Type 2 diabetes in a Senegalese rural area

INTRODUCTION

The World Health Organization[1] estimates that globally,high blood glucose is the third highest risk factor for premature mortality. According to the International Diabetes Federation[2], some 415 million people worldwide are estimated to have diabetes and about 75% live in low- and middle-income countries. The prevalence of diabetes is increasing rapidly, and it is expected that by 2040 there will be 34.2 million adults in sub-Saharan Africa living with diabetes, more than double the number in 2015[2]. This increasing rate of diabetes mellitus is an additional burden to a region that continues to bear the brunt of communicable diseases such as tuberculosis and malaria[3]. Moreover, Africa Region has the highest proportion of undiagnosed diabetes; over two-thirds(66.7%) of people with diabetes are unaware they have the disease[2]. The diabetic condition is usually only diagnosed once patients are overtly symptomatic or present complications[4], which leads to increased risks of serious and fatal consequences associated with the progression of the disease.

Diabetes was virtually non-existent in West African populations about three decades ago[5,6]. But today,an estimated 4% of urban West African adults have diabetes[7], and this figure is higher in some countries:7.7% in Ghana[8], 4.2% in Kenya[9], 4% and 7.7% in rural and urban Guinea respectively[10], and 8.8% in Nigeria[11] for example. Among non-modifiable risk factors, age is one of the most important, making the ageing of the sub-Saharan population a major determinant of the global rise in diabetes on the continent[12]. Gender trends, another non-modifiable risk factor, are not clear in Africa[6,7,12]. Genetic susceptibility,family history of diabetes and intrauterine influence are also classified as non-modifiable risk factors for diabetes[12].

Urbanization is known as a major modifiable risk factor for diabetes: Abubakari et al[7] have shown that individuals living in urban areas were over five times more likely to have diabetes than their rural counterparts. The higher diabetes prevalence in urban compared to rural settings is attributable to nutritional and lifestyle changes[12]. Urbanization is then associated with physical inactivity and adiposity, another modifiable risk factors for diabetes. Indeed, several studies have reported the independent association of higher adiposity with diabetes in sub-Saharan Africa[6,9,10,12-14]. Finally,Peer et al[12] have also mentioned that psychosocial stress or depressive syndrome might be considered a potential risk factor for diabetes.

Whereas Senegal is in the top five sub-Saharan African countries in terms of advanced nutritional transition status and dietary composition - which indicates increased risk for non-communicable diseases[15] - few studies have attempted to describe national trends in diabetes. In 1960, Payet et al[16] estimated the prevalence of diabetes in Dakar to be 1.1%. In 2015,the International Diabetes Federation reckoned the prevalence to be 1.8%[2]. In 2009 in Dakar, 17.8% of the population had a fasting blood glucose (FBG) level≥ 110 mg/dL[17]. Information about diabetes prevalence in Senegalese rural areas is scarce. Consequently,the aim of this study is to estimate the prevalence of impaired fasting glucose (IFG) and diabetes in the rural population of Tessekere municipality (Senegal) and to investigate associated risk factors. Tessekere is a rural area populated mainly by nomadic pastoralists,whose culture and economy revolve around two hypotheses are therefore that the intense physical activity, low-fat diets and traditional way of life characterizing Ferlo’s Fulani population would protect them from diabetes, leading to a low prevalence of this disease, and that considering the type of population,the diabetes epidemic is likely to be in the early stages. Emerging risk factors such as depression or stress, identified mainly in developed countries[18,19],will probably not be associated with diabetes in our population.

MATERIALs AND METhODs

Population sample

In order to carry out this study, a comprehensive survey was conducted from February to August 2015 in the municipality of Tessekere (Ferlo region, northern Senegal). In 2014, according to Senegal’s National Agency for Statistics and Demography (ANSD), a total of 8999 individuals aged 20 and over were living in Tessekere municipality[20]. The population sample selected for this study comprised 500 individuals aged 20 and over. The sample was constructed using the combined quota method (cross-section by age and gender) to strive for representativeness of the population of Tessekere aged 20 and over. Data from the ANSD dating from the last census (2013) were used. The quota variables used were gender (male/female) and age (20-29/30-39/40-49/50 and over).

Eight trained investigators (PhD students in Sociology, Medicine and Pharmacy) started out from different points each day to interview individuals in Wolof or Haalpulaar in each camp. Investigators had a certain number of individuals to interview to meet the quotas. Only one person was selected as a respondent in each home. Investigators went to the house, inquired about the inhabitants and then chose the first person they saw who met the characteristics needed for the quotas. In-person interviews were conducted. They ranged from 30 to 45 min, depending on respondent availability and desire to talk. As the objectives of this study include analysis with BMI, pregnant women were withdrawn from the sample, resulting in a sample of 496 individuals.

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