The workshop comes at a time when the developing world is facing challenges of double burden of communicable and non-communicable diseases. Read on…
A story among diabetes experts is told of a Tanzanian man who lived with diabetes for 25 years with no treatment. After stepping on a burning coal he had to travel 600 kilometres to attend a hospital in Dar es Salaam as the wound had become infected.
The doctor explained to the man that his leg would not recover and that the best treatment was to amputate it above the knee. He had no choice but to succumb to the operation even when he was worried about how he would afford an artificial leg or how he could cope life with one leg.
Unfortunately the operation weakened the man as his blood glucose level went out of control. He died leaving two wives and six children.
Current statistics indicate that there are approximately 415 million adults above the age of 20 years with diabetes in the world and out of these, approximately 14 million reside in sub-Saharan Africa. These figures are projected to double by the year 2040.
He said Tanzania is not spared from the epidemic adding in 1986-1989 prevalence of diabetes in rural population was less that one percent and in urban areas approximately two percent.
In 2005-2007, the prevalence in urban areas had increased to five percent and the recent national survey in 2012 revealed a national prevalence of nine percent, he says.
“The drivers of this epidemic are increased rates of obesity in rural and urban areas, decreased level of physical activity and altered eating habits, he stressed.”
For countries such as Tanzania, which is just coming to terms with control of HIV/AIDS, the tuberculosis and malaria, the coming epidemic of non-communicable diseases (NCDs) is an additional burden with catastrophic economic costs to an individual, family, communities and country at large.
“This double burden of infectious and non-infectious diseases is a major challenge for developing economies such as Tanzania,” he says.
A decade ago, only a handful of diabetes and clinics and services existed in the country.
Tanzania has been pointed out as a good example of how the World Diabetes Foundation works to improve the access to diabetes care in sustainable and replicable way, according to World Diabetes Foundation experts.
“All the projects we initiated in Tanzania attracted government attention and support which ultimately created the motivation at the Ministry of health to establish a national diabetes programme, the foundation’s report says.
The magnitude of the diabetes in the world is big. According to the recently published International Diabetes Federation (IDF) more than 320,000 deaths in the sub Saharan Africa region could be attributed to diabetes and that more that 79 percent of these deaths occurred in people under the age of 60 years, -the highest proportion of any other region.
Opening a two-day workshop , Deputy Minister of health, Community Development, Gender, Children and the Elderly, Hamis Kigwangwala stated that African region still remains focused primarily on infectious diseases management rather than non communicable diseases.
The health minister says the region spends 3.4 billion USD to US Dollars 5.9 bn a year on diabetes stating, major challenge is weak response from health system, lack of funding and lack of prevention strategies.
In the year 2001-2002, there were few clinics managing diabetes in the country. Awareness of diabetes and other non-communicable diseases was almost non-existent.
Since then the ministry of health worked with TDA with financial support from WDF and DANIDA to establish a national network of diabetes services in the country.
“Currently there are diabetes /Non-communicable diseases clinics at all the zonal, regional and district hospitals in the country and over 2,400 health care providers have been trained in diagnosis and management of diabetes/NCDs,” he noted.
The ministry of Health worked with TDA, the International Diabetes Federation and Child sponsorship and ‘ Changing Diabetes in Children (CDiC) to to establish care for children with type 1 diabetes.
“Children get free diabetes education, laboratory tests, insulin and glucose test strips. I have been informed that there are currently more than 1,900 children in the programme all over the country,” the minister says.
Experts however say that non-communicable diseases (NCD) and their risk factors are increasing in sub—Saharan Africa.
NCDs, four-Cardiovascular diseases, diabetes, cancers and chronic respiratory illnesses have been identified globally as being responsible for greatest burden.
These four disease groups also share a set of four risk factors namely, tobacco use, unhealthy diets, alcohol misuse and physical inability, the deputy minister says.
Sponsored by World Diabetes Foundation (WDF) and conducted by East African Diabetes Study Group and Tanzania Diabetes Association the workshop sought to exchange notes among diabetes experts on significant strides in the area of diabetes and other communicable diseases.
Tanzania was a model for other countries to borrow a leaf from on how best to implement national programmes on diabetes control.
Chief Medical Officer in the Ministry of Health, Community Development, Gender, Elderly and Children, Prof. Mohammad Bakari Kambi says that Tanzania is signatory to the WHO Non-Communicable Diseases Global Action Plan with targets for member states to achieve 25 percent reduction in the premature mortality attributed to Non-Communicable Diseases by the year 2025.
Consultant Physician, Dr Kaushik Ramaiya, says there are however a number of challenges that still need to be addressed.
He notes that the sustainability of training is an issue pointing out that after two to three years, about 50 percent of the trained staff leave the clinic or are being transferred.
“We don’t want the clinics to close when the trained personnel leave or to have clinics run by those not trained in diabetes care,” he says.
He also wants to see to it that health care professionals are trained in antenatal clinics to educate expectant mothers about gestational diabetes.
He says the issue of medical supply is also a big one.
“There is little benefit to the patient if we have diabetes clinics, but an inadequate amount of glucose monitors, oral hypoglycaemic tables and insulin available to treat them,” he says.
Presenting a paper on ‘Implementation of non-communicable diseases Tanzania status during the symposium , Dr Mariam Kalomo from the Medical Association of Tanzania says Tanzania is facing rising burden of NCDs stating that Cardiovascular disorders, cancers, and anaemia accounted for another 25 perfcent of the burden share requiring long-term services.
She said recent survey shows high burden of risk factors and diseases saying that current stating that
Current tobacco users is 16 percent, alcohol drinkers –(29 percent), use of fruits and vegetables of less than 5 servings of fruit and/or vegetables per day – (97 percent), overweight and obese – (26 percent), raised cholesterol – (26 percent), raised triglycerides (Triglycerides are a type of fat found in your blood) – (34 percent).
Others are pprevalence of diabetes – (9 percent), Prevalence of hypertension – (26 percent),
She said the New national strategy for the Prevention and Control of NCDs has been prepared mainly in response to the growing problem of NCDs in Tanzania.
According to of the World Diabetes Foundation Managing Director, Anders Dejgaard, from 2002 to 2015. The foundation provided USD113m in funding to 430 partnership projects in 113 countries, focusing on awareness, education and capacity building at the local, regional and global level.
“For every dollar spent, the Foundation is able to raise approximately two dollars in cash or as in-kind donations from other sources,” he says.
The foundation is an independent trust dedicated to the prevention and treatment of diabetes in the developing world.
It aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease.
There was a passionate call from Past IDF, Prof. Jeen Claude Mbanya who voiced out the importance of self-reliant on matters concerning diabetes.
“We cannot be begging all these years. We have to have find out ways of self-sustaining at least in matters concerning diabetes,” he said.
He also asked governments in developing countries to make sure that much of the taxes on alcohol and cigarettes to directly go to the control of diabetes as they are the main causes of diabetes.
“You can’t allow alcohol and cigarettes knowing for sure that it would affect people and use the money you charge as taxes to other development activities without thinking of the people who are affected by the product you allow to be used,” he expressed.
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