Background: Diabetes Mellitus is an increasing medical problem in Sub-Saharan Africa (SSA). Current evidence suggests an epidemic proportion of this condition in this developing region, largely due to increasing urbanization and epidemiological transition.
There are suggestions that the quality of diabetes care in Africa is suboptimal. However, there is unclear evidence to substantiate these claims. There was the need to systematically assess and summarise the existing evidence on quality of care among patients with type 2 diabetes mellitus (T2DM), whilst identifying any gaps in information and exploring possible barriers to care in a SSA context. This will provide policy makers and health care providers with a systematic overview of the available evidence on the state of diabetes care in this region from which they can base decision making.
Aim and Objectives: The aim of the systematic review was to examine the existing quality of management of type 2 diabetes in SSA by addressing the following questions:
i. How good is the current control of type 2 DM in SSA based on indicator outcome of blood pressure?
ii. Have implemented strategies, treatment or interventions improved the outcome of type 2 DM in Sub-Saharan African countries?
Methods: This study was a systematic review of quantitative studies. The population comprised people with type 2 diabetes in sub-Saharan Africa. All ages, gender, ethnicities irrespective of race, residence, locality, immigration status, educational background and socio-economic status were included. The studies included cross-sectional studies, experimental, quasi-experimental studies, observational studies and review papers. Only full papers as opposed to abstracts were included in the review. Conference proceedings, editorials and case reports were excluded. Two databases were explored to develop search strategies – MEDLINE via Pubmed (1946 to February 2013) and EMBASE via Ovid (1974 to April 2013). Terms such as hypertension and blood pressure, and terms related to these were used in the search strategy. The search included searching reference lists of derived papers and contacting experts. Data on measures of blood pressure control as primary outcome of interest were extracted and summarised upon. Secondary outcomes included process measures like the frequency of blood pressure levels documentation. Duration of diagnosed diabetes and assessment of diabetes complications were considered. The interventions or implementation strategies within studies or data collected on these were also assessed. Study quality was assessed based on components in a quality assessment tool from the Effective Public Health Practice Project.
Results: Eleven published studies were identified and included in the review. These were all cross sectional studies. Education on diabetes management and prevention of complications seemed to be the most consistent intervention carried out, followed by drug treatment, then dietary measures. In most studies less than 40% (Between 15.6% and 35.1%) had target systolic BP value of ≤ 130mmHg and/or diastolic value of ≤ 80 mmHg.
Conclusion: This review found the quality of care of type 2 diabetes based on blood pressure control, to be sub-optimal in sub-Sahara African countries. Therefore, quality of care needs to be improved upon in this region. It is likely that several interventions, mainly secondary preventive strategies, and implementation strategies identified would improve quality of care in this region. Targeted interventions and strategies specific to the local populace would be beneficial. Other forms of interventions like primary preventive strategies can be useful and may need to be investigated. Barriers to good diabetes management should also be taken into consideration when looking at factors impeding quality of care.
Impact Factor
2022: 6.012
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