BACKGROUND: Although the large majority of persons with diabetes and other non-communicable diseases (NCDs) lives and
dies in low- and middle-income countries, the prevention and treatment of diabetes and other NCDs is widely neglected in
these areas. A contributing reason may be that, unlike the impacts of acute and communicable diseases, the demands on
resources imposed by diabetes is not superficially obvious, and studies capable of detecting these impacts have not be
METHODS: To ascertain recent use of medical services and medicines and other information about the impact of ill-health,
we in 2008–2009 conducted structured, personal interviews with 1,780 persons with diagnosed diabetes (DMs) and 1,770
matched comparison subjects (MCs) without diabetes in Cameroon, Mali, Tanzania and South Africa. We sampled DMs from
diabetes registries and, in Cameroon and South Africa, from attendees at outpatient diabetes clinics. To recruit MCs, we
asked subjects with diabetes to identify five persons living nearest to them who were of the same sex and approximate age.
We estimated diabetes impact on medical services use by calculating ratios and differences between DMs and MCs, testing
for statistical significance using two-stage multivariable hurdle models.
FINDINGS: DMs consumed 12.95 times more days of inpatient treatment, 7.54 times more outpatient visits, and 5.61 times
more medications than MCs (all p,0.001). DMs used an estimated 3.44 inpatient days per person per year, made 10.72
outpatient visits per person per year (excluding traditional healers), and were taking an average of 2.49 prescribed
medicines when interviewed.
CONCLUSIONS: In Sub-Saharan Africa, the relative incremental use of medical care and medicines associated with diagnosed
diabetes is much greater than in industrialized countries and in China. Published calculations of the health-system impact of
diabetes in Africa are dramatic underestimates. Although non-communicable diseases like diabetes are commonly thought
to be minor problems for health systems and patients in Africa, our data demonstrate the opposite.