Tackling Type 2 diabetes in Nigeria

In a research I conducted while studying at the University of Sheffield, United Kingdom,  it was discovered that Nigeria had the highest population of diabetics in Africa and it is projected to more than double by 2030. And, the Diabetes Association of Nigeria (DAN) suggests the increasing prevalence of diabetes in Nigeria also accounts for the highest mortality rates, where diabetes-related mortality from inadequate management outweighs that of HIV/AIDs, malaria and cancer in the country. 

Additionally, the IDF’s 2013 global study estimates 5 per cent of the adult Nigerian population have diabetes. A national survey of non-communicable diseases in Nigeria, in 1997, also estimated a crude prevalence of 2.2% of diabetes. A 2008 study, cited 1.7 million diabetics in Nigeria by WHO while other studies estimated 4 million as at 2014.

Curiously, my findings showed that it is estimated that one in every twenty of Nigerian’s adult population is diabetic. I also found out that drivers of Type 2 diabetes mellitus (T2DM) in Nigeria are an aging Nigerian population; rapid transformation to high process sugar and highly refined carbohydrate diets; and increasing urbanization with increasing consumption of cheaper convenience foods.

Another factor established was poor treatment options in Nigeria’s overburdened health care system results in increased risk of premature death, reduced quality of life of adults with T2DM, increase hospital admissions and deaths from diabetic complications like hyperglycemia, foot ulceration, chronic kidney disease and cardiovascular disease.

A 10-year survey conducted from 1990 – 2000 in Nigeria reported diabetes-related admissions and death rates to be 10% and 7.6%, respectively. Thus, further reducing the life expectancy from 54 years (women) and 52 years (men).

It is equally estimated that the annual expenditure of an adult diabetic in Nigeria is  US$137; double that of non-diabetics. The national direct costs of diabetes in Nigeria were estimated to range between $3.5 and $4.5 billion per annum.

In terms of the health beliefs and perceptions held by Nigeria’s adults with T2DM, one of the studies reviewed found that one-third of the participants who were classed as obese did not believe obesity to be associated with their T2DM. 

In one of the studies of 121 ambulatory patients in Nigeria, it was found that a total of 59.5% did not know the cause of T2DM. Another study found that 73.7% of patients were unaware that they needed to continue their medication throughout their lifetime; 39.5% were unaware of how long they were meant to take it; 14% had the lay belief that medication should only be taken until the next physician appointment; and 12.3% had the belief that medication should only be taken when they experience symptoms. 

Furthermore, studies have shown that 42% of patients with a low perception of health belief had poor diabetes management in Nigeria, while 49% of those with a high perception of health belief had good management.

In my thesis, I found that more than half of the participants in one study believed that herbs could cure their diabetes. One of the studies found that about 60% of the participants with a low level of diabetes knowledge also had poor management status. Lack of knowledge meant that diabetics were not able to recognize the inherent danger of not complying as well as recognizing the complications of the disease.

In Nigeria, 15. 88% of patients with T2DM did not know that free food often means less than 20 calories/serving. In terms of exercise, of the 82.6% that were recommended aerobic exercise all reported that they were unaware of its importance. 

In conclusion, I also found that all previous studies I reviewed had recommended expanding access to diabetes education, awareness management, and control. It was concluded by one of the authors that there must be increased funding of a robust health promotion program on T2DM which should be integrated into the national primary health care policy. The health promotion program must address misperceptions, traditional beliefs and the preference for traditional medicine.

I believe that these findings in my studies will go a long way in adding to the growing search for cure for the disease.

Hashim wrote from Number 1B Lumsar Street, Ibrahim Sani Abacha Estate, Wuse Zone 4, Abuja.