Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.

<h4>Background</h4>Although the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be...

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Autores principales:	Jonathan Betz Brown, Kaushik Ramaiya, Stéphane Besançon, Paul Rheeder, Clarisse Mapa Tassou, Jean-Claude Mbanya, Katarzyna Kissimova-Skarbek, Eva Wangechi Njenga, Eva Wangui Muchemi, Harrison Kiambuthi Wanjiru, Erin Schneider
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/45e06c93838c4388b133bf158293d78a
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spelling	oai:doaj.org-article:45e06c93838c4388b133bf158293d78a2021-11-25T06:00:53ZUse of medical services and medicines attributable to diabetes in Sub-Saharan Africa.1932-620310.1371/journal.pone.0106716https://doaj.org/article/45e06c93838c4388b133bf158293d78a2014-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0106716https://doaj.org/toc/1932-6203<h4>Background</h4>Although the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done.<h4>Methods</h4>To ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008-2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770 matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age. We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing for statistical significance using two-stage multivariable hurdle models.<h4>Findings</h4>DMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times more medications than MCs (all p<0.001). DMs used an estimated 3.44 inpatient days per person per year, made 10.72 outpatient visits per person per year (excluding traditional healers), and were taking an average of 2.49 prescribed medicines when interviewed.<h4>Conclusions</h4>In Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought to be minor problems for health systems and patients in Africa, our data demonstrate the opposite.Jonathan Betz BrownKaushik RamaiyaStéphane BesançonPaul RheederClarisse Mapa TassouJean-Claude MbanyaKatarzyna Kissimova-SkarbekEva Wangechi NjengaEva Wangui MuchemiHarrison Kiambuthi WanjiruErin SchneiderPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 9, p e106716 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jonathan Betz Brown Kaushik Ramaiya Stéphane Besançon Paul Rheeder Clarisse Mapa Tassou Jean-Claude Mbanya Katarzyna Kissimova-Skarbek Eva Wangechi Njenga Eva Wangui Muchemi Harrison Kiambuthi Wanjiru Erin Schneider Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.
description	<h4>Background</h4>Although the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done.<h4>Methods</h4>To ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008-2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770 matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age. We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing for statistical significance using two-stage multivariable hurdle models.<h4>Findings</h4>DMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times more medications than MCs (all p<0.001). DMs used an estimated 3.44 inpatient days per person per year, made 10.72 outpatient visits per person per year (excluding traditional healers), and were taking an average of 2.49 prescribed medicines when interviewed.<h4>Conclusions</h4>In Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought to be minor problems for health systems and patients in Africa, our data demonstrate the opposite.
format	article
author	Jonathan Betz Brown Kaushik Ramaiya Stéphane Besançon Paul Rheeder Clarisse Mapa Tassou Jean-Claude Mbanya Katarzyna Kissimova-Skarbek Eva Wangechi Njenga Eva Wangui Muchemi Harrison Kiambuthi Wanjiru Erin Schneider
author_facet	Jonathan Betz Brown Kaushik Ramaiya Stéphane Besançon Paul Rheeder Clarisse Mapa Tassou Jean-Claude Mbanya Katarzyna Kissimova-Skarbek Eva Wangechi Njenga Eva Wangui Muchemi Harrison Kiambuthi Wanjiru Erin Schneider
author_sort	Jonathan Betz Brown
title	Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.
title_short	Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.
title_full	Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.
title_fullStr	Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.
title_full_unstemmed	Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.
title_sort	use of medical services and medicines attributable to diabetes in sub-saharan africa.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/45e06c93838c4388b133bf158293d78a
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Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.

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