title: Use of medical services and medicines attributable to diabetes in Sub-Saharan Africa.
abstract: BACKGROUND
  Although the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be done.
  
  
  METHODS
  To ascertain recent use of medical services and medicines and other information about the impact of ill-health, we in 2008-2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770 matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age. We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing for statistical significance using two-stage multivariable hurdle models.
  
  
  RESULTS
  DMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times more medications than MCs (all p<0.001). DMs used an estimated 3.44 inpatient days per person per year, made 10.72 outpatient visits per person per year (excluding traditional healers), and were taking an average of 2.49 prescribed medicines when interviewed.
  
  
  CONCLUSIONS
  In Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought to be minor problems for health systems and patients in Africa, our data demonstrate the opposite.
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon, United States of America.
authors.forename: Jonathan Betz
authors.initials: JB
authors.lastname: Brown
authors.affiliation: Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Ramaiya
authors.affiliation: NGO Santé Diabète, Bamako, Mali.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Besançon
authors.affiliation: School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
authors.forename: Paul
authors.initials: P
authors.lastname: Rheeder
authors.affiliation: Health of Populations in Transition-Research Group, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon.
authors.forename: Clarisse Mapa
authors.initials: CM
authors.lastname: Tassou
authors.affiliation: Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences and Laboratory of Molecular and Metabolic Medicine, Biotechnology Center, University of Yaounde, Yaoundé, Cameroon.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Mbanya
authors.affiliation: Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland; International Diabetes Federation, Brussels, Belgium.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kissimova-Skarbek
authors.affiliation: Kenya Diabetes management and Information Centre (DMI), Nairobi, Kenya.
authors.forename: Eva Wangechi
authors.initials: EW
authors.lastname: Njenga
authors.affiliation: Kenya Diabetes management and Information Centre (DMI), Nairobi, Kenya.
authors.forename: Eva Wangui
authors.initials: EW
authors.lastname: Muchemi
authors.affiliation: Health Systems Management, World Health Organization (WHO), Nairobi, Kenya.
authors.forename: Harrison Kiambuthi
authors.initials: HK
authors.lastname: Wanjiru
authors.affiliation: International Diabetes Federation, Brussels, Belgium; The MAX Foundation, Edmonds, Washington, United States of America.
authors.forename: Erin
authors.initials: E
authors.lastname: Schneider
mesh_terms: D017954:Africa South of the Sahara; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D057566:Self Report
chemical_list: D007004:Hypoglycemic Agents