Diabetes: A Neglected Disease In Sub-Saharan Africa : a comparative study between Rwanda and Norway

Aim: To illustrate diabetes care in Rwanda and to compare childhood diabetes care in Rwanda, Sub-Saharan Africa and Norway with guidelines from International Society for Pediatric and Adolescent Diabetes (ISPAD). Methods: Part 1 and part 2: Literature review of diabetes care with focus on children with type 1 diabetes in Sub-Saharan Africa and Norway based on a non-systematic search on PubMed and on a standardized electronic questionnaire quality assessed with a local informant in Norway at Ullevål University Hospital (UUH). Part 3: A partly personal observational study from University Teaching Hospital (UTHB) in Rwanda based on eight pediatric case reports and an interview with a local informant. Results: Norway has among the highest incidences in the world of type 1 diabetes in the age group 0-14 years (36 per 100 000 PYR), Rwanda has among the lowest (0.3 per 100 000 PYR). Type 1 diabetes constitutes the major subtype of diabetes among children and adolescents at UUH (92%) and UTHB (100%). The mean age at onset was 8.1 years at UUH and 10.2 years at UTHB. All children (100%) at UTHB had diabetic ketoacidosis at onset compared to 25 % at UUH. The most common administration form at UUH was continuous subcutaneous insulin infusion subsequently the pen and all subjects followed a multiple daily injection regime. At UTHB all patients used syringes and injections twice daily. Survival rate in Norway is 94.6% after 25 years. Type 1 diabetes in Rwanda reduces life expectancy with 20 years (from 58 years to 30 to 35 years). Having diabetes in a developing country as Rwanda implies a great financial burden on the family and outcome is often poor. Insulin availability remains a problem and urgent international financial support is needed. Re-hospitalized patients were admitted to hospital with multiple organ pathologies, but no registration of direct diabetic complications was done. Currently, there is no official diabetes registry or guidelines of diabetes care in Rwanda. Conclusion: Diabetes is still a neglected disease in Rwanda, though, greater awareness and knowledge is rising. Implementing of current ISPAD guidelines is not possible in Rwanda emphasizing the importance of new guidelines directed towards developing countries