The General Assembly of the United Nations (UN) in December 2006 unanimously adopted a Resolution on diabetes. The resolution acknowledged that diabetes is a global pandemic that is as serious a threat to global health as the infectious disease epidemics such as HIV/AIDS, tuberculosis (TB), and malaria. Statistics also show that almost 460 million adults were living with diabetes globally in 2019 and estimates show that this is likely to rise to 700 million by 2045.
Low- and middle-income countries, including Botswana bear the brunt of most of this increase. According to the Institute for Health Metrics and Evaluation (IHME), the number of deaths from diabetes in Botswana from 2009 to 2019 increased by 40.1% making it the highest. IHME is an independent health research center that provides comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. The IHME research also shows that deaths from diabetes from 2009 to 2019 were higher than other NCDs such as heart disease and stroke which registered a death rate increase of 31% and 18.8% respectively.
While Botswana might find comfort in the fact that deaths from HIV/AIDS between 2009 and 2019 registered a decrease of -29.1%, public health experts are advising that the same vigor that has been used to fight HIV/AIDS should also be used to fight NCDs. A Public Health worker who spoke to this publication on condition of anonymity indicated that if Botswana does not direct its efforts towards fighting the burden of NCDs, then chances are high that NCDs and conditions such as cancer and cardio vascular diseases will move closer to becoming the greatest threats to human lives in Botswana.
“While i applaud the announcement by the government on its intention to improve on the UNAIDS 90-90-90 target to 95-95-95%, there is also need to scale up the fight against NCDs which are now slowly altering demographics, stunting development and impacting on economic growth,” she says.
She also noted that policymakers in Botswana must come up with strategies to encourage citizens to eat healthy and be physically active.
The Global Burden of Disease Study also estimates that the next 25 years will be a defining period for Botswana as the number of diabetes cases are expected to grow exponentially. There are three main types of diabetes being Type 1 diabetes, Type 2 diabetes, and gestational diabetes. Type 2 diabetes also called type 2 diabetes mellitus is the most common type in Botswana and mainly occurs in adults between the 20 to 79 age range and is characterised by high levels of sugar in the blood.
In 2019, the World Health Organisation (WHO) which is the specialised agency of the United Nations responsible for international public health stated that 6% (approximately 138 000 people) of the population in Botswana had diabetes. “A healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of type 2 diabetes,” says WHO.
This might prove to be a challenge in Botswana as the rising prevalence of diabetes is linked to the increase in obesity and poor eating habits. Although diabetes has changed from an incurable disease to a treatable condition, the consequences of the disease can be avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications. WHO estimates that almost 25% of the population in Botswana is categorised as physically inactive. This is mainly blamed on unhealthy diets, some of which have excess saturated fat and carbohydrates, which cause obesity and are a strong risk factor for diabetes.
Currently the world has nine NCD targets to be achieved by the year 2025 some of which include decreasing tobacco use by a third, reducing physical inactivity by ten per cent as well as reduction of alcohol use and salt intake. On average, people diagnosed with diabetes have medical expenditures approximately two and half times higher than what expenditures would be in the absence of diabetes.
Medical experts have come up with various reasons to the high rate of diabetes-related mortality in Botswana. Lack of awareness by the population of and facilities for detection and monitoring, unskilled health care staff, delay in seeking medical attention, and lack of access to affordable drugs are some of the reasons believed to be behind the scourge.
As recommendations, experts say there is need to embark on a sensitisation exercise across Botswana about the importance of screening. They also note that affordability of good health services remains an issue in Botswana, where an increasing number of people are paying for them from lean pockets. Furthermore, the present healthcare structure and system in Botswana does not support high quality care of diabetes patients.
Unless some of these factors are taken into account when planning effective preventive strategies, the objectives will not be attainable.
