World Diabetes Day in Kumasi, Ghana: A view from the frontlines

Between 1980 and 2014, the number of people with diabetes around the world nearly quadrupled, and the prevalence of the disease in middle-and low-income countries is now growing faster than in the developed world. A major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation, diabetes hits women especially hard.

This year, World Diabetes Day on November 14th focuses on “Women and Diabetes,” highlighting the fact that diabetes now takes the lives of about two million women a year.

More than 199 million women have diabetes, and health experts predict a 57 percent increase within 23 years. Worse still, two out of every five women with diabetes are of reproductive age, about 60 million women worldwide. Women with type 1 diabetes face a greatly increased risk of early miscarriage or of giving birth to a malformed baby.

At WomenStrong International, we see what these numbers look like on the ground — the true impact of diabetes on individual women facing a devastating disease without access to care or money for monitoring or treatment.

No one is more familiar with the problem than Abenaa Akuamoa-Boateng, executive director of WomenStrong’s Consortium member in Kumasi, Ghana, Women’s Health to Wealth. For the past three years, WHW has been testing for diabetes as part of WomenStrong’s Mobile Women’s Health Clinic services, a model for last-mile health care. These mobile services are anchored by a permanent clinic in the midst of the city’s vibrant Bantama Market set up to provide care for the hardworking but impoverished market women. Through these clinics and Abenaa’s efforts, WHW is on the forefront of diabetes diagnostics in a low-resource setting.

Abenaa says that in her lifetime she has witnessed the dramatic spread of disease. “When I was a girl,” she says, “diabetes was known as the disease of the affluent coastal tribes in Ghana, who were often obese and lived a life of ease, doing very little manual work.” Elsewhere in her country, most people farmed and so were physically active, eating a diet dominated by fruits and vegetables.

Today, Ghana is one of 73 countries where diabetes has doubled since 1980. Over this same time period, Ghana’s obesity rate has skyrocketed 650 percent, from less than two percent of the population to 13.6 percent, according to the Institute for Health Metrics and Evaluation. Abenaa has seen firsthand what The New York Times wrote about last September, in an article on fast food consumption in the developing world, a major contributor to obesity and diabetes.

“Fast food restaurants seem to be popping up in Ghana by the minute,” says Abenaa, who worked for 21 years as a senior nutritionist within Ghana’s national Ministry of Health and for 18 years headed Nutrition Services for Ashanti, Ghana’s most populous region.

Ghanaians see the eating of fast food as a sign of affluence. Sweeping changes in lifestyle due to urbanization also have impacted health, and Abenaa notes that her countrymen now consume large amounts of sugary drinks and alcohol, less fresh fruit and vegetables, and more empty calories.

Abenaa points to data indicating that women are twice as likely as men to suffer from diabetes. Among the women she sees, the disease is often first diagnosed when a woman becomes pregnant, making the pregnancy high-risk.

For many other women in Kumasi, diagnosis isn’t made until they’re middle aged because of lack of access to basic health care. Diagnosis takes place only after they have exhibited debilitating or life-threatening symptoms, and by then it harder to control the disease and its progression. Few women seen in Abenaa’s clinics can afford the ongoing cost of a pack of 50 test strips for the Ultra mini Onetouch® glucometer, which cost 110 GHs ($25 U.S.). For those with few resources, early detection saves lives.

The International Diabetes Federation recommends screening for diabetes as part of integrated primary healthcare services, which WHW has been doing for some years. Diabetes testing is done alongside a check-up on height and weight, BMI, and blood pressure. Patients identified as pre-diabetic receive counseling on nutrition, exercise, and lifestyle changes that can reduce their risk. Monthly specialist clinics run at the Bantama Market location also offer more holistic diabetes care, dealing with problems of feet, eyes, and drug compliance.

WHW has developed a high level of expertise in diabetes diagnostics through its work in both the permanent and mobile women’s clinics. The free screenings are conducted by trained nurses and by Abenaa herself, at a cost of 6 GHs ($1.40 U.S.) per patient. Testing takes about a minute, and women leave their appointment with their results.

Women testing with elevated blood glucose levels are either sent to their doctor, if they have National Health Insurance, or are seen at WHW’s own clinic. WHW does monthly follow-up calls, to check on drug compliance and to answer questions.

But Abenaa knows that the solution to the diabetes epidemic lies elsewhere. Solving this public health crisis requires educating adolescent girls. Through WomenStrong’s Girls’ Clubs operated by WHW, nearly 2,000 girls are taught about healthful eating, exercise, and healthy lifestyles. IDF says 70 percent of Type 2 diabetes cases could be prevented through lifestyle change, and these girls are learning how to live. The girls in the Clubs today will someday be mothers themselves, the gatekeepers to the longterm health of their children. They hold the key to diabetes prevention — within their own households and beyond. “Healthy eating habits and exercise should start at kindergarten,” Abenaa says.

WHW receives substantial support from WomenStrong and Americares, which generously provides glucometers, test strips, lancets, alcohol wipes, and gloves. Glucometers from Americares are also distributed by WHW to the Komfo Anokye Teaching Hospital and 11 district hospitals, to be used in weekly diabetes clinics.

“People in Ghana need to understand that food can kill and be armed with the knowledge and skills to avoid unnecessary waste of life,” she says. In Kumasi, Abenaa is leading the battle on the frontlines.