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Sagna Y, Bagbila WPAH, Sawadogo N, Savadogo PPC, Zoungrana L, Séré L, Yanogo ADR, Saloukou KEM, Zemba D, Zio GU, Zombre YT, Millogo R, Traoré S, Ilboudo A, Bognounou R, Ouedraogo NCJ, Nikiema P, Bengaly S, Gilberte Kyelem C, Guira O, Maniam J, Ogle GD, Ouedraogo MS, Drabo JY. Incidence, prevalence, and mortality of type 1 diabetes in children and youth in Burkina Faso 2013-2022. Diabetes Res Clin Pract 2024; 207:111086. [PMID: 38181985 DOI: 10.1016/j.diabres.2023.111086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
AIM There are no data on type 1 diabetes (T1D) incidence and prevalence in Burkina Faso. We aimed to determine these in persons aged <25 years (y) since the implementation of Life for a Child (LFAC) program in 2013. PATIENTS AND METHODS Data were collected from the prospective program register. Diagnosis of T1D was clinical, based on presentation, abrupt onset of symptomatic hyperglycemia, need for insulin replacement therapy from diagnosis, and no suggestion of other diabetes types. RESULTS We diagnosed 312 cases of T1D <25y in 2013-2022. Male-to-female ratio was 1:1. T1D incidence <25y per 100,000 population/year increased from 0.08 (CI 95% 0.07-0.60) in 2013 to 0.34 (CI 95% 0.26-0.45) in 2022 (p=0.002). Incidence <15y/y rose from 0.04 (CI 95% 0.01-0.10) to 0.27 (CI 95% 0.18-0.38) per 100,000/year in 2013 and 2022, respectively (p < 0.002). Prevalence per 100,000 population <25y was 0.27 (CI 95% 0.19-0.37) in 2013 and rose to 1.76 (CI 95% 1.546-1.99) in 2022 (p<0.0001). Mortality rate was 20 (CI 95% 13-29.6) per 1,000-person y. CONCLUSIONS There is a low but sharply rising T1D incidence and prevalence rates in children and youth in Burkina Faso since LFAC program implementation. It is very likely this is partly due to improved case detection. Mortality remains substantial.
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Affiliation(s)
- Yempabou Sagna
- Service de Médecine Interne CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso; INSSA, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso.
| | - W P Abraham H Bagbila
- Service de Médecine Interne CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso; INSSA, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | - Nongoba Sawadogo
- Service de Médecine Interne, CHUR de Ouahigouya, Burkina Faso; Faculté de Médecine, Université de Ouahigouya, Ouahigouya, Burkina Faso
| | | | - Lassane Zoungrana
- Service de Médecine Interne, CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso; UFR/SDS, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Lassina Séré
- Service de Médecine Interne, CHU de Tengandogo, Ouagadougou, Burkina Faso
| | - A Donald R Yanogo
- Service de Médecine Interne, CHU de Tengandogo, Ouagadougou, Burkina Faso
| | | | - Daniel Zemba
- Service de Médecine, CHR de Tenkodogo, Burkina Faso
| | - Gael U Zio
- Service de Médecine, CHR de Tenkodogo, Burkina Faso
| | | | | | - Solo Traoré
- Service de Médecine, CHR de Ziniaré, Médecine, Ziniaré, Burkina Faso
| | | | - Réné Bognounou
- Service de Médecine Interne, CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso; UFR/SDS, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | | | - Péré Nikiema
- Service de Médecine, CHR de Koudougou, Médecine, Koudougou, Burkina Faso
| | - Seydou Bengaly
- Service de Médecine Interne, CHU de Tengandogo, Ouagadougou, Burkina Faso
| | - Carole Gilberte Kyelem
- Service de Médecine Interne CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso; INSSA, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | - Oumar Guira
- Service de Médecine Interne, CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso; UFR/SDS, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Jayanthi Maniam
- Life for a Child Program, Diabetes NSW & ACT, Sydney, New South Wales, Australia
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW & ACT, Sydney, New South Wales, Australia
| | - Macaire S Ouedraogo
- Service de Médecine Interne CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso; INSSA, Université Nazi BONI, Bobo-Dioulasso, Burkina Faso
| | - Joseph Y Drabo
- Service de Médecine Interne, CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso; UFR/SDS, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
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Walker AF, Graham S, Maple-Brown L, Egede LE, Campbell JA, Walker RJ, Wade AN, Mbanya JC, Long JA, Yajnik C, Thomas N, Ebekozien O, Odugbesan O, DiMeglio LA, Agarwal S. Interventions to address global inequity in diabetes: international progress. Lancet 2023; 402:250-264. [PMID: 37356448 PMCID: PMC10726974 DOI: 10.1016/s0140-6736(23)00914-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/27/2023]
Abstract
Diabetes is a serious chronic disease with high associated burden and disproportionate costs to communities based on socioeconomic, gender, racial, and ethnic status. Addressing the complex challenges of global inequity in diabetes will require intentional efforts to focus on broader social contexts and systems that supersede individual-level interventions. We codify and highlight best practice approaches to achieve equity in diabetes care and outcomes on a global scale. We outline action plans to target diabetes equity on the basis of the recommendations established by The Lancet Commission on Diabetes, organising interventions by their effect on changing the ecosystem, building capacity, or improving the clinical practice environment. We present international examples of how to address diabetes inequity in the real world to show that approaches addressing the individual within a larger social context, in addition to addressing structural inequity, hold the greatest promise for creating sustainable and equitable change that curbs the global diabetes crisis.
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Affiliation(s)
- Ashby F Walker
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Sian Graham
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Endocrinology, Royal Darwin and Palmerston Hospitals, Darwin, NT, Australia
| | - Leonard E Egede
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of General Internal Medicine, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, Wits School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jean Claude Mbanya
- Division of Endocrinology, Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Judith A Long
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J Crescenz VA Medical Center, Philadelphia, PA, USA
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, India
| | | | | | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Department of Endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, Bronx, NY, USA.
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Ludvigsson J, Edna M, Ramaiya K. Type 1 diabetes in low and middle-income countries - Tanzania a streak of hope. Front Endocrinol (Lausanne) 2023; 14:1043370. [PMID: 37033222 PMCID: PMC10080134 DOI: 10.3389/fendo.2023.1043370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION In several of the Low and Middle Income countries , many patients with Type 1 diabetes (T1D) are most probably not diagnosed at all which may contribute to their low incidence. As an example of a country with low income and poor resources, we have chosen to study T1D in children/young people in Tanzania. METHODS Analyses of casebooks and statistics at several Tanzanian hospitals treating young patients with insulin dependent diabetes, usually Type 1 diabetes, and collection of information from different organisations such a Tanzanian Diabetes Association, Life for a Child, Changing Diabetes in Children and World Diabetes Foundation. RESULTS The incidence in several areas is low. However, a lot of data are often missing at studied clinics and therefore the incidence might be higher, and with increased awareness in recent years the number of patients has increased many-folds. Most patients present with typical symptoms and signs of T1D, and a high proportion with plausible ketoacidosis , although this proportion has decreased from about 90% to about 40% in recent decades. Many patients have poor blood glucose control, and complications often develop already after short diabetes duration. In recent years resources have increased, awareness has increased and diabetes clinics started where staff has got training. CONCLUSIONS There are problems with diabetes care in Tanzania but several facts give hope for the future.
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Affiliation(s)
- Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- *Correspondence: Johnny Ludvigsson,
| | - Majaliwa Edna
- Department of Pediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Kaushik Ramaiya
- Hindu Mandal Hospital, Dar es Salaam, Tanzania
- Tanzanian Diabetes Association, Dar es Salaam, Tanzania
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Majaliwa ES, Minja L, Ndayongeje J, Ramaiya K, Mfinanga SG, Mmbaga BT. Survival of children and youth with type 1 diabetes mellitus in Tanzania. Pediatr Diabetes 2022; 23:1560-1566. [PMID: 36193929 DOI: 10.1111/pedi.13425] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Survival from type 1 diabetes Mellitus is low in lower-income countries with underdeveloped health systems. Support programs from partners like life for a child (LFAC) and changing diabetes in children (CDiC) were implemented in Tanzania in 2005 to provide diabetes care to children and youth. No evaluation of survival has been done since their implementation. OBJECTIVE To assess the survival of children and youth living with diabetes mellitus (CYLDM) in Tanzania. METHODS A retrospective data collection from 39 clinics of CYLDM was done by extracting data from the diabetes registry between 1991 and 2019. Three cohort were analyzed (1) Cohort 1991-2004 (pre-implementation), (2) Cohort 2005-2010 (during implementation), and (3) 2011-2019 (after the implementation of LFAC/CDiC). Data were analyzed using STATA-version 14. RESULTS A total of 3822 data of CYLDM were extracted, mean age at diagnosis was 13.8 (±5) years. Approximately fifty-one percent (50.8%) were male. The total observation time was 28 years, and the Median duration of diabetes of 5 (IQR2, 8) years. Total death was 95 (3%), with a mean age at death of 17.7 (SD 4.7) years. The last cohort (2011-2019) had more diagnosis 2353 (72.7%), as compared to the <2005 cohort with only 163(5%). The survival improved from 59% before 2005 to 69% in the last cohort (2011-2019). CONCLUSION The implemented programs have facilitated the diagnosis and retention of CYLDM in the health care system. In doing so, it has also increased the survival probability in Tanzania compared to the early 90s.
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Affiliation(s)
- Edna Siima Majaliwa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - Sayoki G Mfinanga
- National Institute for Medical Research, Dar es Salaam, Tanzania.,Department of Epidemiology and Statistics, The Muhimbili University of Health and Allied Sciences, School of Public Health, Dar es Salaam, Tanzania.,Alliance for Africa Research and Innovation (A4A), Dar es Salaam, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Abdraimova A, Besançon S, Portocarrero J, Ramaiya K, Dunganova A, Ewen M, Hogerzeil H, Lazo‐Porras M, Laing R, Lepeska M, Nchimbi H, Sidibé A, Swai A, Tenorio‐Mucha J, Yudkin JS, Zafra‐Tanaka JH, Zurdinova A, Beran D. Management of type 1 diabetes in low- and middle-income countries: Comparative health system assessments in Kyrgyzstan, Mali, Peru and Tanzania. Diabet Med 2022; 39:e14891. [PMID: 35621029 PMCID: PMC9543552 DOI: 10.1111/dme.14891] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/12/2022] [Accepted: 05/22/2022] [Indexed: 11/26/2022]
Abstract
AIMS To describe and compare the health system responses for type 1 diabetes in Kyrgyzstan, Mali, Peru and Tanzania. METHODS The Rapid Assessment Protocol for Insulin Access, a multi-level assessment of the health system, was implemented in Kyrgyzstan, Mali, Peru and Tanzania using document reviews, site visits and interviews to assess the delivery of care and access to insulin. RESULTS Despite the existence of noncommunicable or diabetes strategies and Universal Health Coverage policies including diabetes-related supplies, this has not necessarily translated into access to insulin or diabetes care for all. Insulin and related supplies were often unavailable and unaffordable. Across the four countries test strips and insulin, when paid for by the individual, represented respectively 48-82% and 25-36% of total costs. Care was mainly delivered at tertiary-level hospitals by specialists. Only Kyrgyzstan had data collection systems integrated into the Ministry of Health structure. In addition, issues with healthcare worker training and education and empowerment of people with diabetes were present in these health systems. CONCLUSIONS People with type 1 diabetes in these countries face different barriers, including the cost of insulin and care. Given the renewed attention to diabetes on the global health agenda tailored health system responses for type 1 diabetes are needed. Insulin should be prioritized as it is the foundation of type 1 diabetes care, but other elements of care and support need to be fostered by different actors.
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Affiliation(s)
| | | | - Jill Portocarrero
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | - Kaushik Ramaiya
- Hindu Mandal HospitalDar es SalaamTanzania
- Tanzanian Diabetes AssociationDar es SalaamTanzania
| | | | | | | | - Maria Lazo‐Porras
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - Richard Laing
- Boston University School of Public HealthBostonUSA
- School of Public HealthUniversity of Western CapeSouth Africa
| | | | | | | | - Andrew Swai
- Tanzanian Diabetes AssociationDar es SalaamTanzania
| | - Janeth Tenorio‐Mucha
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | | | - Jessica H. Zafra‐Tanaka
- CRONICAS Centre of Excellence in Chronic DiseasesUniversidad Peruana Cayetano HerediaLimaPeru
| | | | - David Beran
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
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