The Rising Burden of Diabetes and Hypertension in Southeast Asian and African Regions: Need for Effective Strategies for Prevention and Control in Primary Health Care Settings
Aim. To review the available literature on burden of diabetes mellitus (DM) and hypertension (HTN) and its coexistence in Southeast Asian (SEA) and the African (AFR) regions and to suggest strategies to improve DM and HTN prevention and control in primary health care (PHC) in the two regions. Methods. A systematic review of the papers published on DM, HTN, and prevention/control of chronic diseases in SEA and AFR regions between 1980 and December 2012 was included. Results. In the year 2011, SEA region had the second largest number of people with DM (71.4 million), while the AFR region had the smallest number (14.7 million). Screening studies identified high proportions (>50%) of individuals with previously undiagnosed HTN and DM in both of the SEA and AFR regions. Studies from both regions have shown that DM and HTN coexist in type 2 DM ranging from 20.6% in India to 78.4% in Thailand in the SEA region and ranging from 9.7% in Nigeria to 70.4% in Morocco in the AFR region. There is evidence that by lifestyle modification both DM and HTN can be prevented. Conclusion. To meet the twin challenge of DM and HTN in developing countries, PHCs will have to be strengthened with a concerted and multipronged effort to provide promotive, preventive, curative, and rehabilitative services. 1. Introduction Diabetes mellitus (DM) and hypertension (HTN) have emerged as major medical and public health issues worldwide, and both are important risk factors for coronary artery disease (CAD), heart failure, and cerebrovascular disease. DM is increasing in epidemic proportions globally. According to the WHO, the prevalence of DM in adults worldwide was estimated to be 4.0% in 1995 and is predicted to rise to 5.4% by the year 2025 such that the number of adults with DM in the world would rise from 135 million in 1995 to 300 million in the year 2025 [1]. The recent Burden of Metabolic Risk Factors of Chronic Diseases Study [2] conducted in 199 countries worldwide to assess the national, regional, and global trends in diabetes reported that the age-standardized adult diabetes prevalence was 9·8% (8.6–11.2) in men and 9.2% (8.0–10.5) in women in 2008, up from 8.3% (6.5–10.4) and 7.5% (5.8–9.6) in 1980. The number of people with diabetes increased from 153 (127–182) million in 1980 to 347 (314–382) million in 2008. The International Diabetes Federation (IDF) has come up with much higher figures in a recent report which estimated that in 2011, 366 million people worldwide had DM and if this trend continues, by 2030, 552 million people, or one in 10 adults, will have DM [3]. In the
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