Addressing Diabetes in Nigeria

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While Nigeria has the highest burden of diabetes in sub-Saharan Africa with over five million cases diagnosed, Novo Nordisk and other health experts believe its incidence can be reduced if Nigerians adopt healthy lifestyles. Martins Ifijeh writes

Though Fred, a 32-year-old financial consultant has heard about diabetes before, he found out the consequences of the chronic disease the hard way because it most often doesn’t ring a bell when it starts to manifest.

He lost his mother suddenly, who until her death was full of life. They had both discussed about her July 2017 trip to the United States, where she was billed to visit her first daughter who she hadn’t seen for years.

But on Friday May 26th, life served Fred lemons. He lost his 66 years old mother, who hardly get ill and was always full of life. No thanks to the silent, creepy but dangerous diabetes. A disease that doesn’t tell it’s victims to get prepared.

“I got a call from her that morning that she was feeling dizzy and weak. That is something she hasn’t complained about since I can remember. So I told one of our relatives staying with her to take her to the family clinic, but before she could get there, I learnt she was fast losing strength.
“Diagnosis was done on her and they realised her blood sugar level was over 400. I had to tell the doctor to do anything he can to stabilise her, and then commence treatment to reduce the fatally high level,” Fred said.

But the damage was done already. There were already severe complications from the diabetes. In no time she was gasping for breath, and then she died from what the doctor called heart attack caused by blood clot to the arteries.

The normal blood sugar range is between 70 to 100 but Fred’s mother had over 400 per cent higher than the normal level.

“The doctor told me my mum didn’t just develop the disease, that it has been there for years, but was slowly doing damage to her heart and other organs until the day she died. He said if she was doing regular checkups, she would have been able to adjust her lifestyle or possibly be on medication to reduce the level of sugar in her circulating system,” Fred regrettably said.
Fred couldn’t make lemonades from what life served him. He lost his mum to a highly preventable disease when diagnosed on time.

Mummy Fred is just one among several hundreds of thousands of Nigerians who die yearly due to ignorance of their health status, especially on non communicable diseases like diabetes that do not give warning signs.

In 2015 alone, about 120,000 Nigerians were said to have lost their lives to diabetes; which may, if recent predictions are relied on, become the number one cause of deaths in the country among other non-communicable diseases, thereby topping the chart, as against cardiovascular diseases currently leading the causes of deaths occasioned by NCDs in Nigeria.

What is even more worrisome is that apart from the over five million Nigerians currently suffering from the chronic disease, indications show that not less than an entirely different five million Nigerians are diabetic but unaware since it does not come with symptoms. By indication, this shows that more than 10 million Nigerians are actually suffering from diabetes in the country; a figure experts say will continue to increase unless Nigeria and Nigerians make conscious efforts to tackle it head on.

This is evident in the steady rise of diabetes, diabetes-related complications or deaths recorded in the country, leaving most sufferers at the mercy of the disease, since they are neither aware of the disease or are unable to receive treatment.

Over the past 30 years, the prevalence rate of the disease was said to be 0.4 per cent among the Nigerian population; in 1992, it rose to 1.6 per cent; in 2004 it was 3.1 per cent, and just recently, it has risen above 4.5 per cent, according to a survey conducted by Osuntokun et al.
But experts at the launch of the Base of Pyramid Project by Novo Nordisk say the steady rise of the disease in the country is associated with lifestyle changes; overweight and obesity, physical inactivity, alcohol consumption, dietary changes and cigarette smoking, adding that if nothing was done both on the part of the citizens and the stakeholders, the disease may spiral into a national health emergency that would take more lives out of their prime; a disease they have noted was partly preventable.

Diabetes, the most common disorder of the body’s hormonal system, occurs when blood sugar levels consistently stay above normal, thereby unable to let the body cells receive glucose due to lack of insulin to drive it into the body cells or lack of the cell receptors to recognise insulin, and then utilise its function. Glucose is an essential source of energy for the brain and the body. Insulin is one of the main hormones that regulates blood sugar levels and allows the body to use sugar (called glucose) for energy.

In her presentation at the launch, Consultant Endocrinologist, and Acting Deputy Provost, Academics, College of Medicine, Lagos, Professor Anthonia Obera, said many Nigerians do not access medical checkup, a reason she said has led to delayed or undiagnosed diabetes in the country, leading to complications and possible death.

She said unfortunately, six out of 10 Nigerians who have diabetes do not know they have it because they are not checking their health status.

“Every adult beyond 40 years old should undergo regular check ups at least twice a year. When tackled on time, there is a very high possibility the person will lead a normal life. Such person will also know first hand what and what to avoid,” she said.

While stating that undiagnosed or delayed diabetes contributes to the development of complications, she said some of the consequences of the disease could result to peripheral neuropathy, retinopathy, cataract, cardiovascular disorders, and even death.

She called for strengthening of the healthcare system, timely screening, provision of treatment guidelines, upgrade of infrastructure and equipments, and the integration of private sector into the national health and information system framework.

The National Vice President, Diabetes Association of Nigeria, Dr. Ejiofor Ugwu, said 75 per cent of diabetics globally reside in low and middle income countries like Nigeria, where majority could barely afford treatment cost.

He said the burden was heavy in Nigeria than the international federation estimates, adding that due to lack of reliable national data on diabetes, it was difficult putting actual figure to the number of diabetics in the country, but he insisted that the burden is underestimated in the country.

“The last national surgery we had was decades ago. It is a national embarrassment. We are therefore calling for national surgery on non communicable diseases.

“Another issue is that we have insufficient diabetologists in Nigeria. We have about 140 for the entire 180 million Nigerians. Majority of them resides in urban areas. That means the presence of diabetologists in rural areas is very insignificant,” he added.

He called on Nigerians to eat healthily, avoiding junk foods, smoking, alcohol intake, sedentary lifestyles. “Regular check up is very important as a step to preventing diabetes,” he added.

On his part, the Minister of Health, Professor Isaac Adewole, who was represented by the Medical Director, Federal Medical Centre, Ebutte Meta, Dr. Adedamola Dada said government, in partnership with stakeholders have designed framework for intervention against the disease.
He said critical areas the government has considered is the development of national diabetes plan and policy, monitoring trends of the disease, provision of access to care and sustainable financing, provision of nutrition guidelines, among others.

He said Novo Nordisk, through its Base of Pyramid Project was providing good partnership in the fight against diabetes in the country.

On his part, the General Manager, Middle Africa, Novo Nordisk, Mr. Venkat Kalyan said that Novo Nordisk was committed to addressing the barriers to better care for people with diabetes.
He said the Base of the Pyramid (BoP) project was aimed at providing access to diabetes care for people in low and middle-income countries. “The project runs in Nigeria, Ghana, and Kenya. The purpose of the BoP project is to create shared value by developing scalable, sustainable and profitable solutions that increase access to diabetes care and treatment for the “working poor” as well as provide value to the business of Novo Nordisk.

“Building on the success of a diabetes awareness campaign conducted last year in partnership with Family Health International 360 (FHI 360), the goal of this pilot project is to improve diabetes care through the integration of diabetes screening services and linkage to care and treatment into routine general health services in private health facilities.

“FHI 360 will adopt the ‘House of Care’ approach, a system of delivering care and support centered and coordinated around the needs of individuals living with diabetes at the base of the economical pyramid to enable access to affordable diabetes care.”

He said the approach was predominantly facility-based and will strengthen the capacity of participating hospitals to integrate diabetes care by refocusing services and removing barriers to access. “In addition, this framework will improve outcomes for individuals with diabetes and provide value for the health system.”

According to him, the project objective is to conduct diabetes risk-assessment for 82,500 individuals using a risk-scoring tool; conduct blood glucose tests for 40,000 high-risk individuals, among others.