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Open Access Debate

Diabetic retinopathy in sub-Saharan Africa: meeting the challenges of an emerging epidemic

Philip I Burgess1*, Gerald Msukwa2 and Nicholas AV Beare34

Author Affiliations

1 Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi

2 Lions First Sight Eye Unit, Queen Elizabeth Central Hospital, Blantyre, Malawi

3 St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, UK

4 Department of Eye and Vision Sciences, University of Liverpool, Liverpool, UK

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BMC Medicine 2013, 11:157  doi:10.1186/1741-7015-11-157

Published: 2 July 2013

Abstract

Background

Sub-Saharan Africa faces an epidemic of diabetes. Diabetes causes significant morbidity including visual loss from diabetic retinopathy, which is largely preventable. In this resource-poor setting, health systems are poorly organized to deliver chronic care with multiple system involvement. The specific skills and resources needed to manage diabetic retinopathy are scarce. The costs of inaction for individuals, communities and countries are likely to be high.

Discussion

Screening for and treatment of diabetic retinopathy have been shown to be effective, and cost-effective, in resource-rich settings. In sub-Saharan Africa, clinical services for diabetes need to be expanded with the provision of effective, integrated care, including case-finding and management of diabetic retinopathy. This should be underpinned by a high quality evidence base accounting for differences in diabetes types, resources, patients and society in Africa. Research must address the epidemiology of diabetic retinopathy in Africa, strategies for disease detection and management with laser treatment, and include health economic analyses. Models of care tailored to the local geographic and social context are most likely to be cost effective, and should draw on experience and expertise from other continents. Research into diabetic retinopathy in Africa can drive the political agenda for service development and enable informed prioritization of available health funding at a national level. Effective interventions need to be implemented in the near future to avert a large burden of visual loss from diabetic retinopathy in the continent.

Summary

An increase in visual loss from diabetic retinopathy is inevitable as the diabetes epidemic emerges in sub-Saharan Africa. This could be minimized by the provision of case-finding and laser treatment, but how to do this most effectively in the regional context is not known. Research into the epidemiology, case-finding and laser treatment of diabetic retinopathy in sub-Saharan Africa will highlight a poorly met need, as well as guide the development of services for that need as it expands.

Keywords:
Africa; Diabetic retinopathy; Epidemiology; Health services; Screening