VOLUME 7 NUMBER 4 • NOVEMBER 2010
159
SA JOURNAL OF DIABETES & VASCULAR DISEASE
AFRICAN FOCUS
himself suffering from type 1 diabetes since childhood, shared his
experience of being a patient for 36 years, with the audience in a
talk on ‘Care of Children with Diabetes’. A child diagnosed with
type 1 diabetes in Africa has a life expectancy of seven months to
seven years! Healthcare facilities do not exist or are inaccessible,
there are many socio-economic constraints and families often live
from hand to mouth. Day-to-day survival is much more important
than worrying about the long-term complications of the disease.
There is a high prevalence of acute and chronic complications;
25 to 90% of children with diabetes will develop keto-acidosis.
The prevalence of severe hypoglycaemia is also very high. Most
patients do not have access to home blood glucose monitoring.
The lack of insulin is the biggest cause of death in children with
diabetes. He then gave an insight into his own experience – living
with diabetes. He found that the doctors had minimal knowledge
of this condition. His diet consisted mostly of beans and cabbage.
Follow-up appointments were erratic and unstructured. Access to
insulin was problematic, especially when there was a coup in the
country. He experienced a lot of anxiety.
Over time he and his family realised that effective management
of diabetes could only be achieved if they understood the disease
and made necessary changes and adjustments. He concluded that
it is possible for someone who lives in a resource-poor setting with
diabetes to live a normal life if he has the tools and support. It is
important to enable patients to take control of their diabetes. In
order to improve the lives of children with diabetes, the following
aspects are important: improve availability and accessibility of insulin;
education; diagnostic tools must be made available; improvement
in drug procurements and supplies; training of healthcare workers;
positive policy environment; reduction in the gap between
the standards that we accept and what we deliver at primary-
care level. Several initiatives are now available in sub-Saharan
Africa to improve the care of children with diabetes, e.g. ISPAD.
Dr Mesmin Deyamen Yefou discussed some issues relating
to diabetes foot care in sub-Saharan Africa. Three main factors
contribute to the development of the diabetic foot, namely
neuropathy, peripheral arterial disease and infection. In the
developed world, it is mostly due to peripheral arterial disease,
but in the developing world, the diabetic foot is due to peripheral
neuropathy. Many countries have a very high rate of amputations
due to diabetes. In Burkina Faso it is estimated to be 48%.
There is a very high financial burden due to the diabetic foot and
foot ulcers. In Africa, patients have amputations to reduce the cost
of ulcers! In order to improve this, diabetes has to be prevented,
patients must be educated, lesions should be detected at an early
stage, and management of the diabetic foot must be improved.
In order to improve the organisation of care, the political will is
very important, especially in locating the necessary resources. There
is a need for structures for education, screening, treatment and
auditing, and healthcare workers must be trained.
The topic of the following session was ‘Improving patient care
– targeting the right patient with the right treatment’
Dr Alieu
Gaye, vice president of the IDF
, introduced this theme with
a talk ‘Providing access to Medicines and essential technologies:
The Essential Medicine Box’. He defined essential medicines as
those medicines that satisfy the priority healthcare needs of the
population. They are selected with due regard to public health
relevance, evidence on efficacy and safety, and comparative cost-
effectiveness. Essential medicines are intended to be available
within the context of functioning health systems at all times, in
adequate amounts, in the appropriate dosage forms, with assured
quality and adequate information, and at a price the individual and
the community can afford. Medicines regarded as essential remain
a national responsibility. Access to healthcare, and, therefore, to
essential medicines is a part of the fulfillment of the fundamental
right to health. The global number of people with access to essential
medicines has increased from 2.1 billion in 1977 to 3.8 billion in
1997. Essential medicines are only one element in the continuum
of healthcare provision but they are a vital element.
The major challenges that can be obstacles to health
improvements are:
• Inequitable access: 30% of the world’s population lack regular
access to essential drugs. In the poorest parts of Africa and Asia
it can be as high as 50%.
• Health reforms: in many low- and middle-income countries,
health-sector reforms have led to insufficient funding for health.
• Medicine financing: In many poor countries 50–90% of the
medicines are paid for by the patients themselves.
Dr Gaye went on to discuss the Access Framework intended to
optimise access to essential drugs. This framework hinges on
rational drug selection, affordability, sustainable financing, and
reliable health and supply systems.
Dr Mapoko Ilondo, senior advisor, Global Health
Partnerships, Novo Nordisk
addressed the meeting with the
‘Changing Diabetes
in Children initiative’. Childhood diabetes
has a high mortality rate in poor countries. The IDF estimates that
there are 280 000 children under the age of 14 living with type 1
diabetes in developing countries. The annual cost of insulin and
diabetes care may easily exceed a family’s total income. Urgent
action is needed to improve conditions. There are several barriers to
care, including poverty, lack of diagnosis, lack of proper treatment
and inadequate infrastructure.
The Changing Diabetes
in Children programme is designed to
provide long-term solutions to sustainable diabetes care for children
in developing countries. Components of the programme include
patient education, setting up a diabetes registry, monitoring and
control, providing infrastructure and equipment, training healthcare
workers and providing free or low-cost insulin. Novo Nordisk has
a long-term commitment to improve the outcomes of children
with diabetes. Under this initiative young people were trained to
become diabetes ambassadors.
The Changing Diabetes
in Children programme is a partnership
initiative with Ministries of Health, civil society, WDF, Roche and
ISPAD. The ultimate goal is to change the outlook for children with
diabetes from hopeless to hopeful. The programme has already
been rolled out in six countries, namely Bangladesh, Cameroon,
the DRC, Guinea, Tanzania and Uganda; 1 100 children have been
enrolled to date. The ambition is to have 10 000 children enrolled
in the programme by 2015.
This very successful meeting was closed by Silver Bahendeka,
chair, IDF African Region by quoting Ms Grace Atieno Jalong’o:
‘Let’s stop the wave of diabetes before it turns into a tsunami.’
Contributions by: Prof WF Mollentze, Dr JMM Koning, University of
the Free State, Bloemfontein, and Peter Wagenaar, correspondent
No patient should die because of a lack of awareness of diabetes
–
First lady Bongiwe Ngema Zuma
