Uganda struggles to cope with rise in diabetes incidenceBMJ 2006; 333 doi: http://dx.doi.org/10.1136/bmj.333.7570.672-c (Published 28 September 2006) Cite this as: BMJ 2006;333:672
Doctors and government officials in Uganda are becoming increasingly concerned at the country's growing incidence of diabetes, which they attribute to changes in lifestyle and rising obesity. The number of people with diabetes is now thought to have passed a million, in a population of 28 million.
The health ministry is embarking on an exercise to assess the problem, including the ability of the existing facilities to handle the growing number of patients, said Sam Okware, a commissioner in the health ministry.
“We are carrying out an assessment of the seriousness of the disease, the mechanisms available to handle it, and the facilities in place,” Dr Okware said.
He explained, “There is a new thrust of non-communicable diseases in the country, and among these is diabetes. It is a very serious problem. People are changing their lifestyles. Many no longer get exercise: they do not work, and instead of walking they are driven in cars.”
In 1972 only 254 people in Uganda had been given a diagnosis of diabetes. They attended the country's only diabetes clinic, in the main hospital of Mulago, near Kampala.
Now Uganda has 560 000 registered people with diabetes. But it is thought an additional 560 000 patients may have the disease but are unaware of it.
Andrew Otim, a diabetes expert who is chairman of the Uganda Diabetic Association, said: “The total number of sufferers is 4% of the total population, or 1 120 000 patients. There are 10 centres handling diabetic patients countrywide.”
He explained that three types of diabetes affected Uganda. Type 1 accounts for about 8% of the total number of patients with diabetes. Type 2, or adult onset diabetes, particularly affects overweight people. Tropical diabetes also affects adults and is caused by poor nutrition.
The number of members of the Uganda Diabetic Association, currently 20 000, has doubled since 2001.
“Due to urbanisation most children spend a lot of time on computers and do less exercise. People eat sweets [and] processed foods and drink sodas,” Professor Otim said.
The disease is particularly acute among the cattle-keeping peoples of the southwestern part of the country, where 20 hospitals have been chosen to handle the growing number of patients. Three hospitals in major towns in the region handle between them 2400 patients with diabetes.
Meldard Behekyereza, who is based at a medical university in the region's main town of Mbarara, agreed that the main reason for the increase in numbers was changing lifestyles. He said, “People in the area have put on a lot of weight, as they do not do exercise. They take a lot of milk, ghee [a type of butter], and animal products. The problem is particularly acute among women.
“They become fatter, especially at the age of 40, and parts of their bodies, especially legs and feet, become big. Many of the patients do not put on shoes because of their big feet,” he said.