In Guinea, the 2009 Steps survey conducted in Conakry highlights a prevalence of 5.6%
in patients aged 25 to 64 years. Undiagnosed diabetes cases were 57.3%, and of the
known cases, 68.5% were untreated.[1] Poor control of diabetes (hemoglobin A1C (HbA1C) ≥ 7%) was noted in 84% of Guinean
diabetics, of whom, 41% had HbA1C ≥ 10%.2
Moreover, different studies showed that diabetes is often complicated: 20% of patients
on dialysis.[2] In addition, 5% of diabetic patients seen in 2000 were blind,[2] and 10% of them sustained an amputation in the thigh in 2001.[3] Nearly one-half of men with diabetes (48.4%) surveyed in a study in 2003 showed
erectile dysfunctions.[4] A study conducted in 2000 showed that 8% of patients had a stroke.[5]
Cardiovascular risk factors were also noted in the 2009 Steps survey in Conakry. Hypertension
was found in 33.4% of the population aged 25 to 64, 67.9% of them were not known before
the study, and 87.5% of all patients with high blood pressure were not treated. In
addition, 14.3% of the population had hypercholesterolemia (total cholesterol ≥190
mg/dL), 10% were smokers, and 59.3% did not have any physical activity.[1]
In the hospital, diabetes-related mortality (7.67% of admissions) was essentially
the result of acute complications (ketoacidosis) entangled with infectious complications
including diabetic foot lesions.[6]
Diabetic patients in Guinea face enormous difficulties in accessing care because of
the lack of qualified medical and paramedical personnel, insufficient diabetes care
facilities, the scarcity of affordable and reliable drugs and equipment, and limitation
of geographical and financial accessibility (high out-of-pocket payment). Less than
one-third of the patients can afford the direct cost of diabetes. Less than 1.5% of
Guineans are covered by multiple fragmented community health insurances, whereas 47%
of the population is living below poverty line.[7]
[8]
In Guinea, all diabetic patients are managed at the tertiary level, and the gaps at
the first line and secondary level are filled by a various number of providers. These
include, but are not limited to, private for-profit care providers and traditional
healers.[9]
These barriers are an impediment to the early diagnosis and appropriate diabetes case
management. They lead to more complications and diabetes-related deaths.
The growing number of people in need of care for diabetes is proving to a challenge
for the Guinean health system. This situation is worsened by the burden of communicable
diseases including the Ebola virus disease (EVD).[10]
It is important to decentralize the care (first and second lines) and also build a
partnership between the health system and community to reduce the economic burden
of management of NCDs through continued care within the community and to enhance patients’
awareness and knowledge via counseling activities revolving around drug adherence,
lifestyle changes, psychosocial support, and peer support groups. It is also important
to train and task shift (from doctors to nurses or from nurses to stable diabetic
patients), to negotiate standardized price for a selected package of activities and
generic drug, and to introduce social health insurance in Guinea.
