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Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Self-management of diabetes in Sub-Saharan Africa: a systematic review

Authors: Victor Stephani, Daniel Opoku, David Beran

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

The prevalence of diabetes in sub-Saharan Africa has increased rapidly over the last years. Self-management is a key element for the proper management, but strategies are currently lacking in this context. This systematic review aims to describe the level of self-management among persons living with type 2 diabetes mellitus in sub-Saharan Africa.

Method

Relevant databases including PubMed, Web of Science and Google Scholar were searched up to September 2016. Studies reporting self-management behavior of people with type 2 diabetes mellitus and living in sub-Saharan Africa were included.

Results

A total of 550 abstracts and 109 full-text articles were assessed. Forty-three studies, mainly observational, met the inclusion criteria. The studies showed that patients rarely self-monitored their glucose levels, had low frequency/duration of physical activity, moderately adhered to recommended dietary and medication behavior, had poor level of knowledge regarding diabetes related complications and sought traditional or herbal medicines beside of their biomedical treatment. The analysis also revealed a lack of studies on psychosocial aspects.

Conclusion

Except for the psychosocial area, there is a good amount of recent studies on self-management behavior of type 2 diabetes mellitus sub-Saharan Africa. These studies indicate that self-management in sub-Saharan Africa is poor and therefore a serious threat to the health of individuals and the health systems capacity.
Appendix
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Literature
1.
Curbing N. Noncommunicable diseases in Africa: youth are key to curbing the epidemic and achieving sustainable development. Washington: Population Reference Bureau; 2015.
2.
Beran D, Yudkin JS. Diabetes care in sub-Saharan Africa. Lancet. 2006;368(9548):1689–95.CrossRef
3.
Cho NH, Kirigia J, Mbanya JC. IDF diabetes atlas - eighth edition 2017. The International Diabetes Federation. 2017.
4.
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of self-care in management of diabetes mellitus. Journal of Diabetes & Metabolic Disorders. 2013;12(1):14.CrossRef
5.
Haas L, Maryniuk M, Beck J, Cox CE, Duker P, Edwards L, Fisher E, Hanson L, Kent D, Kolb L. National standards for diabetes self-management education and support. The Diabetes Educator. 2012;38(5):619–29.CrossRef
6.
Dube L, Van den Broucke S, Housiaux M, Dhoore W, Rendall-Mkosi K. Type 2 diabetes self-management education programs in high and low mortality developing countries: a systematic review. The Diabetes Educator. 2015;41(1):69–85.CrossRef
7.
Rawal LB, Tapp RJ, Williams ED, Chan C, Yasin S, Oldenburg B. Prevention of type 2 diabetes and its complications in developing countries: a review. Int J behavioral Med. 2012;19(2):121–33.CrossRef
8.
Dube L, Van den Broucke S, Dhoore W, Kalweit K, Housiaux M. An audit of diabetes self-management education programs in South Africa. J Public Health Research. 2015;4(3).
9.
Bank TW. World bank country and lending groups. Washington DC: The World Bank Group; 2017.
10.
Hall V, Thomsen RW, Henriksen O, Lohse N. Diabetes in sub Saharan Africa 1999-2011: epidemiology and public health implications. A systematic review. BMC Public Health. 2011;11(1):564.CrossRef
11.
Association AD: Living with Diabetes. In.; 2017.
12.
Guyatt GH, Sackett DL, Cook DJ, Guyatt G, Bass E, Brill-Edwards P, Browman G, Cook D, Farkouh M, Gerstein H. Users' guides to the medical literature: II. How to use an article about therapy or prevention a. are the results of the study valid? Jama. 1993;270(21):2598–601.CrossRef
13.
14.
Reeves BC, Deeks JJ, Higgins J. Including randomized studies. In: Cochrane handbook for systematic reviews of interventions, vol. 1; 2008. p. 391.
15.
Awah PK, Unwin N, Phillimore P. Cure or control: complying with biomedical regime of diabetes in Cameroon. BMC Health Serv Res. 2008;8:43.CrossRef
16.
Muchiri J, Gericke G, Rheeder P. Subjects' experiences of a nutrition education programme: a qualitative study of adults with type 2 diabetes mellitus living in a rural resource-limited setting in South Africa. S Afr J Clin Nutr. 2016;29(2):83–9.CrossRef
17.
Muchiri JW, Gericke GJ, Rheeder P. Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial. Public Health Nutr. 2016;19(1):142–55.CrossRef
18.
Baumann LC, Frederick N, Betty N, Jospehine E, Agatha N. A demonstration of peer support for Ugandan adults with type 2 diabetes. Int J behavioral Med. 2015;22(3):374–83.CrossRef
19.
van der Does AM, Mash R. Evaluation of the “take five school”: an education programme for people with type 2 diabetes in the Western cape, South Africa. primary care diabetes. 2013;7(4):289–95.CrossRef
20.
Mash B, Levitt N, Steyn K, Zwarenstein M, Rollnick S. Effectiveness of a group diabetes education programme in underserved communities in South Africa: pragmatic cluster randomized control trial. BMC Fam Pract. 2012;13:126.CrossRef
21.
Awodele O, Osuolale JA. Medication adherence in type 2 diabetes patients: study of patients in Alimosho general hospital, Igando, Lagos, Nigeria. Afr Health Sci. 2015;15(2):513–22.CrossRef
22.
Adeniyi OV, Yogeswaran P, Wright G, Longo-Mbenza B. Diabetic patients' perspectives on the challenges of glycaemic control. African journal of primary health care & family medicine. 2015;7(1):1–8.CrossRef
23.
de-Graft Aikins A, Awuah RB, Pera TA, Mendez M, Ogedegbe G. Explanatory models of diabetes in urban poor communities in Accra, Ghana. Ethnicity & health. 2015;20(4):391–408.CrossRef
24.
Adisa R, Alutundu MB, Fakeye TO. Factors contributing to nonadherence to oral hypoglycemic medications among ambulatory type 2 diabetes patients in southwestern Nigeria. Pharm Pract. 2009;7(3):163–9.
25.
Hjelm K, Mufunda E. Zimbabwean diabetics' beliefs about health and illness: an interview study. BMC Int Health Hum Rights. 2010;10(1):7.CrossRef
26.
Obirikorang Y, Obirikorang C, Odame Anto E, Acheampong E, Dzah N, Akosah CN, Nsenbah EB. Knowledge and lifestyle-associated prevalence of obesity among newly diagnosed type II diabetes mellitus patients attending diabetic Clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana: a hospital-based cross-sectional study. Journal of diabetes research. 2016;2016:9759241.CrossRef
27.
Doherty ML, Owusu-Dabo E, Kantanka OS, Brawer RO, Plumb JD. Type 2 diabetes in a rapidly urbanizing region of Ghana, West Africa: a qualitative study of dietary preferences, knowledge and practices. BMC Public Health. 2014;14(1):1069.CrossRef
28.
Mayega RW, Etajak S, Rutebemberwa E, Tomson G, Kiguli J. ‘Change means sacrificing a good life’: perceptions about severity of type 2 diabetes and preventive lifestyles among people afflicted or at high risk of type 2 diabetes in Iganga Uganda. BMC Public Health. 2014;14(1):864.CrossRef
29.
Adisa R, Fakeye TO, Fasanmade A. Medication adherence among ambulatory patients with type 2 diabetes in a tertiary healthcare setting in southwestern Nigeria. Pharm Pract. 2011;9(2):72.
30.
Mogre V, Nsoh JA, Wanaba P, Apala P. Demographic factors, weight management behaviours, receipt of healthcare professional's counselling and having knowledge in basic anthropometric measurements associated with underassessment of weight status in overweight and obese type 2 diabetes patients. Obesity research & clinical practice. 2016;10(4):381–9.CrossRef
31.
Sorato MM, Tesfahun C, Lamessa D. Levels and predictors of adherence to self-care behaviour among adult type 2 diabetics at Arba Minch general hospital, Southern Ethiopia. J Diabetes Metab. 2016;7(6):11.CrossRef
32.
Kamuhabwa AR, Charles E. Predictors of poor glycemic control in type 2 diabetic patients attending public hospitals in Dar Es Salaam. Drug, Healthcare and Patient Safety. 2014;6:155–65.CrossRef
33.
Nthangeni G, Steyn NP, Alberts M, Steyn K, Levitt NS, Laubscher R, Bourne L, Dick J, Temple N. Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services. Public Health Nutr. 2002;5(2):329–38.CrossRef
34.
Hjelm K, Nambozi G. Beliefs about health and illness: a comparison between Ugandan men and women living with diabetes mellitus. Int Nurs Rev. 2008;55(4):434–41.CrossRef
35.
Steyl T, Phillips J. Management of type 2 diabetes mellitus: adherence challenges in environments of low socio-economic status. Afr J Prim Health Care Fam Med. 2014;6(1):E1–7.CrossRef
36.
Jackson IL, Adibe MO, Okonta MJ, Ukwe CV. Knowledge of self-care among type 2 diabetes patients in two states of Nigeria. Pharm Pract. 2014;12(3).CrossRef
37.
Awotidebe TO, Adedoyin RA, Afolabi MA, Opiyo R. Knowledge, attitude and practice of exercise for plasma blood glucose control among patients with type-2 diabetes. Diabetes & metabolic syndrome. 2016;10((2 Suppl 1):S1–6.CrossRef
38.
Adibe MO, Aguwa CN, Ukwe CV. The construct validity of an instrument for measuring type 2 diabetes self-care knowledge in Nigeria. Trop J Pharm Res. 2011;10(5):619–29.
39.
Okonta HI, Ikombele JB, Ogunbanjo GA. Knowledge, attitude and practice regarding lifestyle modification in type 2 diabetic patients. Afr J Prim Health Care Fam Med. 2014;6(1):1–6.CrossRef
40.
Ogbera A, ADEYEMI-DORO A. Emotional distress is associated with poor self care in type 2 diabetes mellitus. Journal of diabetes. 2011;3(4):348–52.CrossRef
41.
Nielsen J, Bahendeka SK, Bygbjerg IC, Meyrowitsch DW, Whyte SR. Diabetes treatment as “homework”: consequences for household knowledge and health practices in rural Uganda. Health education & behavior : the official publication of the Society for Public Health Education. 2016;43(1 Suppl):100S–11S.CrossRef
42.
Wabe NT, Angamo MT, Hussein S. Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia. N Am J Med Sci. 2011;3(9):418–23.CrossRef
43.
Kassahun A, Gashe F, Mulisa E, Rike WA. Nonadherence and factors affecting adherence of diabetic patients to anti-diabetic medication in Assela general hospital, Oromia region, Ethiopia. J Pharm Bioallied Sci. 2016;8(2):124–9.CrossRef
44.
Matheka DM, Kilonzo JM, Munguti CM, Mwangi PW. Pattern, knowledge and practices of HbA1C testing among diabetic patients in a Kenyan tertiary referral hospital. Glob Health. 2013;9:55.CrossRef
45.
Abdelgadir A, Elbagir A, Eltom A, Berne C. The influence of glucose self-monitoring on glycaemic control in patients with diabetes mellitus in Sudan. Diabetes Res Clin Pract. 2006;74(1):90–4.CrossRef
46.
Yusuff KB, Obe O, Joseph BY. Adherence to anti-diabetic drug therapy and self management practices among type-2 diabetics in Nigeria. Pharmacy world & science : PWS. 2008;30(6):876–83.CrossRef
47.
Iwuala SO, Olamoyegun MA, Sabir AA, Fasanmade OA. The relationship between self-monitoring of blood glucose and glycaemic control among patients attending an urban diabetes clinic in Nigeria. Annals of African medicine. 2015;14(4):182–7.CrossRef
48.
Ezuruike U, Prieto JM. Assessment of potential herb-drug interactions among Nigerian adults with Type-2 diabetes. Front Pharmacol. 2016;7:248.CrossRef
49.
Onakpoya OH, Adeoye AO, Kolawole BA. Determinants of previous dilated eye examination among type II diabetics in southwestern Nigeria. European journal of internal medicine. 2010;21(3):176–9.CrossRef
50.
Bruce SP, Acheampong F, Kretchy I. Adherence to oral anti-diabetic drugs among patients attending a Ghanaian teaching hospital. Pharm Pract. 2015;13(1):533.CrossRef
51.
Jackson IL, Adibe MO, Okonta MJ, Ukwe CV. Medication adherence in type 2 diabetes patients in Nigeria. Diabetes Technol Ther. 2015;17(6):398–404.CrossRef
52.
Oyetunde OO, Aina BA, Tayo F. Impact of generic substitution practice on care of diabetic patients. Int J Clin Pharm. 2014;36(3):623–9.CrossRef
53.
Haque M, Emerson SH, Dennison CR, Navsa M, Levitt NS. Barriers to initiating insulin therapy in patients with type 2 diabetes mellitus in public-sector primary health care centres in Cape Town. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde. 2005;95(10):798–802.PubMed
54.
Obirikorang Y, Obirikorang C, Anto EO, Acheampong E, Batu EN, Stella AD, Constance O, Brenya PK. Knowledge of complications of diabetes mellitus among patients visiting the diabetes clinic at Sampa government hospital, Ghana: a descriptive study. BMC Public Health. 2016;16:637.CrossRef
55.
Matwa P, Chabeli MM, Muller M, Levitt NS. Experiences and guidelines for footcare practices of patients with diabetes mellitus. Curationis. 2003;26(1):11–21.CrossRef
56.
Mendenhall E, Norris SA. Diabetes care among urban women in Soweto, South Africa: a qualitative study. BMC Public Health. 2015;15:1300.CrossRef
57.
Awah PK, Unwin NC, Phillimore PR. Diabetes mellitus: indigenous naming, indigenous diagnosis and self-management in an African setting: the example from Cameroon. BMC Endocr Disord. 2009;9:5.CrossRef
58.
Ezuruike U, Prieto JM. Assessment of potential herb-drug interactions among Nigerian adults with Type-2 diabetes. Front Pharmacol. 2016;7.
59.
Nicolucci A, Kovacs Burns K, Holt RI, Comaschi M, Hermanns N, Ishii H, Kokoszka A, Pouwer F, Skovlund S, Stuckey H. Diabetes attitudes, wishes and needs second study (DAWN2™): cross-national benchmarking of diabetes-related psychosocial outcomes for people with diabetes. Diabet Med. 2013;30(7):767–77.CrossRef
60.
Brown SA. Interventions to promote diabetes self-management: state of the science. The Diabetes Educator. 1999;25(6_suppl):52–61.CrossRef
61.
Naicker S, Plange-Rhule J, Tutt RC, Eastwood JB. Shortage of healthcare workers in developing countries--Africa. Ethnicity & disease. 2009;19(1):60.
62.
Kirigia J, Barry S. Health challenges in Africa and the way forward. In: BioMed Central. 2008.
63.
Stephani V, Opoku D, Quentin W. A systematic review of randomized controlled trials of mHealth interventions against non-communicable diseases in developing countries. BMC Public Health. 2016;16(1):572.CrossRef
64.
Mayberry LS, Osborn CY. Family support, medication adherence, and glycemic control among adults with type 2 diabetes. Diabetes Care. 2012;35(6):1239–45.CrossRef
65.
Mbanya JCN, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-saharan africa. Lancet. 2010;375(9733):2254–66.CrossRef
Metadata
Title
Self-management of diabetes in Sub-Saharan Africa: a systematic review
Authors
Victor Stephani
Daniel Opoku
David Beran
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-6050-0

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