Advertisement

International Journal of Public Health

, Volume 60, Issue 1, pp 1–11 | Cite as

Prevalence of diabetes in Zimbabwe: a systematic review with meta-analysis

  • Mutsa MutowoEmail author
  • Usha Gowda
  • John Chamunorwa Mangwiro
  • Paula Lorgelly
  • Alice Owen
  • Andre Renzaho
Review

Abstract

Objective

Diabetes appears to be a growing problem in the African region. This study aims to estimate the prevalence of diabetes in Zimbabwe by collating and analyzing previously published data.

Methods

Systematic review and meta-analysis of data reporting prevalence of diabetes in Zimbabwe was conducted based on the random effects model. We searched for studies published between January 1960 and December 2013 using MEDLINE, EMBASE and Scopus and University of Zimbabwe electronic publication libraries. In the meta-analysis, sub-groups were created for studies conducted before 1980 and after 1980, to understand the potential effect of independence on prevalence.

Results

Seven studies were included in the meta-analysis with a total of 29,514 study participants. The overall pooled prevalence of diabetes before 1980 was 0.44 % (95 % CI 0.0–1.9 %), after 1980 the pooled prevalence was 5.7 % (95 % CI 3.3–8.6 %).

Conclusions

This study showed that the prevalence of diabetes in Zimbabwe has increased significantly over the past three decades. This poses serious challenges to the provision of care and prevention of disabling co-morbidities in an already disadvantaged healthcare setting.

Keywords

Prevalence Systematic review Meta analysis Diabetes mellitus Zimbabwe 

References

  1. Afoke AO, Ejeh NM, Nwonu EN, Okafor CO, Udeh NJ, Ludvigsson J (1992) Prevalence and clinical picture of IDDM in Nigerian Igbo school children. Diabetes Care 15:1310–1312PubMedCrossRefGoogle Scholar
  2. Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetes Med 15:539–553CrossRefGoogle Scholar
  3. Alberti KG, Zimmet P, Shaw J (2007) International Diabetes Federation: a consensus on Type 2 diabetes prevention. Diabetes Med 24:451–463CrossRefGoogle Scholar
  4. American Diabetes Association (2013) Diagnosis and classification of diabetes mellitus. Diabetes Care 36(Suppl 1):S67–S74PubMedCentralCrossRefGoogle Scholar
  5. Amoah AGB, Owusu SK, Adjei S (2002) Diabetes in Ghana: a community based prevalence study in Greater Accra. Diabetes Res Clin Pract 56:197–205PubMedCrossRefGoogle Scholar
  6. Assah FK, Ekelund U, Brage S, Mbanya JC, Wareham NJ (2011) Urbanization, physical activity, and metabolic health in sub-Saharan Africa. Diabetes Care 34(2):491–496PubMedCentralPubMedCrossRefGoogle Scholar
  7. Bardgett HP, Dixon M, Beeching NJ (2006) Increase in hospital mortality from non-communicable disease and HIV-related conditions in Bulawayo, Zimbabwe, between 1992 and 2000. Trop Doct 36:129–131PubMedCrossRefGoogle Scholar
  8. Barendregt JJ, Mozurkewich EL (2011) Meta-analysis of heterogeneous clinical trials: an empirical example. Contemp Clin Trials 32:288–298PubMedCrossRefGoogle Scholar
  9. BeLue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C et al (2009) An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective. Global Health 5:10PubMedCentralPubMedCrossRefGoogle Scholar
  10. Beran D, Yudkin JS, de Courten M (2005) Access to care for patients with insulin-requiring diabetes in developing countries: case studies of Mozambique and Zambia. Diabetes Care 28(9):2136–2140PubMedCrossRefGoogle Scholar
  11. Betz Brown J, Gagliardino JJ, Ramaiya K, for International Diabetes Federation (2009) Studies on the economic and social impact of diabetes in low- and middle-income countries. Presentation to IDF World Diabetes Congress. Montreal, October 2009. http://www.idf.org/webdata/docs/WDC-PC-IDF%20Impact%20Studies.pdf
  12. Blair Research Institute (1996) The early socio-demographic impact of the HIV-1 epidemic in rural Zimbabwe. Blair Research Institute, HarareGoogle Scholar
  13. Bratton M, Masunungure E (2008) Zimbabwe’s Long Agony. J Democr 19(4):41–55CrossRefGoogle Scholar
  14. Burgess DJ, Ding Y, Hargreaves M, van Ryn M, Phelan S (2008) The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. J Health Care Poor Underserved 19(3):894–911PubMedCrossRefGoogle Scholar
  15. Carr WR, Gelfand M (1961) The incidence of Diabetes in the African. Cent Afr J Med 7(9):332–335PubMedGoogle Scholar
  16. Castle WN, Wicks ACB (1980) Follow-Up of 93 newly diagnosed african diabetics for 6 years. Diabetologia 18:121–123PubMedCrossRefGoogle Scholar
  17. Ceesay MM, Morgan MW, Kamanda MO, Willoughby VR, Lisk DR (1997) Prevalence of diabetes in rural and urban populations in southern Sierra Leone: a preliminary survey. Trop Med Int Health 2:272–277PubMedCrossRefGoogle Scholar
  18. Christensen DL, Eis J, Hansen AW, Larsson MW, Mwaniki DL, Kilonzo B et al (2008) Obesity and regional fat distribution in Kenyan populations: impact of ethnicity and urbanization. Ann Hum Biol 35:232–249PubMedCrossRefGoogle Scholar
  19. Dagogo-Jack S (2008) HIV therapy and diabetes risk. Diabetes Care 31(6):1267–1268PubMedCrossRefGoogle Scholar
  20. Danaei G et al (2011) National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 378(9785):31–40PubMedCrossRefGoogle Scholar
  21. Delamothe T (2009) Aid agencies neglect non-communicable diseases, international health organisations warn. BMJ 338:b2102PubMedCrossRefGoogle Scholar
  22. Dooley KE, Chaisson RE (2009) Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis 9:737–746PubMedCentralPubMedCrossRefGoogle Scholar
  23. Dye C (2006) Global epidemiology of Tuberculosis. Lancet 367(9514):938–940PubMedCrossRefGoogle Scholar
  24. Dyerberg J, Pedersen L, Aagaard O (1976) Evaluation of dipstick test for glucose in urine. Clin Chem 22:205–210PubMedGoogle Scholar
  25. Ejim EC, Okafor CI, Emehel A, Mbah AU, Onyia U, Egwuonwu T et al (2011) Prevalence of cardiovascular risk factors in the middle-aged and elderly population of a Nigerian rural community. J Trop Med 2011:308687PubMedCentralPubMedGoogle Scholar
  26. Elamin A, Eltayeb B, Tuvemo T (1997) High incidence of type I diabetes mellitus in Sudanese children. Ann Saudi Med 17(4):478–480PubMedGoogle Scholar
  27. Elamin A, Omer MI, Zein K, Tuvemo T (1992) Epidemiology of childhood type I diabetes in Sudan, 1987–1990. Diab Care 15:1556–1559CrossRefGoogle Scholar
  28. Gill G (1990) Practical management of diabetes in the tropics. Trop Doct 20:4–10PubMedGoogle Scholar
  29. Gill GV, Mbanya JC, Ramaiya KL, Tesfaye S (2009) A sub-Saharan African perspective of diabetes. Diabetologia 52:8–16PubMedCrossRefGoogle Scholar
  30. Gu K, Cowie CC, Harris MI (1998) Mortality in adults with and without diabetes in a national cohort of the U.S. population, 1971–1993. Diabetes Care 21:1138–1145PubMedCrossRefGoogle Scholar
  31. Guidotti L, Gelfand M (1976) Frequency of Diabetes Mellitus in Mtoko. Centr Afr J Med 22(2):28–29Google Scholar
  32. Hakim JB, Mujuru N, Rusakaniko S, Gomo Z (2005) Zimbabwe noncommunicable disease risk factors (ZiNCoDs): preliminary report. Harare, Republic of Zimbabwe: Ministry of Health & Child Welfare, University of Zimbabwe, World Health Organization, United Nations Children’s Fund. http://www.who.int/chp/steps/STEPS_Zimbabwe_Data.pdf. Accessed 16 June 2014
  33. Hall V, Thomsen RW, Henriksen O, Lohse N (2011) Diabetes in Sub Saharan Africa 1999–2011: epidemiology and public health implications. A systematic review. BMC Public Health 11:564PubMedCentralPubMedCrossRefGoogle Scholar
  34. Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558PubMedCrossRefGoogle Scholar
  35. Hjelm K, Mufunda E (2010) Zimbabwean diabetics’ beliefs about health and illness: an interview study. BMC Int Health Hum Rights 10:7PubMedCentralPubMedCrossRefGoogle Scholar
  36. Hjelm K, Mufunda E, Nambozi G, Kemp J (2003) Preparing nurses to face the pandemic of diabetes mellitus: a literature review. J Adv Nurs 41:424–434PubMedCrossRefGoogle Scholar
  37. International Diabetes Federation (2013) IDF Diabetes Atlas, 6th edn. International Diabetes Federation, Brussels, Belgium. http://www.idf.org/diabetesatlas-new/how-to-cite
  38. Jha TK, Sharma VK (1984) Pentamidine-induced diabetes mellitus. Trans R Soc Trop Med Hyg 78:252–253PubMedCrossRefGoogle Scholar
  39. Kengne A, Amoah AG, Mbanya JC (2005) Cardiovascular complications of diabetes mellitus in sub-Saharan Africa. Circulation 112:3592–3601PubMedCrossRefGoogle Scholar
  40. Kirigia JM et al (2009) Economic burden of diabetes mellitus in the WHO African region. BMC Int Health Hum Rights 9:6PubMedCentralPubMedCrossRefGoogle Scholar
  41. Kohler E (1978) For the Committee on Materials and Therapeutic Agents, American Diabetes Association: Policy Statement. On materials for testing glucose in the urine. Diabetes Care 1:64–67PubMedCrossRefGoogle Scholar
  42. Kornum JB, Thomsen RW, Riis A et al (2008) Diabetes, glycemic control, and risk of hospitalisation with pneumonia: a population-based case control study. Diabetes Care 31(8):1541–1545PubMedCentralPubMedCrossRefGoogle Scholar
  43. Larsson R, Capili B, Eckert-Norton M, Colagreco JP, Anastasi JK (2006) Disorders of glucose metabolism in the context of human immunodeficiency virus infection. J AANP 18:92–103Google Scholar
  44. Lasky D, Becerra E, Boto W, Otim M, Ntambi J (2002) Obesity and gender differences in the risk of type 2 diabetes mellitus in Uganda. Nutrition 18:417–421PubMedCrossRefGoogle Scholar
  45. Lee CMY, Huxley RR, Wildman RP, Woodward M (2008) Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol 61:646–653PubMedCrossRefGoogle Scholar
  46. Levesque JF, Mukherjee S, Grimard D, Boivin A, Mishra S (2013) Measuring the prevalence of chronic diseases using population surveys by pooling self-reported symptoms, diagnosis and treatments: results from the World Health survey of 2003 for South Asia. Int J Public Health 58:435–447PubMedCrossRefGoogle Scholar
  47. Levitt NS (2008) Diabetes in Africa: epidemiology, management and healthcare challenges. Heart 94:1376–1382PubMedCrossRefGoogle Scholar
  48. Linetzky B, De Maio F, Ferrante D, Konfino J, Boissonnet C (2013) Sex-stratified socio-economic gradients in physical inactivity, obesity, and diabetes: evidence of short term changes in Argentina. Int J Public Health 58:277–284PubMedCrossRefGoogle Scholar
  49. Lopez D, Mathers Colin D et al (2006) Global Burden of Disease and Risk Factors. Oxford University Press and The World Bank, WashingtonCrossRefGoogle Scholar
  50. Madu EC, Richardson KD, Ozigbo OH, Baugh DS (2003) Improving cardiovascular disease prevention and management in Africa: issues to consider for the 21st century. Ethn Dis 13(2 Suppl. 2):S71–S76PubMedGoogle Scholar
  51. Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3:e442PubMedCentralPubMedCrossRefGoogle Scholar
  52. Mbanya JC, Ngogang J, Salah JN, Minkoulou E, Balkau B (1997) Prevalence of NIDDM and impaired glucose tolerance in a rural and urban population in Cameroon. Diabetologia 40:824–829PubMedCrossRefGoogle Scholar
  53. Mbanya JC, Cruickshank JK, Forrester T et al (1999) Standardized comparison of glucose intolerance in west African-origin populations of rural and urban Cameroon, Jamaica, and Caribbean migrants to Britain. Diabetes Care 22:434–440PubMedCrossRefGoogle Scholar
  54. Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST (2010) Diabetes in sub-Saharan Africa. Lancet 375:2254–2266PubMedCrossRefGoogle Scholar
  55. McKinsey Global Institute (2010a) Lions on the move—the progress and potential of African economies. http://www.mckinsey.com/insights/africa/lions_on_the_move.  Accessed 1 July 2014
  56. McKinsey Global Institute (2010b) Closing the R&D gap in African health care. http://www.mckinsey.com/insights/health_systems_and_services/closing_the_r_and_38d_gap_in_african_health_care. Accessed 1 July 2014
  57. McLarty DG, Swai AB, Kitange HM, Masuki G, Mtinangi BL, Kilima PM et al (1989) Prevalence of diabetes and impaired glucose tolerance in rural Tanzania. Lancet 1:871–875PubMedCrossRefGoogle Scholar
  58. Michael C, Edelstein I, Whisson A, MacCullum M, O’Reilly I, Hardcastle A et al (1971) Prevalence of diabetes, glycosuria and related variables among a Cape Coloured population. S Afr Med J 45:795–801 (pmid: 5095432)PubMedGoogle Scholar
  59. Microsoft Office (2012) MetaXL. http://www.epigear.com/index_files/metaxl.html. Accessed 20 May 2014
  60. Ministry of Health and Child Welfare (2009) Zimbabwe National Health Strategy for Zimbabwe 2009–2013: equity and quality in health: a people’s right. MOHCW, ZimbabweGoogle Scholar
  61. Misra A, Khurana L (2008) Obesity and the metabolic syndrome in developing countries. J Clin Endocrinol Metab 93(11 Suppl. 1):s9–s30PubMedCrossRefGoogle Scholar
  62. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med 6:e1000097PubMedCentralPubMedCrossRefGoogle Scholar
  63. Morgan CL, Currie CJ, Peters JR (2000) Relationship between diabetes and mortality: a population study using record linkage. Diabetes Care 23:1103–1107PubMedCrossRefGoogle Scholar
  64. Msamati BC, Igbigbi PS (2000) Anthropometric profile of urban adult black Malawians. East Afr Med J 77:364–368PubMedGoogle Scholar
  65. Mudiayi TK, Onyanga-Omara A, Gelman ML (1997) Trends of morbidity in general medicine at Unired Bulawayo Hospitals, Bulawayo. Cent Afr J Med 43(8):213–219PubMedGoogle Scholar
  66. Mufunda J, Chatora R, Ndanbakuwa Y, Nyarango P, Chitanba J, Kasia A, Sparks (2006) Prevalence of noncommunicable diseases in Zimbabwe: results from analysis of data from the National Central Registry and Urban survey. Ethn Dis 16:718–722PubMedGoogle Scholar
  67. Murithi T, Mawadza A, Institute for Justice and Reconciliation (South Africa) (2011) Zimbabwe in transition: A view from within. Fanele, Auckland Park, South AfricaGoogle Scholar
  68. Naafs B (1985) Pentamidine-induced diabetes mellitus. Trans R Soc Trop Med Hyg 79:16CrossRefGoogle Scholar
  69. Ng SW, Norton EC, Popkin BM (2009) Why have physical activity levels declined among Chinese adults? Findings from the 1991–2006 China Health and Nutrition Surveys. Soc Sci Med 68(7):1305–1314PubMedCentralPubMedCrossRefGoogle Scholar
  70. Popkin BM (2001) The nutrition transition and obesity in the developing world. J Nutr 131(3):871S–873SPubMedGoogle Scholar
  71. Ryan AM, Gee GC, Griffith D (2008) The effects of perceived discrimination on diabetes management. J Health Care Poor Underserved 19(1):149–163PubMedCrossRefGoogle Scholar
  72. Sims M, Diez Roux AV, Boykin S et al (2011) The socioeconomic gradient of diabetes prevalence, awareness, treatment, and control among African Americans in the Jackson Heart Study. Ann Epidemiol 21:892–898PubMedCentralPubMedCrossRefGoogle Scholar
  73. Smith SM, Mensah GA (2003) Population aging and implications for epidemic cardiovascular disease in Sub-Saharan Africa. Ethn Dis 13:S77–S80PubMedGoogle Scholar
  74. Steyn K, Damasceno A (2006) Lifestyle and related risk factors for chronic diseases. In: Jamison DT, Feachem RG, Makgoba MW, et al (eds) Disease and mortality in SUB-Saharan Africa, 2nd edition. World Bank, Washington. Chapter 18. http://www.ncbi.nlm.nih.gov/books/NBK2290/
  75. Swai ABM, Lutale J, McLarty DG (1990) Diabetes in tropical Africa: a prospectivestudy 1981–7. Br Med J 300:1103–1106CrossRefGoogle Scholar
  76. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (1997) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20:1183–1197CrossRefGoogle Scholar
  77. Townsend L, Flisher AJ, Gilreath T, King G (2006) A systematic literature review of tobacco use among adults 15 years and older in sub-Saharan Africa. Drug Alcohol Depend 84:14–27PubMedCrossRefGoogle Scholar
  78. Tuei VC, Maiyoh GK, Ha CE (2010) Type 2 diabetes mellitus and obesity in sub-Saharan Africa. Diabetes Metab Res Rev 26(6):433–445PubMedCrossRefGoogle Scholar
  79. United Nations Population Fund (2007) State of world population 2007: unleashing the potential of urban growth. http://www.unfpa.org/swp/2007/english/introduction.html. Accessed 18 June 2014
  80. Virtanen SM, Aro A (1994) Dietary factors in the aetiology of diabetes. Ann Med 26:469–478PubMedCrossRefGoogle Scholar
  81. Whiting DR, Hayes L, Unwin NC (2003) Challenges to Health Care for Diabetes in Africa. J Cardiovasc Risk 10:103–110PubMedCrossRefGoogle Scholar
  82. Wicks ACB, Jones JJ (1974) Diabetes mellitus in Rhodesia: a comparative study. Postgrad Med J 50:659–663PubMedCentralPubMedCrossRefGoogle Scholar
  83. Wicks ACB, Castle WM, Gelfand M (1973) Effect of time on the prevalence of diabetes in the urban African of Rhodesia. Diabetes 22(10):733–737PubMedCrossRefGoogle Scholar
  84. Wong MCS, Leung MCM, Lo SV, Tsang CSH, Griffiths SM (2013) The rising tide of diabetes mellitus in a Chinese population: a population-based household survey on 121,895 persons. Int J Public Health 58:269–276PubMedCrossRefGoogle Scholar
  85. World Health Organization (1999) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. WHO/NCD/NCS/99.2, GenevaGoogle Scholar
  86. World Health Organization (2014) Global Health Observatory Data Repository, Life Expectancy Data. http://apps.who.int/gho/data/view.main.690?lang=en. Accessed 20 June 2014
  87. Zhang PZX, Brown JB, Vistisen D, Sicree RA, Shaw J, Nichols GA (2009) Economic Impact of Diabetes. In Diabetes Atlas, IDF. 4th edition. International Diabetes Federation, BrusselsGoogle Scholar
  88. Zhang P, Zhang X, Brown J et al (2010) Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract 87:293–301PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2014

Authors and Affiliations

  • Mutsa Mutowo
    • 1
    Email author
  • Usha Gowda
    • 1
  • John Chamunorwa Mangwiro
    • 3
  • Paula Lorgelly
    • 2
  • Alice Owen
    • 1
  • Andre Renzaho
    • 1
  1. 1.School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  2. 2.Centre for Health EconomicsMonash UniversityClaytonAustralia
  3. 3.Zimbabwe Diabetes AssociationHarareZimbabwe

Personalised recommendations