A Systematic Review of Diabetes Risk Environment and Protective Factors in Africa: Implications for International Social Work

Background: As noted by the 2030 Agenda for Sustainable Development, non-communicable diseases like diabetes remain a major threat to the global public health agenda, particularly in low-and-middle-income countries (LMICs). More importantly, the World Health Organization’s (WHO) 2016 Global Report on Diabetes highlights the urgent need for research in regions like Africa wherein diabetes prevalence has more than doubled from 3.1% in 1980 to 7.1% in 2014. Research on diabetes risk environment and protective factors in Africa are urgently needed to identify effective approaches for reducing the burden of diabetes in resource poor settings. Using key social work themes, the aim of this systematic review is to examine risk environment and protective factors associated with diabetes mellitus prevalence and management in Africa.

Methods: We conducted a systematic review of studies published on diabetes in Africa from 2000 to 2015 using PubMed, EMBASE, MEDLINE and Google Scholar. We extracted data based on risk environment (i.e. social situations, structures and places in which risk is produced) and protective (i.e. approaches or interventions shown to be effective in reducing risk) factors. Twenty-five search terms and combinations were used. Using the PRISMA guidelines for systematic reviews, eligible articles focused on environmental factors associated with Type 2 diabetes prevalence, reported successful approaches to Type 2 diabetes management and discussed the implications for Type 2 diabetes prevention in Africa.

Results: Twenty-nine studies were included and focused mostly on either risk environment (n=19) or protective (n=10) factors but none addressed both factors in their analysis. Risk environment factors included: co-morbid mental health disorders; socio-cultural factors associated with individual perceptions of illness; sedentary lifestyles; urbanization and ageing; co-occurrence with communicable diseases such as HIV/AIDS and TB; silos between traditional and Western medicine; access to healthcare; lack of diabetes resources at healthcare clinics; health care professionals untrained in diabetes care and treatment; and limited support for diabetes  at governmental levels. Protective factors included: integrated traditional and western medicine practices; multidisciplinary team of allied health professionals; health promotion with faith-based institutions; diabetes advocacy through self-help groups; and the inclusion of peer supporters for diabetes management at clinics.

Conclusion and implications: The increasing burden of diabetes in the region has linkages to risk factors both exogenous and endogenous to the individual. Additionally, successful examples of diabetes care and treatment in Africa are associated with protective factors that include integrated care models and multidisciplinary teams of allied health professionals such as social workers. Findings suggest that interventions focused on prevention and/ or management must address both diabetes risk and protective factors that have the potential to reduce diabetes burden in resource poor settings throughout Africa. This systematic review highlights the need for more research on diabetes prevention and intervention in Africa in addition to calling attention to the role of international social work in filling this gap.