Surviving ‘sugar’ disease in rural areas

CHIKUMBE —We are trying to stock hospitals with testing kits

When Edda Ngumbo, 42, from Lirangwe in the rural outskirts of Malawi’s commercial capital Blantyre, was diagnosed with Type 2 diabetes, she was left bewildered and in denial.

Edda’s disbelief was rooted in the popular myth that diabetes, or sugar disease as it is widely known in Malawi, is associated with the lifestyle of the affluent classes in the cities.

Having lived nearly all her life in the village where she is a farmer, Edda thought her diagnosis had come about by mistake. In some cases, she suspected the ailment to be some form of punishment from her ancestral spirits. In her village, spirits are known to attack people, and Edda believed her time for atonement had come.


She recalls the symptoms she had been experiencing before the diagnosis.

“I was urinating frequently. I was experiencing excessive thirst even after drinking enough water, fatigue, weight loss, and blurred vision to the extent that one day, I fell as I was coming from the bathroom,” Ngumbo says.

Ngumbo is one of the thousands of people in Malawi who are living in rural areas with diabetes.


But the challenge is that health centres in rural areas are known to be not fully equipped to manage diseases like this. For example, Lirangwe Health Centre where Gumbo accesses treatment has not had testing kits for months now. As such, patients are referred to a private clinic where they pay K500 for the test.

When Gumbo got tested at the private clinic, her sugar levels were above 300 milligrams per decilitre—way above the normal level between 70 and 140 milligrams per decilitre.

“After the test came out, I was referred back to Lirangwe Health Centre to start treatment,” she says.

A health worker at Lirangwe Health Centre, who is not authorised to speak to the media on behalf of the institution, says the health centre run out of testing kits early this year such that it just provides drugs without conducting tests.

On average, according to the health worker, the health centre treats about 150 diabetic and hypertension patients a month.

A study conducted in Mangochi District by the Kamuzu University of Health Sciences (Kuhes) titled ‘The Quality of care of diabetic patients in rural Malawi: A case of Mangochi District’ and published in the Malawi Medical Journal also found that more than half of patients in the district had little or no information about diabetes.

It found that guidelines on diabetes management were not accessible and that there were shortages in medicines and reagents.

Diabetes Association of Malawi president, Clement Mandala, says the association is aware that rural hospitals are facing enormous challenges in dealing with diabetics.

“That is a big problem and about three months ago I went to some hospitals in Kasungu and Ntchisi districts and I found no glucometers. It is saddening that medical personnel administer drugs without measuring one’s blood sugar levels,” he says.

Mandala says he alerted Central Medical Stores Trust (CMST), a body established by the government of Malawi to ensure reliable and continuous access to the highest quality medicines and medical supplies through efficient procurement, warehousing and distribution services.

“CSMT said it was having issues procuring such medical supplies due to forex shortage and assured me that it was sorting out the issue,” he says.

According to Mandala, just like Ngumbo, there are a lot of people in remote areas that know little or nothing at all about diabetes.

He says the association conducts sensitisation campaigns but it is limited to just diabetes clinics in hospitals.

“We have diabetes committees in all district hospitals which are composed of 10 people and are responsible for several issues one of which is raising awareness. All people who come to the hospital are taught about diabetes,” he says.

However, Mandala says the job of creating awareness is quite enormous and challenging for the association to reach everyone in the rural areas.

“We need resources to go to remote areas to raise awareness. At the moment, we raise awareness through radio shows and the belief is that people do listen to such programmes and are aware of the disease,” he says.

Ministry of Health Spokesperson, Adrian Chikumbe, admits that some rural areas are indeed experiencing intermittent supply of diabetes testing kits.

“Yes, recently we have had situations whereby we have run out of diabetes testing kits in most of our health facilities since we didn’t have the kits at Central Medical Stores Trust. The Ministry of Health is aware of this and we are trying our best so that CMST stocks the testing kits,” he says.

Chikumbe also acknowledges the importance of raising awareness about the disease and says the Ministry has been conducting sensitisation campaigns to alert people about the disease.

At the moment, Chikumbe says, the prevalence rate of diabetes is at 1.4 percent which means that one person in every 100 people suffers from diabetes.

According to Chikumbe, unhealthy eating habits, lack of exercise and excessive alcohol consumption are among the factors leading to the increased rate of the disease.

According to the World Health Organisation (WHO), in 2019, diabetes was the direct cause of 1.5 million deaths globally. It says 48 percent of all deaths due to diabetes occurred before the age of 70 years.

To help prevent Type 2 diabetes and its complications, WHO says people should achieve and maintain healthy body weight; be physically active–doing at least 30 minutes of regular, moderate-intensity activity on most days, eat a healthy diet, avoid sugar and saturated fats; and avoid tobacco use as smoking increases the risk of diabetes and cardiovascular disease.

WHO says about 422 million people worldwide have diabetes, the majority living in low-and-medium income countries.

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