Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study

Alisha N Wade; Innocent Maposa; Godfred Agongo; Gershim Asiki; Palwende Boua; Solomon S R Choma; F Xavier Gómez-Olivé; Eric Maimela; Lisa K Micklesfield; Shukri F Mohamed; Engelbert A Nonterah; Shane A Norris; Hermann Sorgho; Michele Ramsay; Nigel J Crowther; AWIGen and the H3Africa Consortium

doi:10.1136/bmjopen-2022-069193

Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study

BMJ Open. 2023 Apr 27;13(4):e069193. doi: 10.1136/bmjopen-2022-069193.

Authors

Alisha N Wade¹, Innocent Maposa², Godfred Agongo^{3

4}, Gershim Asiki⁵, Palwende Boua⁶, Solomon S R Choma⁷, F Xavier Gómez-Olivé⁸, Eric Maimela⁹, Lisa K Micklesfield¹⁰, Shukri F Mohamed⁵, Engelbert A Nonterah³, Shane A Norris^{10

11}, Hermann Sorgho⁶, Michele Ramsay¹², Nigel J Crowther¹³; AWIGen and the H3Africa Consortium

Affiliations

¹ MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa Alisha.wade@wits.ac.za.
² Division of Epidemiology and Biostatistics, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa.
³ Navrongo Health Research Centre, Navrongo, Ghana.
⁴ Department of Biochemistry and Forensic Sciences, School of Chemical and Biochemical Sciences, C. K. Tedam University of Technology and Applied Sciences, Navrongo, Ghana.
⁵ Health and Systems for Health Unit, African Population and Health Research Center, Nairobi, Kenya.
⁶ Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso.
⁷ Department of Pathology and Medical Sciences, DIMAMO Population Health Research Centre, University of Limpopo, Sovenga, South Africa.
⁸ MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa.
⁹ Department of Public Health, University of Limpopo, Sovenga, South Africa.
¹⁰ South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹¹ Global Health Research Institute, School of Health and Human Development, University of Southampton, Southampton, UK.
¹² Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa.
¹³ Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa.

Abstract

Objectives: We investigated progression through the care cascade and associated factors for people with diabetes in sub-Saharan Africa to identify attrition stages that may be most appropriate for targeted intervention.

Design: Cross-sectional study.

Setting: Community-based study in four sub-Saharan African countries.

Participants: 10 700 individuals, aged 40-60 years.

Primary and secondary outcome measures: The primary outcome measure was the diabetes cascade of care defined as the age-adjusted diabetes prevalence (self-report of diabetes, fasting plasma glucose (FPG) ≥7 mmol/L or random plasma glucose ≥11.1 mmol/L) and proportions of those who reported awareness of having diabetes, ever having received treatment for diabetes and those who achieved glycaemic control (FPG <7.2 mmol/L). Secondary outcome measures were factors associated with having diabetes and being aware of the diagnosis.

Results: Diabetes prevalence was 5.5% (95% CI 4.4% to 6.5%). Approximately half of those with diabetes were aware (54%; 95% CI 50% to 58%); 73% (95% CI 67% to 79%) of aware individuals reported ever having received treatment. However, only 38% (95% CI 30% to 46%) of those ever having received treatment were adequately controlled. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), urban residence (OR 2.3; 95% CI 1.6 to 3.5), hypertension (OR 1.9; 95% CI 1.5 to 2.4), family history of diabetes (OR 3.9; 95% CI 3.0 to 5.1) and measures of central adiposity were associated with higher odds of having diabetes. Increasing age (OR 1.1; 95% CI 1.0 to 1.1), semi-rural residence (OR 2.5; 95% CI 1.1 to 5.7), secondary education (OR 2.4; 95% CI 1.2 to 4.9), hypertension (OR 1.6; 95% CI 1.0 to 2.4) and known HIV positivity (OR 2.3; 95% CI 1.2 to 4.4) were associated with greater likelihood of awareness of having diabetes.

Conclusions: There is attrition at each stage of the diabetes care cascade in sub-Saharan Africa. Public health strategies should target improving diagnosis in high-risk individuals and intensifying therapy in individuals treated for diabetes.

Keywords: General diabetes; International health services; PUBLIC HEALTH.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Africa South of the Sahara / epidemiology
Blood Glucose
Cross-Sectional Studies
Diabetes Mellitus* / epidemiology
Diabetes Mellitus* / therapy
Humans
Hypertension* / epidemiology
Middle Aged
Prevalence

Substances

Blood Glucose

Abstract

Publication types

MeSH terms

Substances

Grants and funding