Diabetes care cascade and associated factors in 10 700 middle-aged adults in four sub-Saharan African countries: a cross-sectional study
F Xavier Gómez-Olivé,
Lisa K Micklesfield,
Shane A Norris,
Alisha N Wade,
Gershim Asiki,
Innocent Maposa,
Shukri F Mohamed,
Nigel J Crowther,
Engelbert A Nonterah,
Michèle Ramsay,
Hermann Sorgho,
Godfred Agongo,
Palwende Boua,
Eric Maimela,
Solomon S R Choma
Affiliations
F Xavier Gómez-Olivé
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Lisa K Micklesfield
SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, Gauteng, South Africa
Shane A Norris
2 MRC-Wits DPHRU, University of the Witwatersrand, Johannesburg, South Africa
Alisha N Wade
South African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Gershim Asiki
1 Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
Innocent Maposa
2 Division of Epidemiology and Biostatistics, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, South Africa
Shukri F Mohamed
5 Health and Systems for Health Unit, African Population and Health Research Center, Nairobi, Kenya
Nigel J Crowther
Department of Chemical Pathology, National Health Laboratory Service, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Engelbert A Nonterah
Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
Michèle Ramsay
Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Hermann Sorgho
Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Sante, Nanoro, Burkina Faso
Godfred Agongo
Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
Palwende Boua
Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
Eric Maimela
DIMAMO PHRC, University of Limpopo, Polokwane, South Africa
Solomon S R Choma
7 Department of Pathology and Medical Sciences, DIMAMO Population Health Research Centre, University of Limpopo, Sovenga, South Africa
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.
