Abstract
BackgroundThe prevalence of diabetes is increasing in low-and middle- income countries, due to the adoption of a western diet and decreased physical activity. Diabetes is often underdiagnosed, and the management of the disease is resource intensive. In this paper, we examine the burden of diabetes on a rural population in western, Kenya and assess the ability of the health care system to diagnose, manage, and treat diabetes. MethodsWe utilized verbal autopsies from the Kombewa Health and Demographic Surveillance Site in rural western Kenya from 2011-2018 to measure the burden of diabetes among the deceased. We classified deaths as either primarily caused by diabetes according to verbal autopsy or as a death of any cause that reported having a previous diagnosis of diabetes. We also conducted a survey of health facilities to measure the capacity of the health system to prevent, diagnose, and manage diabetes.ResultsFrom 2011-2018, 85 people died with diabetes as the verbal autopsy reported primary cause in the region (1.8% of verbal autopsies). An additional 4.6% of verbal autopsies indicated the deceased had a previous known diagnosis of diabetes. Deaths with diabetes as the primary cause of death increased with age and were more likely among men than women. Of the 23 surveyed health facilities, 26% regularly screened for diabetes and 39% managed diabetes in their patients. We found a lack of screening and resources to consistently treat patients with diabetes. All facilities reported not having the full range of medications indicated by the Kenya Essential Medication List to treat diabetes. ConclusionsOur results suggest that the undetected burden of diabetes may be greater in rural Western Kenya than previous country-wide studies suggested. Additionally, our results demonstrate that most health facilities in the region do not have the capacity to screen for diabetes nor do they have stocks of the medications to treat diabetes. This lack of care results in patients being referred to larger hospitals for treatment. As the prevalence of diabetes increases in Kenya, and other low- and middle-income countries, improved detection and treatment of diabetes will be important to limiting the deleterious chronic damage caused by undiagnosed and uncontrolled diabetes.
Performance of four computer-coded verbal autopsy methods for cause of death assignment compared with physician coding on 24,000 deaths in low- and middle-income countries
