1) There is an emerging global epidemic of diabetes that can be traced back to rapid increases in overweight, obesity and physical inactivity.
2) Total deaths from diabetes are projected to rise by more than 50% in the next 10 years. Most notably, they are projected to increase by over 80% in upper-middle income countries.
3) Type 1 diabetes is characterized by a lack of insulin production and type 2 diabetes results from the body’s ineffective use of insulin.
4) Type 2 diabetes is much more common than type 1 diabetes, and accounts for around 90% of all diabetes worldwide.
5) Reports of type 2 diabetes in children – previously rare – have increased worldwide. In some countries, it accounts for almost half of newly diagnosed cases in children and adolescents.
6) A third type of diabetes is gestational diabetes. This type is characterized by hyperglycaemia, or raised blood sugar, which is first recognized during pregnancy.
7) In 2005, 1.1 million people died from diabetes. The full impact is much larger, because although people may live for years with diabetes, their cause of death is often recorded as heart diseases or kidney failure.
8) 80% of diabetes deaths are now occurring in low- and middle-income countries.
9) Lack of awareness about diabetes, combined with insufficient access to health services, can lead to complications such as blindness, amputation and kidney failure.
10) Diabetes can be prevented. Thirty minutes of moderate-intensity physical activity on most days and a healthy diet can drastically reduce the risk of developing type 2 diabetes.
Image and Text Credit to World Health Organization; for more info visit here
Since our last meeting with Omolade our relationship has improved drastically, with her mom attestating to the tremendous changes and her improved attitude to health.
So we asked her to reflect on how it has been to date (Her Journey so far) and she dropped us this letter.
MY MEANING OF DIABETES AND MY PERSONAL EXPERIENCE
Diabetes to me is a disease that does not enable my body to provide insulin and does not enable my body to store glucose to glucogen Or A non-communicable disease that can only be transferred through traits or heredity.
MY BRIEF EXPERIENCE OF THE DIABETES DISEASE
On the 13th of august 2012 I realised I am diabetic but because it was new to me and due to my worries all the time i am always saying that there is someone behind my condition and I am always putting myself into crisis, scared, thinking, crying and always running away from people.
When I met My Clinicians and the NGDOC Team this year, they explained a lot to me that many people around the both whites and blacks have diabetes and are living well so I need not to put myself into more crisis.
They said by taking my insulin regularly I will be preventing a lot of problems for myself and my family.
I now have become shy and so happy when I saw people from all over the world on the system, in the books and mobile phone. I realise I need to cope with my diabetes and leave the rest to God Almighty to take control of all.
I have hence begun to rejoice with all the choices of mine, thanks to my doctors and the NGDOC team.
You can read our previous post on omolade here
If you know any Type 1CWD please contact us
We wish to thank the Paediatric Endocrinology Department of the Olabisi Onabanjo University Teaching Hospital under the supervision of Dr Mrs Fetuga (Consultant Paediatric Endocrinologist) for connecting us with Omolade.
DIABETIC EXPERIENCE: NASIRU’S NINE YEARS SECRET AFFAIR
Nasiru’s experience is a certain secret affair that is not known to most people that he has come across at work, school and the neighborhood etc . However, this year, the international diabetes awareness period coincided with his nine years of secret affair with diabetes mellitus and this prompted him to write us this piece on his personal experience.
His early life could be described as very relatively healthy one with little visitations to the hospital, all childhood ailments were treated with over the counter drugs and “epa-ijebu” (a herbal antibiotic) as he called it.
He wrote his final university examination in August 2004 with a heart full of joy and hope of what future holds. He left campus for the National Youth Service Corp (a compulsory 1 year national program for fresh graduates to facilitate cross-cultural mixture). It was early in the month of September 2004 that he started observing some strange changes in his body system.
He observed his excessive crave for water to the extent of drinking water meant for ablution in the mosque whenever he went for prayers, and he would always have water beside him at night. His second observation was frequent urination during the day and night. He initially did not give any serious consideration to these observations simply because he always regarded himself a lover of water.
His third observation was actually made by people around, asking if there was anything wrong with his health because he was losing weight and he always responded to being alright. The curiosity of people about his health prompted him to make consultation.
His first place of consultation was a certain patent medicine store, where he was diagnosed wrongly of having worms (due to his loss of weight). After failed attempt, he visited a “doctor” in his neighborhood that he later discovered to be a quack. After series of injection shots by the “doctor” and with no knowledge of diagnosis by Nasiru, he told the “doctor” he was getting better and the “doctor” then stopped the injection and switched to oral drugs. Consequently his condition became worse again.
This time Nasiru had to visit Apapa Health Centre on the 25th October 2004 where he met a doctor who asked him to go for a test, precisely blood sugar test and urinalysis, in the laboratory. Subsequently, he was diagnosed of Diabetes Mellitus and frightened Nasiru was counselled on the care and management of Diabetes.
For Nasiru the experience of living with diabetes, especially insulin dependent diabetes, is sometimes psychologically awful. The first challenge arises when in the company of others and you’re required to reject some kinds of food without letting them know the reason. Regular injection is another challenge faced by Nasiru.
Some experiences of Hypo by Nasiru have resulted in him passing out in his room and sometimes at public places. He had to be re-deployed from the northern part of Nigeria to the south west on his request due to diabetes and the need for adequate care close to his family.
His non disclosure according to Nasiru are due to some reasons. There are some forms of myths or advice gotten from ignorant people about diabetes. For instance, he had been told once that diabetes is sometime spiritually casted on people. Also, a colleague advised him to come to church where he will be totally healed.
Another person also encouraged him to stop insulin as she had somebody that would give him an herbal medicine that will cure it, though she never brought anything.
When Nasiru volunteered to share his experience with us we were thrilled as it is a common phenomenon for people living with diabetes especially in Africa not to want to share their experience for fear of social stigmatization.
According to Nasiru this medium is also necessary to intimate government on the need to provide assistance to diabetic people, especially the young ones that are insulin dependent, by ensuring easy accessibility of medications. “I am always sad whenever I meet diabetic people from other countries, for instance Europe, describing how insulin is made easily available to them free of charge by their governments” – Nasiru
We at The Nigeria Diabetes Online Community are committed towards advocating for the about 5 million already diagnosed of Diabetes Mellitus in Nigeria and also through adequate education prevent the surge of Diabetes in Nigeria.
Please do feel free to mail your experiences to us (email@example.com) in order to share and build a great and empowered community of people living with diabetes.
Lastly, we want to implore the federal government to kindly live up to the free insulin declaration. Nasiru can be reached via his email: firstname.lastname@example.org
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person’s mind and body, usually meaning to be free from illness, injury or pain.
The World Health Organization (WHO) defined health in its broader sense in 1946 as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Health is of major concern to nations of the world. WHO and the member states strive hard to ensure this is achieved across board. A major WHO goal is to improve equity in health, reduce health risks, promote healthy lifestyles and settings, and respond to the underlying determinants of health.
This among others are the goals expected to be followed by member states and organizations.
A meeting with Prof. Cees Th. Smit Sibinga was a real eye opener as we discussed the problems faced by developing nations and africa as a continent.
Prof Sibinga is a WHO expert involved in international short term consulting missions; medium and long term projects focused on the development of Transfusion Medicine in economically restricted countries in Asia, Eastern Europe, Central Asia, Africa, Western Pacific and the Middle East.
A lot has been invested in terms of resource on health in the continent with little impact and Africa being a toast of many investors has to be self motivated towards adequate care especially in health for her citizens.
Our focus of discussion centered around blood transfusion practices in Africa (His area of expertise) and diabetes (my passion ),we realized that so much needs to be done to step our health practices up to conform to international standards especially in Nigeria.
Nigeria is a large country with great prospect and promising health policies but implementation has been a major hindrance to quality health care delivery.
The World Health Organization’s activities deals directly with member nations and organizations hence whatever agreement signed at the World Health Assembly is binding on all member nations and as such must be implemented, likewise any feedback given by the member nations must reflect the true state of health affairs in the member country as that would be the blue print guiding WHO activity in such country.
So what happens inbetween agreements, implementation and feedback: The Politics of Health;
So many questions ranging from if the Member nations especially developing countries abide by the agreements signed at the World Health Assembly; if they give the true state of health in their respective countries as a feedback to WHO?
These questions are endless but from the few minutes interaction with Prof Sibinga i realized that the problems are not as cumbersome as thought and the solution is within reach.
Prof Sibinga said: “When you vote, you exercise your authority not just to choose your favorite candidate to govern your affairs for a particular period but also to represent your interest within that same period’
So, it is not just in us as individuals or as a nation to vote for personalities we love or adore but we also need to vote for policies and adequate representation especially in health care delivery across board.
It is imperative to note that once we are misrepresented at the international level as against the true state of health affairs or when policies end only on the papers then we need not scream isolation by the international community when in real truth the world can only help those willing to help themselves.
Interesting to note is that topmost on the agenda at this year’s world health assembly is Non Communicable diseases (click here) among which is Diabetes which has affected over 347million people worldwide (about 50% of those with diabetes are yet to be diagnosed; More than 80% of diabetes deaths occur in low- and middle-income countries; WHO projects that diabetes will be the 7th leading cause of death in 2030)
With all these knowledge at our fingertips it is important for all stake holders and health advocates to rise to the challenge of ensuring that proper health care policies and delivery are achieved at all levels of governance.
This is a clarion call to all health advocates especially at community level to also encourage the people to in addition to voting for personalities also consider policies that will make their health better and more secured.
We believe all governmental administrative structures from the community to national heads must be filled with people who stand for policies that will better the health and lives of the people
With this evolutionary mind set in view and in place we believe the African health care system will become more proactive.
HEALTHY HABITS TURNED LIFESTYLE: LESSONS TO BE LEARNT FROM GRONINGEN, THE NETHERLANDS
Groningen is the main municipality as well as the capital city of the eponymous province in The Netherlands.
With a population of around 190,000, it is the largest city in the north of the Netherlands. An ancient city, Groningen was the regional power of the northern Netherlands, a semi-independent city-state and member of the German Hanseatic League. Groningen is a university city: the University of Groningen and Hanze University of Applied Sciences each have about 25,000 students.
With a background knowledge of Diabetes mellitus, or simply diabetes, being a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced.
There are 3 main classifications of Diabetes Mellitus but for the purpose of this article we would major on Type 2 DM which makes up about 90% of cases of diabetes with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.
Obesity is thought to be the primary cause of type 2 diabetes in people who are genetically predisposed to the disease. Type 2 diabetes is initially managed by increasing exercise and dietary modification.
Rates of type 2 diabetes have increased markedly over the last 50 years in parallel with obesity: As of 2010 there are approximately 285 million people with the disease compared to around 30 million in 1985.
Long-term complications from high blood sugar can include heart disease, strokes, diabetic retinopathy where eyesight is affected, kidney failure which may require dialysis, and poor circulation of limbs leading to amputations. The acute complication of ketoacidosis, a feature of type 1 diabetes, is uncommon. However, non-ketotic hyperosmolar coma may occur
But aproper diet and exercise are the foundations of diabetic care, with a greater amount of exercise yielding better results. A diabetic diet that promotes weight loss is important. Aerobic exercise leads to a decrease in HbA1c and improved insulin sensitivity. Resistance training is also useful and the combination of both types of exercise may be most effective.
Culturally appropriate education may help people with type 2 diabetes control their blood sugar levels, and also prevent type 2 diabetes.
Groningen has been called the “World Cycling City”, since 57% of journeys within the city are made by bicycle. The city is very much adapted to the wishes of those who want to get around without a car, as it has an extensive network of segregated cycle-paths, good public transport, and a large pedestrianized zone in the city centre.
The transformation of the historic centre into a pedestrian priority zone enables and invites walking and biking by making these active modes of transport comfortable, safe and enjoyable. These attributes are accomplished by applying the principle of “filtered permeability”.
It means that the network configuration favours active transportation and selectively, “filters out” the car by reducing the number of streets that run through the centre. While certain streets are discontinuous for cars, they connect to a network of pedestrian and bike paths which permeate the entire centre. In addition, these paths go through public squares and open spaces increasing the enjoyment of the trip.
The logic of filtering a mode of transport is fully expressed in a comprehensive model for laying out neighbourhoods and districts – the Fused Grid.
In the Italian TV programme of investigative journalism “Report” appeared a short film, considering the use of bikes in Groningen a good practice to emulate in Italy.
My experience at The International Student Congress of (bio)medical sciences in Groningen is a typical example of a healthy habit turned Lifestyle, I was thrilled by the fact that a city can turn cycling a good means of daily exercise into a lifestyle and I was thrilled seeing kids cycling around.
Nigerian Medical Students at the ISCOMS (From Ukraine and Nigeria)
I believe other countries like Nigeria can emulate this great healthy habit, the hot West African weather might not allow for cycling all day long but evenings are great time to cycle. So in the future, road constructions should have bicycle lanes; there should be subsidized rates on bicycles and importation of bicycles to Nigeria must be encouraged.
All these efforts will go a long way in creating healthy lifestyles for Nigerians thereby preventing and managing type 2 diabetes among Nigerians. Also I will suggest the Nigerian Government should encourage student research exchanges through adequate funding and motivation as this is instrumental to economic and academic development, as this exposure is one not easily forgotten.
On the 28th of April The Nigeria Diabetes Online Community and Diabeticare International in their usual style had a 1hour tweetchat that aimed at discussing the way forward in diabetes mellitus care in Nigeria.
There has been a progressive increase in the prevalence of diabetes mellitus in Nigeria and the burden is expected to increase even more. Considering this fact there is an urgent need to examine our healthcare systems, work on existing programmes for persons with diabetes and effectively implement a process that facilitates accessibility to such.
This discussion that pulled interested participants from Nigeria and beyond was aimed at getting opinions and suggestions that are people oriented towards forging ahead in our clamour for quality health care services and delivery in Nigeria.
Five questions were thrown in the chat. Responses are summarized
1st QUESTION: On a scale of 1-10, how would you rate DM (Diabetes Mellitus) care in Nigeria and why?
Diabetic care in Nigeria is very poor because it is reactive rather than proactive. Prevention should be a key strategy
2nd QUESTION: how do you think NGOs can help with DM care and T2 (type2) DM prevention in your community?
Access to information & education is key. People can be empowered to be advocates for change in their own #diabetes communities
Education is key; insulin without education is like a car without a steering wheel and of course access to supplies is essential: affordability & availability are major issues in many countries, especially rural areas.
NGOs have more ability to influence education in a sustainable fashion and can help through health education programmes and the organisation of peer support groups for affected individuals
Crucial programs need to consider local customs & culture – involving #youth is essential!
Founders of t1 international and 100 campaign (international NGOs dedicated to T1DM CARE and promotion of access to insulin by all by 2022) our partners find it hard to believe that insulin is still so expensive – they believe insulin should be a human right.
3rd QUESTION: How can Health care providers enhance adequate support for people with D (diabetes)?
There should be more awareness and education provided in the communities
Pressure needs to be put on the pharmaceutical Companies – Diabetes is not a money making scheme
Connecting them to others. Empowering people to realize they can live a normal life, without limitations
By working together we can achieve this! We can learn from other movements. Strength in numbers & empowered groups
Individualising the treatment is key. Proper education of patients with Diabetes and making them partners in their own treatment
4th QUESTION: What role can the food, drinks and beverage industry play in DM care and prevention?
The food, drink and beverage industries need to be properly regulated!
Remember type1 is about a lack of insulin nothing to do with food types – watching food groups helps maintain better blood glucose control
Although food, drink & beverage industries do play a role in the lifestyles of people (& co morbidities), more sugar free alternatives of common beverages should be made available
5th QUESTION: In what ways can ‘WE’ increase community awareness on a large scale?
TV campaigns or radio jingles on Diabetes happen to be important means of mass education and this can be linked to a local community (health/ fitness) prevention event.
Empowering local role models with diabetes.
recognizing the basic symptoms and encouraging a healthy lifestyle for all
All forms of media (TV, Radio, Print, and Social) will help with the awareness. Currently very little is being done through them.
In lieu of this we at the Nigeria Diabetes Online Community hope to partner with individuals and organizations who see a need to propose and effect change in the Nigeria Healthcare system towards adequate Diabetes Care.
Thanks to all our Nigerian participants and our international friends who graced the meeting and also participated through great ideas and suggestions.
NGDOC’S HALIMAH BECOMES LEAP AFRICA SOCIAL INNOVATORS’ FELLOW
We are excited to have our own Halimah Odewale as one of Leap Africa’s 20 Outstanding Social Innovators and Fellows in Nigeria.
Since its inception in May 2002, LEAP Africa has successfully launched programmes for entrepreneurs and youth in twenty six cities including the FCT in collaboration with non-profit organizations and leading financial institutions.
LEAP offers a range of training programmes for youth, business owners, social entrepreneurs, managers and public officers.
Areas of training include life and employability skills development, personal and organizational leadership, governance, business ethics, succession planning and talent management.
These programmes have enhanced the life and leadership skills of over 30,000 youth, business owners and social entrepreneurs.
LEAP is committed to equipping these critical stakeholders with the skills, tools and support that they require to serve as change agents.
In turn, many of LEAP’s beneficiaries have initiated high-impact change projects in their companies and communities.
LEAP programmes include business and youth leadership trainings for entrepreneurs and youth across Nigeria and Africa. Youth Programmes includes:
Social Innovators Programme and Awards (Annual Nigeria Youth Leadership Awards)
Youth Leadership Programme
Leadership, Ethics and Civics Programme
Leadership for Health
We are excited to be recognized by LEAP as Social Innovators to be looked out for.
Omolade is a 13 year old Nigerian Type 1 DM.
For her having Diabetes Mellitus wasn’t something she bargained for. Meeting with her was facilitated through our collaborative partnership with the Paediatric endocrinology department of the Olabisi Onabanjo University Teaching Hospital (O.O.U.T.H), Sagamu, Ogun State, Nigeria.
Dr. Mrs Fetuga (Consultant Peadiatric Endocrinologist and Omolade during one of her clinic sessions)
Diabetes mellitus type 1 (also known as type 1 diabetes, or T1DM; formerly insulin dependent diabetes or juvenile diabetes) is a form of diabetes mellitus that results from autoimmune destruction of insulin-producing beta cells of the pancreas. The subsequent lack of insulin leads to increased blood and urine glucose.
The classical symptoms are frequent urination, increased thirst, increased hunger, and weight loss. (source wikipedia)
Tears of joy flowed through her eyes as she went through our album of PWDs all over the world who identifies with her, understands how she feels and sees her as family.
Omolade is a girl filled with bitterness wondering why God had given her a disease she has to live with forever despite adequate explanation and support from her HCP.
Her hope was re-kindled knowing and practically seeing that she is not alone and she has thousands of children like her all over the world with T1DM, including adults.
This gives us an idea of a need for peer support for T1 PWDs in Nigeria where everyone can relate, interact and socialize.
Speaking with her mom about the financial implication on the family, she explains she spends N1,400 ($9) per vial and omolade uses 6 vials in a month making a total of ($54); this excludes the cost of glucometer and consumables.
This cost for a low income family in a developing country is burdensome and we aim through our partners to make this available thereby putting a smile on Omolara’s face and that of the family.
We have been in constant touch since our meeting on the 4th of April and we have seen the joy associated with having a family united by D.
We wish to use this medium to appreciate the Peadiatric Endocrinology unit of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria for their support.
For every Nigerian T1DM Child we are committed to giving them the support they deserve.
Here’s a call to HCPs, Health Care Givers, Diabetes Advocates and PWDs to identify with T1 children towards giving them the emotional support needed to encourage and motivate them towards a proper self management of D.
Do you know any Type 1 Nigerian Child please feel free to inform us.
According to the international Diabetes Federation diabetic Atlas; Diabetes Mellitus is one of the most common non-communicable diseases (N.C.D) globally. D.M, is the fourth leading cause of death in most high-income countries and now there is substantial evidence showing that it is epidemic in many economically developing and newly industrialized countries.
Africa, a multicultural, religious and ethnically diverse continent had traditionally been dominated by infectious diseases but with rapid urbanization, NCD’s are quickly becoming a priority for health in this continent; with an estimate of about 14.7 million Adults being diabetic in 2011 and a projection of 28.0 million by year 2030.
According to I.D.F, financial estimate of Africa indicate that at least USD2.8billion was spent on health care due to diabetes alone in 2011 and this is expected to rise by 61% in 2030. It is however imperative, based on the facts above as health care givers and stakeholders to firstly understudy Africa with its peculiarities and strategize a befitting and appropriate health care system that put into consideration and accommodates the African mindset.
This health care system must understand Afric’s multicultural settings,religious inclinations and embrace its ethnic diversity.
FACTORS AFFECTING DIABETIC CARE AND POSSIBLE SOLUTIONS
Africa, a developing continent is characterized by multiple factors that has plunged the continent into an era of economic and social setbacks and this has slowed down the rate of health care delivery in the continent. Factors influencing African health care delivery noteworthy include:
Vast majority of Africans anchor their belief to A Supreme Being who is held in the highest esteem with instructions and guidance being handed over through HIS representatives to the followers. These representatives are called clergy. African religious setting is multifaceted and has been a great influence on lifestyle and philosophy.
Some believe diseases and ailments serve as a punishment for wrongdoing or an attack. The role of religion in diabetic care cannot and must not be underestimated as it plays a major role in the attitude of individuals and the community to diabetic care. In view of this, community diabetology should be encouraged with individual communities coming up with programs that put into consideration religious beliefs perculiar to such community. Diabetic education and enlightenment should also be integrated into all religious institutions.
According to UNESCO Africa fact sheet: 176 million Adults are unable to read to write. 47million youth (age 15-24) are illiterates. 21millions adolescents are out of school and 32 million primary aged children are not in school. The fact above reflects a continent with poor educational foundation for both the adults and the youths (future leaders).
Education is paramount to information dissemination and economic Growth International design of diabetic care and education should be revisited with the inclusion of more flexible and grass root friendly Programs. To an average uneducated African, “the absence of disease is Health” as against the W.H.O Definition of Health and this mentality coupled with cultural and religious belief system on disease affect preventive medicine in Africa. To a large extent, people don’t tend to complain until they start noticing complications; this added to the silent nature of D.M results in the highly complicated D.M found at hospitals.
African culture is varied and diverse. With the introduction of westernization, Africa’s age long culture and traditions are being substituted for western styles. This with urbanization has to a greater extent made Diabetic Care progressive in Africa i.e. through the media, internet, community research and community screening. In light of these remarkable progress; styles, trends and culture that promotes preventive care in diabetic health care should be considered in Africa
According to a UN report- Half of the population of Africa lives below a dollar a day. 32 of the world’s 38 heavily indebted poor countries are in Africa (World Bank). Slums are homes to about 72% of urban citizens.
These alarming facts reflects a continent where half of its population can’t boast of good feeding habits, good social status and most importantly access to quality health. Procurement of drugs and the ability to afford healthy diets are difficult by people who live below a dollar a day. Hence, diabetic care should involve Philanthropists, Non-Governmental organizations, Societies, Governments and pharmaceutical companies who through serious effort and commitment would empower the continent economically.
Also, I.D.F through its national bodies in Africa and affiliates should engage government into subsidizing drugs to make them affordable, available and extremely cheap such that majority of the African populace can have access to it and afford it. This will make life easier for those suffering extreme hardship in Africa
Finally, it is imperative I point our attention to a silent but serious issue in Africa: Medical ethics and trado medical ethics. Africa, unlike many developed continents where rules and regulations guide healthcare delivery system is faced with a challenge.
The trado medicals (groups of people that use herbs in treating medical conditions) are generally not well structured and not aligned with the medical professionals.
This has for a long time been a major issue of contention with people being deceived in the ability of a single drug to cure all ailments in existence. ‘Gbogbonise’ – A drug for all ailments as it is called, has been largely marketed and sold amongst the uneducated in the community, with even a small fragment of the educated patronising them giving false hopes of a permanent cure to D.M and this has accounted for high percentage of late presentation at the hospitals.
To forestall these activities, it is important to involve, train, and educate the tradomedicals on diabetic care and this I strongly believe, will go a long way in stopping the menace constituted by late presentations at clinics. In addition, a structure can be put in place by the African government and leaders for the tradomedicals which will spell out the ethics of their profession and limit the unprofessionalism demonstrated in the community.
Various Tradomedical Schemes At Marketing Drugs in Nigeria
In conclusion, the peculiarity of the African continent requires calls for a more radical and strategic approach in diabetic care with health care givers, researchers, government, and NGO’s understanding the challenges posed by the factors and putting these into consideration in developing a plan in diabetic health care delivery for the continent.