How to address challenges of diabetes prevention care in Nigeria-Expert

Dr Ejiofor Ugwu, is the President of the Diabetes Association of Nigeria (DAN). Ugwu, who is also an Associate Professor of Medicine and a Consultant Endocrinologist/Diabetologist in this interview speaks on the burden of diabetes in the country, and ways to address the challenges of diabetes prevention and care in Nigeria among others.

By Ojoma Akor

What is diabetes?

The most common type of diabetes is diabetes mellitus. Diabetes mellitus simply means that the amount of sugar or glucose that is circulating in the bloodstream is too high and is harmful to the organs .

So a medical condition that is associated with an excessive amount of glucose or sugar in the blood circulation is referred to as diabetes mellitus. I’m giving you a layman’s definition. This medical condition doesn’t just happen spontaneously. Something is responsible for it. There is a hormone in the body called insulin, and insulin is produced by an organ known as the pancreas.

The pancreas is located in the abdomen, in the tummy, towards the back, it produces a hormone called insulin. Now the biological function of this insulin is to regulate the amount of sugar in the bloodstream after eating, especially carbohydrate meals, and after digestion, it’s going to result in sugar. So it is this insulin that makes sure that the sugar is removed from the bloodstream and taken to the organs where they are used to generate energy.

When this insulin is lacking, not enough, or it is present but is functionally defective, then diabetes mellitus will  result.

We talk about diabetes mellitus as a chronic medical condition characterized by excess glucose in the blood due to either quantitative or qualitative insulin deficiency.

Diabetes inspidus, on the other hand, is an uncommon condition in which the kidneys are unable to prevent the excretion of water. This is not the same as diabetes mellitus, though both can cause increased thirst and urination; the latter involves high blood sugar, while diabetes insipidus is due to a problem with a hormone called antidiuretic hormone (ADH).

What is the burden of diabetes in Nigeria?

The burden of diabetes in Nigeria is alarming. It has assumed an epidemic proportion. Nigeria has an adult population of about 80 200 million, and out of this, 80 200 million, roughly 5.7% have  diabetes mellitus. So in terms of numbers, about six to 8 million adults in Nigeria suffer from diabetes mellitus.

Diabetes is a very common medical condition in Nigeria. But let me even shock you further, this figure we are talking about represents only one thought of the diabetes cases in Nigeria, because two thoughts of people living to tons of people suffering from diabetes in Nigeria are not yet diagnosed, as in they are not aware. They have not been discovered. So they don’t even know that they have the condition, because of all health-seeking behaviors in the country, lack of regular screening and medical checkpoints so a lot of people with diabetes are not yet diagnosed.

What do you think are the barriers to assessing care, whether preventive or treatment for diabetes in the country?

The challenges to the care of diabetes in Nigeria are  enormous. Number one challenge is the absence of accurate data. Now you heard me say, close to eight million Nigerians have it . That is an estimate from local studies. There was a recent meta analysis by a group of researchers who looked at different studies that were conducted in different parts of the country. That is not representative national data.

Nigeria is supposed to have a national survey of non-communicable diseases. That is how it is done all over the world in any other country. It is that national survey that will give accurate data of the number of people living with diabetes in Nigeria, and that is very important for policy formulation and for national planning.

So one of the barriers is that Nigeria does not have accurate data of diabetes prevalence in this country now.

Number two is the high cost of diabetes care. You know that the national health insurance coverage in Nigeria is still very poor. Most people pay out of pocket. So, out-of-pocket expenditure is the norm in Nigeria.

Now you know the current inflationary trends in Nigeria, resulting to the high cost of living. This has grossly affected, negatively affected individuals living with diabetes in Nigeria. The situation we have in our hands right now is a near-catastrophe. So many people, most people, living with diabetes in Nigeria, can no longer afford care, and it’s a very big challenge.

It’s one of the barriers that needs to be addressed as a matter of urgency, because people are dying. Diabetes is killing people, because a lot of people have dropped their medications, not because they don’t want to live, but because they can no longer afford it, and they resorted to alternative options, including prayer houses and native doctors.

Three vials of insulin, one injection that we use to manage diabetes, including diabetes emergencies, used to cost about N4, 000 but today that same vial of insulin costs between N18,000 and N22,000 .

So there is also a high cost of diabetes medication and the unavailability of essential medicines . Most of the companies manufacturing and marketing diabetes medications are foreign companies, and some of them, many of them, have left the country in the last one to two years due to the harsh business environment.

Another issue is that there is no national there is no national policy on diabetes. You know, a country, every country, they have what they call national policy on non-communicable diseases. Okay and diabetes is one of them.

Such thing is non-existent in Nigeria. One of the things or risk factors predisposing people to developing diabetes is unhealthy diets, especially the high consumption of sugar sweetened beverages.

What other countries do is that they try to impose a kind of tax on soft drinks sugar sweetened be ready to discourage people from consuming them. Now, Nigeria successfully launched this SSB tax like sugar sweetened be registered in June 2022 after several advocacy efforts by so many stakeholders. Those companies manufacturing all these are very rich. They have a lot of money to lobby, and they were able to convince the government to stop the taxation.

And another thing is that even for those three years that the taxation was the money accruing from that taxation was never spent on fighting diabetes and other NCDs, unlike what happens in other countries of the world, because there was no legislation, no legislation on how that money should be spent.

That money is supposed to be spent on creating awareness about diabetes, conducting diabetes surveys, improving access to diabetes medication, subsidizing drugs and stuff like that. But that money was never utilized for that purpose.

Another barrier to care is manpower. Shortage of manpower. Okay, alright, so there are very few diabetes specialists in the country, less than 200 diabetes specialists to manage about six to 8 million Nigerians living with diabetes is a far cry from international recommendations, and these diabetes specialists are almost non-existent in rural and semi urban areas, most of them are concentrated in urban areas.

So we recommend that federal government of Nigeria should, as a matter of urgency, strengthen the primary health care centers. Employ more people there, medical officers and nurses, train them, and then equip those hospitals with facilities to manage diabetes, so that everybody will not have to go to the specialist, so that uncomplicated cases can be managed at primary health care level.

What is the way forward?

Well, I have few recommendations for the federal government of Nigeria to save the masses from this existential threat those who are living with diabetes, one of them is, I recommend that the federal government of Nigeria should, as a matter of urgency, remove all taxations on importations of diabetes medications and supplies and consumables.

There should be a total tax waiver on diabetes drugs diabetes consumables, such as blood glucose testing, meters and strips, so that the landing cost of these medications and supplies will be much lower and they will become much more affordable to people living with diabetes.

They should be implemented as a matter of audience. Then number two, the Diabetes Association of Nigeria, which I represent, strongly recommends a federal government subsidy on diabetes care. See, let me give you an example in Nigeria, for instance, treatment of tuberculosis is free of charge. Treatment of HIV AIDS is free of charge. Leprosy, the treatment is free of charge.

Now, but do you know that the number of deaths from tuberculosis, HIV and even malaria, all combined together, is not up to the death rate from diabetes alone.

Yes, a lot of money and attention are channeled to all these communicable diseases, leading to their free treatment. But treatment for diabetes care is not even subsidized at all.

Insulin, which is an emergency medicine for managing diabetes, is either free, completely free, or heavily subsidized. So we also use this opportunity to call on the federal government to consider this as a matter of urgency. Then, in the medium to long term, there should be a well-conducted National Survey on non-communicable disease in Nigeria, championed by the federal government and involving other stakeholders.

And Nigeria also needs to establish a national policy and strategic planning for diabetes. Then finally, sorry, the sugar sweetened be rich. Taxation needs to be resumed. The federal government of Nigeria should resume the collection, the deduction of sugar, sweeten the registers, in fact, not only the resolution, but to increase it. It was 10 Naira per liter, the land that is advocating that it should be 20 Naira per liter, and there should be legislation to channel the money accruing from such taxation to managing diabetes, improving diabetes care in this country.

Briefly tell us about the Diabetes Association of Nigeria

It is now is a nonprofit organization that has been in existence since 1982 and officially registered in 1994 now, our mandate, our goals, are to improve the lives of people living with diabetes through education, advocacy and improved care.

Now we do this by creating awareness through media (print, electronic), conducting interviews, creating radio and television jingles, and using all our venues to raise awareness about diabetes. And at the same time, we also engage governments to try to create a good enabling environment for proper diabetes care.

Now in this country, there are so many socioeconomic factors militating against the actualization of our goals, and, of course, against efficient diabetes care in this country.