In Africa, more than one in two diabetics are unknowingly ill. The theme of screening and prevention, which affects other regions of the globe, was therefore chosen by the United Nations on Tuesday, November 14, for World Disease Day. Because scientific forecasts are very pessimistic: by 2050, the number of diabetics will have tripled since 1990, in particular due to the increase in overweight and obesity but also because of the progression of food insecurity.
On the continent, 24 million people were affected by the disease in 2021, according to the World Health Organization (WHO). A figure that is expected to more than double by 2045. Diabetes, which killed 416,000 Africans in 2022, could become one of the leading causes of death by the end of the decade. In the Maghreb, rates risk exceeding 20%.
Baye Oumar Guèye is the secretary general of the Senegalese Diabetic Support Association (Assad), created in 1967 and recognized as a public utility in 1982, which today has around 45,000 members and is present throughout Senegal. For him, if the continent has made enormous progress, “States must tackle the health of their population in a global manner”, because “the burden of non-communicable diseases will become an economic burden. It’s the whole question of productivity and development that is at stake.”
Baye Oumar Guèye Globalization has imported highly urbanized lifestyles with stress, a sedentary lifestyle, a diet too rich in sugar and salt. Type 2 diabetes, which affects 9 out of 10 patients, generally develops after the age of 40. It is caused by the body’s improper use of insulin. Overweight, obesity, physical inactivity, tobacco and alcohol consumption are the main causes. It is therefore a disease that is preventable through a healthy lifestyle and a healthy diet.
This globalization has deregulated economic markets and also meals, which were built around cereals. Today, our shelves and supermarkets are invaded by products imported from industries with misleading advertising. In our big cities, we now eat disorderly. The entire continent is affected by this globalization of associated non-communicable diseases: diabetes, but also hypertension, cardiovascular pathologies, cancers, etc.
Unfortunately yes. The Saint-Louis region, both urbanized and immediately rural on the outskirts, is a good example. The epidemiological investigation carried out in Senegal in 2015 revealed that it was much more affected than previously thought. Nationally, we had a diabetes rate of 3.5% for those under 65 and 7.5% for those older. In St. Louis, the rate climbed to 11 percent.
These figures demonstrate that this “epidemic” is everywhere, despite the strong disparities that may exist. I am not taking much risk in telling you that the new investigation, currently underway, will announce a degraded situation. What we feared is happening, the rate of progression of diabetes is frightening. It has become a huge public health issue.
Science has not yet been able to resolve the question of the origin of type 1 diabetes which, remember, is due to insufficient production of insulin by the pancreas and mainly affects children and adolescents. This diabetes is not preventable. We can therefore only observe this explosion empirically and state the strong presumptions that this type of diabetes must also be favored by environmental factors. Here again, lack of physical activity and poor diet are suspected. Moreover, overweight and obesity are also affecting childhood, all over the world.
We must strongly emphasize communication from school onwards, which also makes it possible to reach parents for systematic prevention and screening. The worst enemy of health is ignorance. Here, the decentralization of health care in general and diabetes in particular has enabled enormous progress. Today, diabetes can be detected at any health post. This proximity is a good strategy, but does not solve the daily problems of patients. And we know that with poor care, complications arise. It is a very debilitating disease that lasts a lifetime. We must democratize access to insulin and, more broadly, all medical information.
The smartphone, which is penetrated everywhere, will perhaps change the situation. In Senegal, we have a platform, M-diabète, which provides information and offers a support program, M-ramadan, which has changed the lives of many diabetics to get through this month of celebration, conducive to excesses.
They commit on paper but don’t do enough. It is the donors and international partners of our States who have succeeded in imposing an agenda on diabetes and other non-communicable diseases.
Certainly Senegal is one of the countries where the cost of insulin is among the lowest in sub-Saharan Africa, but this ultimately concerns few patients. As for the universal health coverage put in place, it cannot cover type 2 diabetics who pay on average 75,000 CFA francs for their medicines and a suitable diet. This is more than the average income of many Africans. How to cope? It is a miscalculation of our States not to understand this, because this will have consequences in terms of productivity. The health burden will become an economic burden.
It is in fact a disease which no longer spares vulnerable sections of the population. Without truly inclusive universal health coverage, diabetes and many other pathologies will always be “diseases of the poor”. It is absolutely necessary that the social aspect be taken into account by our States. They have a responsibility to protect their children, who have the right to health and education. For the moment, this work is carried out by all the volunteers from the associations and communities who bring solidarity to life. Social mobilization is enormous, but it cannot be enough.
