Lifestyle Modification Campaigns a Prerequisite in the Fight against Diabetes and Hypertension

By Prince Kurupati

The prevalence of diabetes and hypertension on the African continent is quite high. Alarmingly, projections by scientific institutions suggest that the numbers of the affected are set to surge exponentially in the coming years.

The Integrated African Health Observatory (iAHO) together with the World Health Organization (WHO), in 2021, estimated the number of adults (20 – 79 years) living with diabetes globally to be 537 million. Of these, 24 million are in Africa. Ominously, iAHO reports that between 2011 and 2021, the African region recorded a fivefold rise in Type 1 diabetes among children and teenagers below 19 years, with cases surging from four per 1000 children to nearly 20 per 1000.

Looking ahead to the future, iAHO painted a grim picture, projecting that the prevalence of diabetes in Africa will increase by 129%, hence translating to 55 million people living with diabetes by 2045. Several reports that have emerged since 2021 corroborate this. This grim picture, complemented by the devastating effects of the diseases, has led iAHO and WHO to classify them as Africa’s “silent killer” diseases.

Of the cases recorded in Africa, Gafane-Matemane, Ashleigh Craig, and Andre Pascal Kengne state that sub-Saharan Africa is the most affected. The prevalence of hypertension in this region has increased, reaching a high of 48% in 2024. This corroborates the scientifically claimed assertions that the prevalence of both hypertension and diabetes has been increasing more rapidly in low- and middle-income countries compared to high-income countries.

Attributed to be the main causes behind the ever-increasing prevalence of diabetes and hypertension in the sub-Saharan African region are the conscious and unconscious promotion of a sedentary lifestyle through risk factors such as obesity, stress, excessive salt intake, physical inactivity, excessive alcohol intake, and smoking. Adding to this, poor detection as evidenced by iAHO’s conviction that more than half (54%) of people living with diabetes in the African region are undiagnosed.

Moreover, the huge economic burden that the twin diseases impose on African governments is significant. Considering that most governments have budgetary constraints and are still reeling under the effects of the COVID-19 pandemic, it’s a tall task for African governments to expend much resources to combat diabetes and hypertension. As of 2021, WHO reports that Africa had the second lowest diabetes-related expenditure (US $13 billion), accounting for 1% of global diabetes-related expenditure.

In light of the above, especially Africa’s inability to set aside adequate expenditure for diabetes and hypertension, the feasible solution to use in the fight against the ‘silent killer’ diseases, as proposed by WHO and many other health experts, is lifestyle modification of the affected and all those exposed to the twin diseases.

Dr John Henry and several other health experts all agree that changes to patients’ lifestyles are an effective tool to manage hypertension and diabetes. Relying on empirical scientific research, they state that increasing evidence shows that lifestyle changes are effective and practical treatment solutions for diabetes and hypertension patients.

“Hypertension and diabetes are prevalent and costly conditions, and behavioural risk factors contribute significantly to the development of both. There is good evidence that weight loss, increased physical activity, alcohol reduction, and smoking cessation can help treat both hypertension and diabetes. For example, with behavioural support programmes shown to be effective when delivered in a routine care context, it is possible to achieve diabetes remission or have effects large enough to de-escalate medication for hypertension,” writes Dr. Henry et al.

Based on clinical trials, Dr. Henry states that for behavioral support programmes to produce fruitful rewards, there is a need for stationed health experts to embrace and spearhead such programmes at their respective centers. “Moreover, clinical trials show that, when clinicians endorse, offer, and facilitate referrals to these programmes, this is highly acceptable to patients and leads to high uptake,” states Dr. Henry.

The proposed lifestyle modifications based on empirical scientific research include weight reduction, healthy eating, reduced alcohol consumption, regular physical exercise, and quitting smoking.

Apart from just disseminating information about the need to embrace lifestyle modifications for the affected, many health experts say that the success and effectiveness of behavioural support programmes hinge on ‘adherence.' Primary healthcare workers must be at the forefront of all counselling sessions that entail persuading patients with hypertension and diabetes to embrace lifestyle modifications. Moreover, they must also play the key role of enforcing adherence to the prescribed lifestyle modifications.

Recognizing and acknowledging the huge budgetary and human resources constraints that African governments face when it comes to healthcare provision, Nyaradzai Katena et al. in their research paper stated that nonadherence to recommended lifestyle modifications, especially within the Zimbabwean context, is largely necessitated by a lack of support. This lack of support, in turn, emanates from a limited healthcare human resource base. The few healthcare workers available prioritize counselling new patients to embrace lifestyle modifications rather than enforcing adherence to existing patients. In light of this challenge, Nyaradzai Katerina et al. proposed the use of specially trained voluntary community health workers to fill the void left by the absence of qualified healthcare workers.

“However, in resource-limited settings, where there is a shortage of health care workers, effectively counselling patients on the recommended lifestyle modifications poses a challenge. As a result, there is a need to explore other cost-effective strategies to ensure the effective counselling of patients regarding lifestyle modifications. Task-shifting to community health workers has been proven as one such cost-effective and sustainable approach in chronic disease prevention and control, particularly in areas with limited economic and health care resources,” Katena et al stated.