Uganda has found itself at the center of a growing health crisis, one that isn't always immediately evident but carries significant financial implications.
The International Diabetes Federation (IDF) identifies Uganda as one of the 48 countries facing a concerning diabetes-related health issue. The spotlight in this article falls on Type 2 diabetes mellitus (T2DM), a condition that affects millions of Ugandans, both diagnosed and undiagnosed, causing a heavy economic burden on households and the government.
In 2019, Uganda had a T2DM prevalence rate of 4.1 percent, encompassing all types of T2DM cases. This startling statistic translates to approximately 1.69 million Ugandans grappling with the condition. T2DM is notorious for its costly management and treatment, posing a substantial financial challenge for both individuals and the healthcare system.
The Financial Strain. The year 2022 saw the management and treatment of diagnosed T2DM cost a staggering Shs 2.2 trillion to the government and households combined. What's concerning is that the lion's share of this financial burden falls squarely on households. Oral drugs and outpatient department (OPD) consultations emerge as the primary cost drivers for treating uncomplicated T2DM cases.
Concurrently, complications such as diabetic eye treatments, including laser procedures and cataract treatment, haemodialysis, and strokes, contribute significantly to the soaring costs associated with T2DM-related healthcare. To address this escalating issue, it becomes imperative to focus on raising awareness about T2DM and, more importantly, developing effective prevention programs.
A recent policy brief from the Economic Policy Research Centre (EPRC) underscores the urgency of these initiatives. Impact on Uganda's Economy. The repercussions of lifestyle-related diabetes ripple through Uganda's economy. Unhealthy diets play a prominent role in the surge of non-communicable diseases (NCDs), with T2DM taking a prominent spot among these.
The economic implications are profound as T2DM primarily links to individual lifestyle choices. While the overall prevalence of diabetes in Uganda might seem relatively low at first glance, there are specific regions with alarming rates. For instance, rural Eastern Uganda registers a diabetes prevalence of 7.4 percent, accompanied by a pre-diabetes prevalence of 8.6 percent, according to the Uganda Diabetes Association (UDA).
What's particularly striking is the average age of diabetic Ugandans, a mere 35 years, significantly lower than the demographic seen in high-income countries, where diabetes typically affects those above 60 years of age. This means that diabetes manifests early in Uganda's population, not only posing a medical but also a significant economic concern as it targets the most productive and energetic age group.
Managing T2DM and its associated complications, including diabetic eye problems, diabetic foot conditions, kidney disease, hypertension, and heart diseases, requires continuous clinical attention and resources.
However, the costs involved, especially in low- and middle-income countries like Uganda, need better estimation and documentation.
With these concerns in mind, an EPRC brief has been crafted to analyze the direct economic burden of diagnosed Type 2 diabetes in Uganda.
This condition is emerging as a growing NCD (non-communicable disease) within the population. Understanding the costs and what drives them is essential for effective policymaking. This analysis forms part of the broader research agenda
under the Global RECAP project titled "Assessment of policies and identification of context-specific regulatory interventions for a healthier food environment to prevent diet-related non-communicable diseases in Uganda."
The brief serves as an extract from the paper titled "Economic Burden of Type 2 Diabetes Mellitus (T2DM) in Uganda: A Direct Cost of Illness Analysis."
The estimation of the direct economic burden of T2DM employs a cost-of-illness approach, dissecting various population sizes. The methodology involves five key steps:
1. Case definition, encompassing diabetes conditions and types, along with related complications and prevalence estimation.
2. Identifying cost-generating components, including screening, diagnosis, and treatment expenses.
3. Conversion of resource utilization into unit costs.
4. Attribution of monetary values to cost components.
5. Aggregation across relevant population cohorts, specifically age- standardized groups aged 20+ years and 20-79 years. Data sources include the Institute for Health Metrics and Evaluation (IHME), International Diabetes Federation (IDF), Uganda National Household Survey 2019/20, and a focused literature search. Unit cost data are sourced from hospitals and pharmacies.
Key Findings: The stark reality is that only four out of 10 individuals with Type 2 diabetes mellitus (T2DM) have received a diagnosis. Uganda is grappling with 1.679 million cases of T2DM, combining undiagnosed and diagnosed cases, yet only 676,900 (40 percent) have been identified as living with this life altering NCD.
This implies that a significant portion of Ugandans remains unaware of their condition, potentially leading to late presentations when complications have already taken hold. Intriguingly, among those diagnosed, a majority opt for private healthcare over government facilities, regardless of age group.
In 2022, an estimated Shs 2.2 trillion was expended on diagnosed T2DM patients, accounting for age-standardized figures. Notably, the government contributed approximately Shs 435.8 billion to the care of T2DM patients in the same year. However, households bore the brunt of the financial load, spending four times more than the government on T2DM treatment in private healthcare facilities.
This financial outlay encompasses both diagnosed uncomplicated cases and complicated ones requiring extensive care, management, control, and treatment.
Managing uncomplicated diagnosed T2DM alone translated to a cost of Shs 266.4 billion for the government in public facilities, while households in private facilities bore a staggering Shs 1.1 trillion expense in 2022, considering age-standardized groups. The cost drivers for treating and managing uncomplicated T2DM in both public and private healthcare facilities were predominantly expenditures on oral drugs and OPD consultations, along with diagnostic investigations.
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It's crucial to note that hospitalization for uncomplicated diagnosed T2DM cases is a rarity, and equipment such as glucose meters and batteries are considered luxuries for the affluent.
The total direct economic cost for managing T2DM complications in public facilities amounted to Shs 169.4 billion, while in private facilities, it soared to Shs 681.7 billion for all age-standardized groups. The costs encompassed the treatment and management of complications such as retinopathy, diabetic foot disease, stroke, Ischaemic heart disease, and kidney failures, including kidney transplants.
Notably, the private sector's costs often mirror the actual market costs of treatment, emphasizing the financial burden faced by individuals seeking care. In conclusion, Uganda finds itself grappling with a hidden but severe health and economic crisis in the form of Type 2 diabetes mellitus (T2DM).
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