Review PaperSystematic review on the prevalence of diabetes, overweight/obesity and physical inactivity in Ghanaians and Nigerians
Introduction
Globally, the burden of type 2 diabetes is rising fast. The global prevalence of diabetes among adults was estimated at 150 million in 1995, and this is projected to increase to 300 million by 2025.1 Developing countries including sub-Saharan Africa may experience the largest proportional increase in diabetes.2 The International Diabetes Federation has reported that the annual healthcare cost of diabetes globally for adults (20–79 years old) is 153 billion international dollars. This value is expected to increase to 396 billion international dollars by 2025.3 As recently as 30–40 years ago, the prevalence of diabetes in West Africans was considered to be negligible.4, 5, 6, 7 However, it appears that diabetes is rising rapidly in Africa. The International Collaboration Study of Hypertension in Blacks reported a high prevalence of diabetes and its risk factors among people of West African origin living in middle- and high-income countries compared with those living in African countries.8, 9 Such studies signal what is to come in Africa as changes in lifestyle accompany economic progress.10 This study systematically reviewed the prevalence of diabetes, impaired glucose tolerance (IGT) and two modifiable risk factors (obesity/overweight and physical inactivity) in Ghanaians and Nigerians. These two countries were chosen because they are major English-speaking West African countries, and because their people exhibit similar sociodemographic characteristics as well as political and historic backgrounds. As well as its scientific aim, the work was undertaken to help health policy makers to assess the priority of diabetes for future research and service delivery. In fact, a number of related reviews have recognized the need for more research and surveys on this and related subjects in Africa. A key finding of this review was that the limited existing data sources used incomparable and non-standardized methods.
Section snippets
Search strategy for identification of studies
Searches were undertaken using MEDLINE (from 1966 to July 2005) and EMBASE (from 1980 to July 2005) electronic databases to identify defined population-based studies on the prevalence of diabetes, impaired glucose tolerance, overweight/obesity and physical inactivity in Ghanaians and Nigerians using relevant diagnostic criteria.11, 12, 13, 14, 15, 16, 17 To ensure high sensitivity18 when retrieving studies, both subject headings and free text searches were used. Reference lists of all relevant
Description of studies
Fig. 1 shows the QUORUM statement flow diagram for the review. Fifteen studies were excluded (Appendix A) because they did not report prevalence or due to methodological considerations. Table 1, Table 2, Table 3 show the characteristics of included studies for diabetes and IGT,7, 22, 23, 24, 25, 26, 27, 28, 29 overweight/obesity26, 27, 30, 31, 32, 33, 34, 35 and physical inactivity,27, 29, 34, 36 respectively.
Most of the included studies were either community based7, 22, 23, 24, 26, 27, 28, 29,
Principal findings
Diabetes and its risk factors have increased and are now common in urban areas of Ghana and Nigeria. Over 6% of adult Ghanaians (age ⩾25 years) and Nigerians (age ⩾40 years) were diabetic in the year 2000.22, 29 The prevalence of diabetes and IGT were similar for males and females.
Approximately, 20% and 14% of the Ghanaian population were found to be overweight and obese, respectively. Both conditions were more prevalent among females compared with males, and among urban compared with rural
Acknowledgements
The authors acknowledge the contribution of Marshall Dozier (Librarian) in the design of the search strategy. The authors are also grateful to Dr Charles Agyemang of the Department of Health Policy and Management, Erasmus Medical Centre, Netherlands for his role in pointing out some studies. Finally, the authors would like to thank the staff of the Interlibrary Loan Department for their service.
Ethical approval
Not required.
Funding
None declared.
Competing interests
None declared.
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