Diabetes is among the top range non-communicable diseases (NCD) affecting the highly productive segments of the Nigerian populace. It is a metabolic disorder of chronic hyperglycaemia, which is characterized by disturbances to carbohydrate, protein, and fat metabolism resulting from absolute or relative insulin deficiency resulting in dysfunction of the organ systems.[1] It is a chronic incurable disease requiring lifelong continuing care.[2] Diabetes commonly occurs when the pancreas does not produce enough of the hormone insulin resulting in type 1 diabetes or, when the body is unable to make effective use of the insulin it produces which therefore results in type 2 diabetes.[3] Diabetes, being a common clinical condition in Nigeria, ravages mostly the low and medium income populace who ordinarily cannot access the preventive regimen that could prevent or delay the onset of diabetes mellitus. A recent meta-analysis reported that approximately 5.8% (about six million) adults in Nigeria are living with diabetes mellitus. This statistics could be described as a tip in the iceberg as it is estimated that two-thirds of diabetes cases in Nigeria are yet undiagnosed.[4]
Nigeria’s Policy/Legal Frame Work on Diabetes: Assessment of the National Diabetes Guidelines
The National guideline on prevention, control and management of diabetes mellitus standards helps in ensuring that there is a standardised medical care and patient self-management education in order to prevent immediate problems and reduce the possibility of long-term problems.[5] The aim of the minimal standard of care is to provide patients, doctors, researchers, and other medical personnel with the information, tools, and expertise required to properly manage diabetic patients.[6] It provides realistic goals and measures that are suitable for the majority of patients. One of the objectives of this guideline is to ensure that diabetes care is rendered to everyone based on recommended standards of care that are evidence-based.[7] This guideline is essentially an adaptation of the ADA and NICE guidelines for diabetes care.[8]
The National frame work and policy on diabetes (prevention, management and control) is an embodiment of the National Health Strategic Development Plan II, (NHSDP II), the Sustainable Development Goals (2015 – 2030), the National Policy and Strategic Action Plan on Prevention and Control of Non-Communicable Diseases (NCDs), the National Health Policy embedded within the National Health Act (2014) and the Multi-Sectoral Action Plan for Prevention and Control of Non-Communicable Diseases (NCDs 2019 – 2025). Nigeria is also a signatory to various international and global declarations on action plans towards the prevention and control of diabetes mellitus such as the political declaration at the United Nations General Assembly, High Level meeting on non-communicable diseases (NCDs) held in September, 2011. Furthermore, Nigeria has adopted and domesticated sundry International Conventions and Resolutions proffered by the World Health Organization (WHO).
Nigeria Diabetes Burden and Associated Risk Factors
Nigeria, the most populous country on the continent, has a high incidence of type 2 diabetes mellitus and is still seeing an increase in cases of the disease. There are notable factors fuelling the epidemics of diabetes globally and Nigeria in particular. The effects of globalization, urbanization with the attendant industrial explosion, leave behind them the consequences of life modification and nutrition, resulting in high rate of diabetes scourge.
According to several experts, Nigeria has Africa’s largest diabetes burden.[9] The prevalence of diabetes in Nigeria has not been precisely measured by any recent or well-known national surveys. According to Vanguard Features’ research, diabetes is the underlying cause of a number of serious and expensive health issues.[10] The “rule of half” describes the challenges to effectively controlling diabetes and states that six out of ten diabetics are unaware of their condition and less than one in ten are likely to respond to therapy.[11] According to clinical information, type 2 diabetes poses a threat to millions of Nigerians.[12] Currently, 1.56 million people in Nigeria aged 20 to 79 have diabetes,[13] which gave an estimate of 112 individuals each day, in 2015 as a result of diabetes-related ailments.[14] There are concerns that the number of diabetics in Nigeria would increase by 111% by 2040.[15] This is predicted based on the associated risk factors that influence the onset of diabetes. These factors include but not limited to excessive and harmful alcohol consumption, physical inactivity, and harmful life style resulting in obesity, tobacco consumption and poor nutritional and unhealthy diets.
Prevention and Control Mechanism against the Scourge of Diabetes Mellitus in Nigeria
An informed understanding of the risks associated with the onset of diabetes coupled with the attendant health complications is the first step towards a personal resolve for potential victims of diabetes to make all necessary life style modifications in order to prevent and to an extent, control the ravages of diabetes mellitus. The International Diabetes Federation (IDF) estimates that as many as 212 million people living with diabetes, are undiagnosed.[16]
Amongst the numerous prevention and control measures targeting the curtailment of the diabetes menace, it is recommended that Nigeria should adopt a holistic approach in tackling the diabetes scourge. This approach should align with the World Health Organization (WHO) Global Non-Communicable Diseases Action Plan 2013 – 2020 and the Nigerian Multi-Sectoral Action Plan 2019 – 2025. To this end, an advocacy in targeted response towards the prevention and control of diabetes, is being made for a drastic change in the nutritional characters and values of Nigerians. This could be achieved by dietary modifications such as reducing the consumption of unhealthy diets, usage of iodized salts, limiting the consumption of free sugars and unsaturated fats, resort to exclusive breastfeeding for infants and reformulation of industrially processed foods to reduce salt contents.
There is the need also to educate the populace towards the adoption of safety measures in the selection and consumption of processed foods. This could be enabled by the enforcement of proper food labelling detailing the components of every processed foods put up for sale for the public. This would encourage health promotion. Further, the public should be encouraged to consume more high fibre foods, fruits and vegetables and put a control on their calorie intake.
To go in line with the recommended nutritional and dietary changes, it is further recommended that these value factors must be put in place and enforced by the government as serious measures towards the prevention and control of diabetes in Nigeria:
- Environmental changes and interventions- reduction in air pollutions, creation of recreational spaces.
- Enforcement of the Tobacco Control Act, 2015 as a measure to discourage smoking which exposes people to diabetes.
- Extensive awareness campaign targeting the low and medium income groups as an avenue to enlighten them on the dangers of diabetes mellitus.
- Provision of holistic diabetes care (insulin in particular) with easy access for the most vulnerable segments of the Nigerian populace.
- Government should develop and implement appropriate healthcare measures which are cost effective in the assessment of diabetic drugs.
- Provision of palliative and rehabilitation resources to curtail the menace of diabetes.
- Capacity building for healthcare workers and monitors to ease the burden of the prevention and control of diabetes in Nigeria.
- Creating an enabling environment for people living with diabetes to achieve their full life potentials.
- Encouraging early screening and diagnoses for symptoms of diabetes mellitus.
Constraints to Prevention and Control of Diabetes in Nigeria.
Nigeria has taken some giant steps towards the prevention and control of diabetes in Nigeria, but the desired destination in the provision of a comprehensive healthcare mechanisms to curtail the scourge of diabetes in Nigeria has not been reached. Several factors militate against the attainment of this noble objective and these include:
- Lack of political will to implement adopted national healthcare policies coupled with the slope progress in developing regulation for enforcement, such as the National Tobacco Act, 2015.
- Poor levels of coordination and integration within the multi-sectoral healthcare and related agencies.
- Poor and inadequate funding.
- Lack of up to date data to backup issues relating to diabetes in Nigeria.
- Cultural inhibitions and attachments particularly within the much vulnerable low and medium income groups to their ancient nutritional and unhealthy dietary habits.
The Way Forward
Nigeria will need to develop creative solutions if it wants to reverse the trend of more individuals developing NCDs like diabetes.[17] [18] Due to the National Health Insurance Scheme’s low population coverage level and the nation’s declining health budget, this problem is growing increasingly over time. Nigeria should develop the political will and strong national commitment to prevent and control diabetes in Nigeria. This could be done by the adoption of right healthcare policies and interventions implementable within the tertiary, secondary and primary healthcare sectors. It is recommended the adoption and enforcement of surveillance and evaluation systems to coordinate the multi-sectoral approach towards the prevention and control of diabetes. This could further be attained by the establishment of partnership with Global and Regional Alliances. The capacity of the Federal Ministry of Health to provide leadership and coordination in the fight against diabetes mellitus, should further be enhanced by the allocation of adequate funds. Finally, Nigeria should set her health priorities right. Diabetes is a killer disease.
References
[1] WHO. Definition, diagnosis and classification of diabetes mellitus and its complications, part 1. Geneva: WHO; 1999. https://apps.who.int/iris/handle/10665/66040. Accessed 10th November, 2022.
[2] Adeleye, J. O. (2021). The hazardous terrain of Diabetes mellitus in Nigeria: The time for action is now. Research Journal of Health Sciences, 9(1), 69-76.
[3] American Diabetes Association. (2018). 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes care, 41(Supplement_1), S13-S27. https://diabetesjournals.org/care/article/41/Supplement1/S13/30088/2-Classification-and-Diagnosis-of-Diabetes. Accessed 10th November, 2022.
[4] IDF International Diabetes Federation.
[5] Shrivastava, S. R., Shrivastava, P. S., & Ramasamy, J. (2013). Role of self-care in management of diabetes mellitus. Journal of diabetes and metabolic disorders, 12(1), 14. https://doi.org/10.1186/2251-6581-12-14
[6] See footnote 3
[7] National Guideline for the prevention, control and management of Diabetes. https://www.health.gov.ng/doc/National%20Guideline%20for%20the%20prevention,%20control%20and%20management%20of%20Diabetes%20Mellitus%20in%20Nigeria%20(3). Accessed 10th November, 2022.
[8] IBID
[9] Ogbera, A. O., & Ekpebegh, C. (2014). Diabetes mellitus in Nigeria: The past, present and future. World journal of diabetes, 5(6), 905
[10] Vanguard, 2022. Despite huge advances in diabetes treatment, access remains challenge in poorer countries – Report. https://www.vanguardngr.com/2022/10/despite-huge-advances-in-diabetes-treatment-access-remains-challenge-in-poorer-countries-report/. Accessed 10th November, 2022.
[11] IBID
[12] See footnote 7
[13] Muhammad, M. U., Jiadong, R., Muhammad, N. S., & Nawaz, B. (2019). Stratified diabetes mellitus prevalence for the Northwestern Nigerian States, a data mining approach. International Journal of Environmental Research and Public Health, 16(21), 4089.
[14] Kharroubi, A. T., & Darwish, H. M. (2015). Diabetes mellitus: The epidemic of the century. World journal of diabetes, 6(6), 850–867. https://doi.org/10.4239/wjd.v6.i6.850
[15] IBID
[16] IDF is the umbrella organization of over 230 National Diabetes Associations in 170 countries and territories worldwide.
[17] Maiyaki, M. B., & Garbati, M. A. (2014). The burden of non-communicable diseases in Nigeria; in the context of globalization. Annals of African medicine, 13(1), 1-10.
[18] Fasanmade, O. A., Odeniyi, I. A., Fasanmade, O. O., & Iwuala, S. O. (2014). Global challenges in health: effect of westernization on the prevalence of diabetes mellitus in Nigeria. Research Journal of Health Sciences, 2(2), 56-63.
