14 November 2012

Could families be a key to preventing type 2 diabetes in Uganda?

Ugandans waiting for consultation and treatment at the monthly diabetes clinic at Bwera Hospital, Kasese, Uganda. The patients arrive from sunset until late afternoon.

Jannie Nielsen is a PhD fellow at the University of Copenhagen and she is currently situated in Kasese in Uganda to collect data for her studies. Jannie’s research project is focusing on how diabetes affects not only the diabetic person but the whole family.

We asked Jannie to explain about her research and why family relations are in focus when it comes to managing and preventing diabetes. 

How many people have diabetes in Uganda?

So far, there have been no national surveys in Uganda to assess the number of people with diabetes in the country. Nevertheless smaller studies have found a prevalence of diabetes ranging from 0.4 % in adults living in rural areas to 8.1 % in a group of adults (over 35 years) from urban as well as rural areas. The actual number is probably somewhere in the middle, but with a higher prevalence in urban areas than in rural areas. It is estimated that in a country like Uganda almost 78 % of the individuals with diabetes do not know that they have the disease. This is primarily due to lack of knowledge and screening programmes.

Is diabetes a greater problem in Uganda than in other parts of the world?

The number of people living with Diabetes in Uganda is still very low compared to other places in the world like USA and India. However, living with diabetes in Uganda is very hard compared to many other places. For instance, in Uganda, the health care system is provided by public and private health facilities. The public sector is still donor dependent and only slightly oriented towards chronic diseases like diabetes. Further, the government-run health centres and hospitals that actually provide diabetes care are not always equipped appropriately with educated staff and test equipment and medication to provide sufficient diabetes care. For many Ugandans the use of private facilities is not a sustainable solution, because of the financial cost.

Due to the lack of screening programmes, many patients get the diabetes diagnosis late in the progression of the disease, which means that complications like diabetic wounds and loss of sight are common seen in patients, who only had the diagnosis for few years.

How does the health system to tackle diabetes today?

The research takes place in Kasese in Uganda.In Kasese district where I conduct my research there is one government-run health facility that provides diabetes care. Thus, the first Monday every month there is a diabetes clinic, where consultations and medication are provided for no cost. However, the patients still need to pay for the measure of their blood glucose level and the transportation to the hospital.

The majority of diabetes patients in Uganda do not have a personal glucometer. Therefore, the only possibility to measure their blood glucose level is at the health facilities. This means that many patients only measure their blood glucose once a month or once every second month. In comparison – the majority of Danish diabetes patients have a private glucometer and in average and most Danish patients measure their blood glucose level several times a day.

Due to the scarcity of public health facilities providing diabetes care, the pressure on the diabetes clinics is high. When I visited the diabetes clinic last Monday [5 November] at 8 am, the wing for the diabetes clinic was packed with people. 121 people with diabetes had come for treatment that day and two nurses, one lab technician, one accountant and two clinical medical officers were struggling the entire day to treat all the patients.

Even though the clinical officers work nine hours without any breaks, each patient would get a consultation lasting between 8-9 minutes.

Why is diabetes such a challenge – how does it affect the life of the patients?

Due to lack of treatment possibilities and equipment to test blood glucose level on a daily basis, diabetes patients in Uganda have to be very strict about what they eat. Diabetes patients need to have their blood glucose level as stabile a possible, since they cannot compensate for hyper- or hypoglycaemia with medicine.Due to lack of treatment possibilities and equipment to test blood glucose level on a daily basis, diabetes patients in Uganda have to be very strict about what they eat e.g. avoiding food with a high amount of refined sugar like soda water.This means that they have to avoid food with a high amount of refined sugar, like soda water.

Further, the often poor control of diabetes increases the risk of diabetes related complication like amputations and blindness. Especially the latter is something I often see and unfortunately some patients have lost their job and thereby income due to decreasing sight.

The few number of health facilities providing diabetes care means that the patients often have to travel long distances to get treatment. Once again something that requires out-of-pocket money, which many patients do not have.

What does the project investigate?

We want to know if the family could play a more important role for better management of type 2 diabetes in diagnosed individuals and for the preventionPhD fellow Jannie Nielsen is introducing the research project in the chapel at Bwera Hospital, Kasese, in Uganda of type 2 diabetes in their healthy family members. Therefore we are looking at how the family supports the diabetic person and what the motives or barriers are. The key elements are to study the health status of the family members without diabetes and investigate how much these family members know about diabetes.

Why do you work with this area - why do you find it important?

Type 2 diabetes is a disease highly affected by poor diet and physical inactivity. By changing these habits it is possible to prevent, or at least postpone, the onset of the disease. In a country like Uganda where the number of people with type 2 diabetes is increasing and the health facilities and treatment options are scarce, I find it very important to find other ways to optimise good disease management than only those offered through the health system. Further, if the number of people with diabetes increase as predicted, the burden and cost of the disease will bring the Ugandan health care system and the people with the disease to its knees.

I hope my PhD studies will help clarify whether the family could be a target setting for prevention of type 2 diabetes – this could give Ugandan families and health policy planners new options for future prevention and management of diabetes.