J. Brown led the creation of the IDF Economic Studies Fund with funds from Novo Nordisk, GSK, Takeda, Eli Lilly, and Merck. As per the rules of the Fund established before solicitation, the funders did not participate in decisions regarding countries to be studied or in doing, analyzing or writing up any study. Since election in Oct 2009 as unpaid IDF VP, J. Brown has accepted no grants or contracts or gifts or employment from any drug or device firms and has not accepted any positions on their editorial or advisory groups. In 2010, J. Brown accepted travel reimbursement from Novo Nordisk to speak at the 6th International Symposium on Diabetes and Pregnancy. In 2009, at the request of IDF, J. Brown accepted reimbursement from IDF to speak at a satellite meeting of ADA sponsored by Roche and Co. During most of this study Dr. Skarbek was an employee of the IDF. IDF is supported financially by many commercial entities. She declares that no competing interests exist. All other authors have no potentially competing interests. The authors declare that none of the competing interests described above will alter the authors’ adherence to all the PLOS One policies on sharing data and materials.