Dakar – Senegal, like many African countries, is bearing an increasing heavy diabetes burden. While efforts are being made to improve prevention, care and treatment, Professor Maïmouna Ndour Mbaye, head of the Internal Medicine unit, Cheikh Anta Diop University of Dakar and director of the country’s national Diabetes Centre, notes that stepping up diabetes control in Senegal starts with a strong national programme. The response must involve all the sectors of the society up to individuals who have a crucial prevention role by adopting healthy practices.
Being on the frontlines of the diabetes fight, what are the trends and challenges?
The progression of diabetes in Senegal is much like elsewhere in the world. Although data collection is not done routinely, the first nationwide survey conducted in 2015 showed a prevalence of 3.4% in people aged 18-69 years and 7.9% in those over 45 years.
Hospital statistics, notably those from the National Diabetes Centre, also give a good idea of this progression: in the 1980s, an average of 200 new cases were recorded annually. Since 2005, this has increased to nearly 2500 new cases yearly. Currently, nearly 60 000 diabetes patients are being monitored from all cities in Senegal and even from neighbouring countries.
The number of consultations increased by more than 20% between 2018 and 2019. In 2020, the number dropped significantly due to the COVID-19 pandemic.
This rapid progression of diabetes is one of the main challenges of the national diabetes centre, whose capacity has been largely exceeded. This has an impact on the quality of patient care: instead of doing check-ups every two to three months as recommended, we can only provide two or even one consultation a year.
At the national level, despite major efforts to decentralize care and train health professionals, human resources are still insufficient and there is still a lack of infrastructure and equipment for appropriate care of diabetes and its complications.
Senegal does not yet have a national diabetes programme, but rather a noncommunicable diseases division within the Ministry of Health. Standards and protocols have been developed to improve the management of this disease and its risk factors. Several activities are carried out, but the projects are financed by donors and face recurrent challenges of sustainability since there is no domestic financing for the implementation of strategies.
How is COVID-19 further challenging people living with diabetes?
The COVID-19 pandemic has worsened the picture. Statistics show that diabetes and hypertension are the comorbidities most frequently associated with death in patients hospitalized for COVID-19. The emotional and psychosocial impact is huge among diabetes patients.
The pandemic has cause significant disruptions in diabetes and noncommunicable disease services in general. Infrastructures and care personnel were assigned to the COVID-19 response. For example, in our diabetes department, out of 40 beds, 20 have been allocated to COVID-19 cases. Activities considered non-urgent like systematic screening for chronic complications of diabetes have been postponed, including follow-up appointments.
How has Senegal innovated in its response to the disease?
To address these challenges, innovative approaches were being implemented even before the COVID-19 pandemic. Senegal is the first country in French-speaking Africa to implement the global BeHealthy BeMobile programme to improve diabetes management. This is the mDiabetes project, which consists of using cell phones to deliver simple diabetes prevention messages to the population. In 2014 the mDiabetes platform was used to send millions of prevention messages against the Ebola outbreak and it was also used during the COVID-19 pandemic. This programme has been evaluated and shown to improve beneficiaries’ glycaemic control.
Other telehealth projects are underway: remote consultation for certain patients since the beginning of the pandemic, tele-screening for diabetic retinopathy, e-learning for health professionals.
What more does the country need to do to bring diabetes under control?
There is still room to do more. There is need to set up a national diabetes programme with strategies, objectives and financing. We must also reinforce prevention and epidemiological surveillance of diabetes and noncommunicable diseases. Other keyways to improve diabetes control include stronger coordination of interventions and adopting a multidisciplinary and multisectoral approach including government, health care providers, diabetes patients, civil society, pharmaceutical and food industry, communication professionals. We also need to strengthen our system for chronic diseases management so that we can ensure continuity of care while dealing with emergencies such as COVID-19.