Lukia Mutesi felt weak, sweated profusely, lost hair and her skin began peeling. She wondered what was ailing her. Scared that she could be having HIV/Aids, she feared to go to a health facility. Her husband abandoned her and found another woman.
One morning, Mutesi, a resident of Nakigo Village, Busowobi Sub-county in Mayuge District, was visited by a nurse, who checked her and found that she had Type Two diabetes.
"When I was told I had diabetes, I was shocked. I didn't know much about the disease. Was I going to die? Who would take care of my children?" she says.
She was one of the first beneficiaries of a study and health education carried out by medical and academic experts dubbed "A people-centred approach to self-management and reciprocal learning in the prevention and management of Type Two diabetes - SMART2D" in Iganga and Mayuge districts in eastern Uganda.
In the areas, it was found that health workers did not know much about lifestyle diseases and were trained to handle cases of patients with lifestyle or non-communicable diseases.
"We found out that knowledge is generally very low. People are still unaware of these diseases. They know much about malaria, HIV/Aids but they don't know about diabetes and high blood pressure and yet every person we talked to, has had a relative who has had these diseases," Dr Roy William Mayega from Makerere University School of Public Health (Musph), explains.
Dr David Guwatudde, says findings in the formative research indicated that patients still think it is the doctor who is supposed to help them manage diabetes.
"That feeling is still very strong, so one of the interventions we recommended on health education is the issue of self-management. We also emphasised it on the brochures we shared with patients and health workers, that it is not only the doctor who is going to manage this chronic condition that they are living with but they themselves should have a responsibility of doing something about it," the professor argues.
Dr Mayega and Dr Guwatudde were lead researchers in the study that was also undertaken by doctors under Makerere's School of Public Health; Francis Kasujja, Gloria Naggayi, Elizabeth Ekirapa, Juliet Kiguli, Barbara Kirunda, Ronald Kusolo, Edward Ikoona, Anthony Muyingo and Max Walusimbi, with funding from European Union and the embassy of Sweden.
The objective of the study was to formulate facility and community strategies that improves access and adherence to prevention and management interventions of Type Two diabetes as a lifestyle disease.
Dr Mageya observes that in Uganda, Type 2 diabetes affects young adults from the age of 30, and unlike in the Western world where the diabetes type affects people at an average of 65 years, in Uganda, it is at 50 years.
A recent study conducted by the Ministry of Health indicates that the prevalence of diabetes in adults is one per cent which, when contextualised in the national population, account for 4.5 million people. The study also observes that one in four adults is likely to have high blood pressure.
"We have been doing the studies since 2015 and concluded data collection in December last year and our main areas of research are lifestyle diseases, which are on the rise in Uganda. We are changing our diets, taking on unhealthy ones. We are working out less," he explains.
He adds that people are engaging less in physical work and sitting more, increasing their risk of getting lifestyle diseases.
Figures provided by WHO indicate that global prevalence of diabetes among adults above 18 years of age has risen from 4.7 per cent in 1980 to 8.5 per cent in 2014.
Additionally, in 2016, an estimated 1.6 million deaths were directly caused by diabetes. Another 2.2 million deaths were attributable to high blood glucose in 2012.
"Healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use are ways to prevent or delay the onset of Type 2 diabetes," recommends WHO.
According to Dr Kiguli, new schools do not have enough space for pupils and students to exercise.
The research found misconceptions regarding what constitutes a healthy diet. People think to be healthy, they need to eat things that are sour or according to their blood group. Dr Kiguli says it is important for people to know what they eat and how it impacts on their lives, their level of exercise and how it impacts on their lives.
"Lifestyle diseases such as Type 2 diabetes are on the rise. People need to know what to eat. Half your plate should constitute vegetables, a quarter carbohydrates and some soup. People should not eat to fill the stomach because carbohydrates will store into sugars. You must exercise," she says.
The medics developed a simple intervention that helps to identify people who have diabetes but do not know it. They are initiated on care and provided with health education.
During the research, it was found that the lowest community health centre, a health centre III, had a minimum amount of drugs and diagnostic equipment. The researchers demonstrated that the patients can get better even at lower levels of care through training of nurses and assistant nurses in absence of doctors given the national challenge of inadequate human resource.
With training, nurses can perform some medical tasks, especially for patients who are stable; with no complications or complaints. They can easily get a drug refill and health education and don't necessarily have to see a doctor.
"There is lack of adequate human resource in our health facilities and we have lessons to learn from HIV/Aids where we are using lower cadre health workers to do higher level inter-tasking. After training, for example, if you have a diabetic patient, normally it should be the doctor reviewing them but if you train a nursing assistant or even a nurse, they can ably manage, unless there are complications," Dr Hafisa Kasule, a consultant on non-communicable diseases (NCD) at WHO, says.
She adds that WHO, with studies from other countries, had already designed guidelines called Package of Essential Non-Communicable Disease Interventions for Low Resource Settings, taking into account the constraints that we have.
"We also tested some health education material in form of a manual and leaflet for health workers. What we are recommending for policy, is to adapt some of the things that have worked during the study. Initiating diabetes care at primary health care centres, from a health centre III and above," Dr Mayega explains one of the team's recommendations.
The team also recommends the provision of necessary medicines that are not widely available in health centres, for diabetes and high blood pressure, clinical guidelines for health workers, information and education, supervision and support towards health care centre and workers.
Cause. According to World Health Organisation (WHO), diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar.
Types. Diabetes is of two types. Type 1 diabetes, also known as insulin-dependent, juvenile or childhood-onset, is characterised by deficient insulin production and requires daily administration of insulin.
Symptoms include excessive excretion of urine, thirst, constant hunger, weight loss, vision changes, and fatigue.
Type 2 diabetes, formerly called non-insulin-dependent, or adult-onset, results from the body's ineffective use of insulin. Until recently, this type of diabetes was seen only in adults but it is now also occurring increasingly in children.
Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation.
Treatment. WHO states that diabetes can be treated and its consequences avoided or delayed with diet, physical activity, medication and regular screening and treatment for complications.