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Despite similar national indices of poverty, the newly presenting diabetic child can expect around 5-10 times better prognosis in Zambia than in Mozambique, a difference likely to be accounted for by differences in the organization of healthcare. These differences are closely linked to the availability of insulin, syringes and testing materials as well as healthcare worker training and guidelines, costs for the person with diabetes, and the advocacy role of the diabetes associations. |
Insulin is vital for the survival of people with type 1 diabetes and is necessary for some people with type 2 diabetes 1 . Also of central importance are the means to administer the treatment such as syringe and needles, the means to monitor the response to insulin such as blood and urine tests, supportive care and education, and an understanding of how diabetes impacts the life and work of the individual.
Some 85 years after its discovery, insulin is still not available on an uninterrupted basis in many parts of sub-Saharan Africa (SSA) 2 3 4 . Very little primary data exist on type 1 diabetes in SSA and most information is based on anecdote. The Rapid Assessment Protocol for Insulin Access (RAPIA) was developed 5 in order to clearly assess the barriers to insulin access and proper diabetes care, and to attempt to improve these.
The RAPIA provides information on the different barriers that exist in a given country with regards to access to essential elements needed for the diagnosis, care and management of people with diabetes. The aim is not only to document the problems, but to also work in close collaboration with local stakeholders and international agencies to develop feasible solutions.
The RAPIA tool empowers local stakeholders by involving them in all the steps of the assessment. This model of assessing the health system, developing country specific recommendations and following this with implementation should be a gold standard applicable to other non-communicable diseases beyond diabetes. This will ensure that real needs are being tackled and that appropriate means are used to address the problems in the health system identified by the RAPIA.
For the purpose of this section, insulin-requiring diabetes has been defined as diabetes diagnosed before age 30 and with insulin treatment being commenced within one month of diagnosis. This term is used instead of the more common term ‘type 1 diabetes’, both because scarcity of ketone testing makes for difficulties with the term ‘ketosis-prone’, and because of differences in the spectrum of insulin-requiring diabetes between Africans and Caucasians 6 7 .
Note: the data in this section are correct at the time of the RAPIA assessment in each of these countries.
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3.Deeb,LC Tan,MH Alberti,KGMM Insulin availability among International Diabetes Federation Member Associations. Diabetes Care.1994; 17(3): 220-223
4.Savage,A The insulin dilemma: a survey of insulin treatment in the tropics 1994; 5: 19-20.. International Diabetes Digest.1994; 5(19): 20-
5.Beran,D. Yudkin,J.S. de Court Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a ’Rapid Assessment Protocol for Insulin Access’. BMC.Health Serv.Res..2006; 6: 17-
6.Mauvais-Jarvis,F. Sobngwi,E. Porcher,R. Riveline,J.P. Kevorkian,J.P. Vaisse,C. Charpentier,G. Guillausseau,P.J. Vexiau,P. Gautier,J.F. Ketosis-prone type 2 diabetes in patients of sub-Saharan African origin: clinical pathophysiology and natural history of beta-cell dysfunction and insulin resistance. Diabetes..2004; 53(3): 645-653
7.Swai,ABM Lutale,J. McLarty,D. Diabetes in tropical Africa: a prospective study, 1981-7 I. characteristics of newly presenting patients in Dar es Salaam, Tanzania, 1981-7. BMJ.1990; 300: 1103-1106
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