By Sifelani Tsiko
Harare,Zimbabwe  (Dec 14 2006)

The number of people seeking medical assistance for diabetes is rising in Africa at a time when health experts say the continent's overburdened health care systems are ill-equipped to diagnose the disease and the majority of the poor cannot afford the cost of treatment.

According to the World Health Organisation, an estimated seven million Africans suffer from this disease which is now ranked as the fourth main cause of death in most developing countries.

The International Federation of Diabetics (FID) projects that the prevalence rate will shoot up by 95 percent by 2010 from the current 0,5 to 3 percent range across the continent.

National surveys in most parts of Africa indicate that diabetes cases are on the rise due to rapid urbanisation and fast changing diets which are marginalising traditional ones in favour of the western diets.

In 2003, Zimbabwe recorded more than 90 000 cases of diabetes, an increased of 3 000 from the 1997 figure. The prevalence of diabetes in the adult population was estimated at 10 percent in 1995, a figure which health experts say is very high at a time when 50-80 percent of all the people in the developing world are unaware on their condition.

The Diabetic Association of Zimbabwe estimates that around 400 000 people in the country have the disease but are not aware of this chronic disease that occurs when the pancreas does not produce enough insulin, a hormone that regulates sugar in the blood.

Health experts estimate that 800 000 Zimbabweans suffer from this disease which is also reaching worrying levels in most countries in Southern Africa.

 The South African Medical Research Council, in a report, says death rates from obesity and diabetes are on the rise owing to growing urbanisation which has led to "less walking and exercise and televisions has led to a generation of couch potatoes rather than athletes."

"We face a very difficult situation in trying to manage obesity. We are up against social and traditional norms that being fat is a sign that you are wealthy, you are successful, you are happy, that your husband can feed you," says Krisela Stayn, a retired professor with the SA Medical Research Council. "We have gone from under-nutrition to over-nutrition without ever having passed healthy nutrition."

Analysts say more than one-third of African women and a quarter of men are estimated to be overweight and WHO says this will rise to 41 percent and 30 percent respectively in the coming 10 years.

In the past, the disease was thought to be a disease of 'affluence' mainly found in the rich north. WHO now says that 75 percent of the world's diabetics will live in developing countries by 2025.

WHO also reports a growing number of people seeking medical assistance in West Africa. It estimates that more than 3,3 million people in West Africa suffer from this disease.

In Senegal, the National Center Against Diabetes reported an average of 200 new cases each year in the 1980s. However, this figure has increased more than 10 times with 2 411 new cases reported in 2005.

"There is more eating out, rising consumption of fried foods, brochettes and fritters, which are now consumed more often than proper grain-based meals," Stephane Besancon, the director of programmes at the French NGO Mali Diabetic Health.

"The problem of over eating (in Africa) is progressing exponentially."
He says the disease is more prevalent in urban areas where traditional foods are being replaced by Western foods high in fat and sugar.

Worldwide, analysts say, an estimated 1 billion people are overweight while 800 million are undernourished. Health experts say the poor are the most vulnerable.

The prevalence rate of this chronic disease was estimated at 194 million in 2003 and it estimated that this figure will hit 333 million by 2025 as a result of what health experts say longer life expectancy, sedentary lifestyle and changing dietary patterns.

Most African countries, including South Africa still face a number of problems related to the management and treatment of the disease. Critical shortages of diabetic medicine, the rising cost of drugs and treatment, competition of resources by HIV/Aids, tuberculosis and malaria diseases which often get priority and the general lack of equipment to diagnose the diabetes has hampered efforts to manage and control the disease.

In Zimbabwe, pharmacies and all major hospitals, at times go without essential diabetic medicines owing largely to lack of foreign currency to import some of the drugs.

Diabetes is a chronic condition and diabetics have to inject themselves with insulin daily for the rest of their lives as their bodies are unable to produce enough hormones.

Many diabetics in Zimbabwe are battling to raise money to buy essential drugs as well as buying nutritious food which is also now very expensive.

Health experts warn that the high cost of medicines means that the majority of the poor often go untreated or have no regular treatment.

In Mali, insulin chews about 20 percent of monthly household income while in Burkina Faso, health experts say, a monthly minimum treatment for diabetics costs between US$16-24 excluding examinations and follow-up health care.

The average cost for primary healing in the US after amputation is estimated between US$7 000 and US$10 000. In Africa, the cost are much higher given the prohibitive cost to import drugs and equipment and the shortage of specialists.

A diabetic patient in Zimbabwe now needs more than $10 000 for needles and insulin more than $15 000, a month. The majority of the poor patients cannot afford this.

Health experts also say that the poor with no electricity or refrigerators face the added problem of how to store insulin.

"Even in relatively sophisticated cities like Cape Town, the number of diabetes sufferers with amputated feet due to late diagnosis and poor treatment is distressingly high," says a South African-based health commentator.

Adds Jean-Claude Mbaya, director of the Cameroon National Obesity Centre: "It's not true that only the rich have problems with obesity and weight. The poor even suffer more."

Diabetes is a chronic life-long condition which requires careful monitoring and control. Common symptoms include excessive thirst, frequent urination, sudden weight loss, extreme tiredness and blurred vision.

Without proper management and control, health experts say it can lead to hyperglycaemia or raised blood sugar which can damage the body and lead to failure of various organs, nerves and blood vessels.

A number of programmes have been initiated by the Diabetics Federation to raise awareness about the disease in Africa as well as promote support for the disadvantaged communities and vulnerable groups that experience difficulties in accessing optimal healthcare.

"This epidemic is responsible for so much suffering and loss of life, yet so little is being done to tackle it," says an official of the Diabetics Federation. "Doing nothing in the face of the epidemic will place significant stress on the economic development of many countries and jeopardise the Millennium Development Goals."

The promotion of traditional African diets still remains a powerful weapon in the fight against diabetes.
But for now, its difficult to stop rapidly urbanising Africa from the appeal of high fat, high sugar fast foods, the snacks and the fizzy drinks.

With more diabetic deaths, Africans will realise the wisdom of their ancestors