APPLICATION OF EPIDEMIOLOGY IN DIABETES MELLITUS IN SUB SAHARAN AFRICA : SCREENING OF DIABETES MELLITUS

Sub Saharan African is being faced with an increased burden of diabetes mellitus. High levels of undiagnosed diabetes mellitus have been reported which is a cause of concern since diabetes mellitus causes complications which are expensive to manage. However screening for diabetes mellitus has not received much attention due to overwhelming of healthcare facilities with multiple disease burdens. The review sought to address screening of diabetes in Sub Saharan Africa. Published journal articles and grey literature on screening of diabetes mellitus in Sub Saharan Africa were sought from pubmed, google scholar and google. Reports of screening of diabetes mellitus in a general practice setting were found. In a rural setting community based and home based strategies of screening of diabetes mellitus were reported to be feasible. Diabetes mellitus screening was also reported be possible to integrate it with communicable disease screening. Diabetes mellitus screening in Sub Sahara Africa is feasible. The integration of diabetes mellitus screening with communicable diseases is a worthwhile consideration in sub Saharan Africa taking into consideration the communicable disease burden. STATEMENT OF PURPOSE The review sought to address screening of diabetes mellitus in Sub Saharan Africa. South American Journal of Public Health, Volume-3, Issue-2, 2015 LITERATURE REVIEW INTRODUCTION Type 2 diabetes mellitus constitute approximately 90% of diabetes mellitus in Sub Saharan Africa where as type 1 diabetes mellitus, gestational diabetes and other variant forms make up the remainder (Hall, Thomsen, Henriksen, & Lohse, 2011). In Africa type 2 diabetes mellitus is becoming a major chronic disease health burden. 14 million people were estimated to have diabetes mellitus in Africa in 2011 and in 2030 the increase is expected to reach 28 million. In urban areas that’s where the highest increase in prevalence is noted. The changing patterns of diet, physical activity and the ageing population are the major causes associated with increase prevalence of diabetes mellitus in Africa. High fat and high energy food together with less physical activity causes increase prevalence of obesity which leads to impaired glucose tolerance leading to increased susceptibility to diabetes mellitus (Bos & Agyemang, 2013). The prevalence of type 2 diabetes mellitus in SubSaharan Africa reported in prevalence surveys ranges from 0.6 % observe in a rural area in Uganda to 12% observed in an urban area in Kenya. The prevalence of type 2 diabetes mellitus is showing an increasing prevalence from the studies carried out before 1985 in (Hall et al, 2011). In a recent study in Cape Town they have also demonstrated this increase in diabetes mellitus prevalence (Peer et al, 2012). In Zimbabwe the last survey carried out between May to June 2005, the prevalence of diabetes mellitus was found to be 10.2% whilst participants with a known history of diabetes mellitus were found to be 2.4% of the study participants (Ministry of Health and Child Welfare Government of Zimbabwe, University of Zimbabwe, World Health Organisation & United Nations Children’s Fund, 2005). Incidence of type 2 diabetes mellitus has been reported in one study in Sub Saharan Africa carried out in Kinshasa between 2004 and 2008 in which an incidence rate of 29 per 1000 person years with 95% confidence interval of 15-43 (Hall et al, 2011). Type 1 diabetes mellitus has been reported in four studies carried out in Sub Saharan Africa since 1990. The studies reported a prevalence of type 1 diabetes mellitus of 3.5 per 100 000 persons in Mozambique and 12 per 100 000 persons in Zambia. Incidence of type 1 diabetes mellitus range from 1.5 per 100 000 persons per year in Tanzania and 2.1 per 100 000 persons per year in Ethopia. The prevalence rate of gestational diabetes, mellitus recorded in Sub Saharan Africa range from 0% observed in Tanzania to 9% observe in Ethiopia. The population prevalence of other types of diabetes mellitus has not been reported in Sub Saharan Africa (Hall et al, 2011). High rates of undiagnosed an uncontrolled diabetes mellitus reported in Sub Saharan Africa indicates the presence of barriers to accessing diagnosis and treatment. These high rates of patients with undiagnosed diabetes mellitus suggest that the screening practices in the region are not effective. There several barriers to accessing diagnosis and treatment which have been documented these include high cost of diabetes mellitus treatment, the limited availability of South American Journal of Public Health, Volume-3, Issue-2, 2015 tools for diagnosis, treatment and management of glucose. Low level of diabetes mellitus knowledge among health care workers has also been reported. Implementation of effective interventions will reduce the diseases burden of diabetes mellitus, as primary prevention and the treatment of diabetes mellitus can reduce the incidence of diabetes mellitus and its complications (Hall et al, 2011) and premature mortality (Peer et al, 2012). It is important to note that screening for diabetes mellitus and other non communicable diseases has received little attention this has been attribute to overwhelming of health care facilities with multiple diseases burdens especially Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome(HIV/AIDS) (Peer et al, 2012). Considering that the budget allocation for diabetes mellitus has to compete with other pressing health issues in Sub Saharan Africa such as antiretroviral treatment, tuberculosis treatment and malaria control programs (Gill, Mbanya, Ramaiya & Tesfaye, 2009). Thus the review sought to highlight the need and feasibility of screening of diabetes mellitus in sub Saharan Africa.