Like most African countries, non-communicable (NCDs) diseases, including diabetes, is increasing in Zimbabwe. And children are increasingly among the cases that go undetected or treatment until severe symptoms emerge. 

HARARE, Zimbabwe – Ten-year-old Tadisa Sayi already contends with diabetes and when his blood sugar levels spike his mother, Naume Shereketo, endures the mood swings induced by his condition.

Three years ago, Shereketo, a single mother of two, discovered the root cause of her son’s misery during a severe bout of illness.

“It was in 2021. He was weak and vomiting. When I went to the hospital with him, doctors told me he was diabetic,” Shereketo told Health Policy Watch.

“He always says: “Mama, I’m weak’, and some other time he is harsh,” said Shereketo.

Shereketo, a vegetable vendor on the streets of Harare, faces ballooning costs to attend to her son’s special dietary needs.

She struggles to provide the specific foods required for her son’s health. For Sayi, a grade four learner, fruit, vegetables, milk and high-fibre foods, have become a regular but costly part of his diet, costing his mother between $60 and $80 monthly.

Shereketo is puzzled about her son’s diabetes. No one else is diabetic in her family or the boy’s paternal side.

Dr Life Zambezi, the boy’s doctor, confirmed that Sayi had Type 1 diabetes, and said that this can be challenging to manage in young children due to limited support at the community level as well as the difficulty of maintaining strict insulin routines.

Type 1 diabetes, which causes glucose (sugar) in one’s blood to become too high, happens when a person’s body cannot produce a hormone called insulin that controls blood glucose.

Changes in diet also cause rise in Type 2 diabetes

While Type 1 diabetes is generally the result of a genetic condition, children also are being increasingly affected by Type 2 diabetes, as a result of changing diets and lifestyles, according to the UN children’s agency, UNICEF.

Type 2 diabetes typically develops as a result of sedentary lifestyles, obesity and unhealthy eating habits, Zambezi notes. While it’s on the rise in most African countries, and usually associated with adults, he’s seeing more such cases among children.

“Of late, children are also getting Type 2 diabetes, mainly caused by the changes in lifestyle. There is a rise in poor eating habits among children. In most cases they eat processed and unhealthy food leading to childhood obesity and eventually type 2 diabetes,” said Zambezi.  

But diabetic children like Sayi are too often only diagnosed only when they have developed a severe crisis, such as a diabetic coma.

“NCDs in children result from a combination of genetic, environmental and behavioural factors,” Health and Child Care Deputy Minister Dr John Mangwiro explained at the launch. “When a young child is diagnosed with a non-communicable disease, this implies long-term treatment.”

Diabetes incidence in Zimbabwe soaring – although data remains spotty  

Approximately 537 million people worldwide are living with diabetes, according to the according to the International Diabetes Federation (IDF), an umbrella organisation of over 240 national diabetes associations in 160 countries and territories globally.  That includes 422 million people worldwide suffer from type 2 diabetes, the majority living in low- and middle-income countries, according to WHO, of the disease that kills 1.5 million people every year.

That includes approximately  106,400 adults in Zimbabwe living with diabetes Type 1 and 2, a prevalence of 1.5% in the adult population of about 7.1 million, according to the International Diabetes Federation (IDF), an umbrella organisation of national diabetes associations in 160 countries and territories.  

However,  IDF’s local member, the Zimbabwe Diabetic Association, says that’s a woeful underestimate. It estimates that as many as 10 out of every 100 people in Zimbabwe’s population of 17 million had diabetes, including children, as of 2017. But many cases go undiagnosed until the child or adult in question becomes seriously ill.

A 2014 meta-analysis also suggests diabetes incidence has grown exponentially. Prior to 1980, the prevalence of diabetes in Zimbabwe was just 0.44 %, while after 1980 the prevalence was 5.7 %, according to that systematic review. By 2018, prevalence was estimated at 8.5%, according to yet another study. 

As of 2016, Zimbabwe had the third highest estimated per-person cost of diabetes care in sub-Saharan Africa. Insulin’s exorbitant prices also cause many to miss out on essential medication, exacerbating their condition and long-term health risks, Zambezi said.  

Treatment at primary health care level is spotty

Treatment in primary health clinics remains spotty, the studies also suggests.  One small study comparing treatment in primary versus hospital facilities  in Harare, the capital city, found that more patients treated at hospital outpatient clinics ahd received some form of diabetes self-management education (DSME), and had higher levels of diabetes knowledge, as compared to those treated in primary care facilities.  At the same time, people who had consulted a dietician had the best levels of diabetes knowledge and self-care routines. 

“Dietitian-led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in primary clinics where limited interventions occur,” concluded the July 2019 study led by a researchers at the University of Cape Town and the University of Zimbabwe’s  Department of Community Medicine.

“Though improvements have been made in self-management therapies, there seems to be a high prevalence of hospital admissions with relapse of symptoms in Zimbabwe. Relapse in diabetes predicts poor prognosis,” concluded another, 2021 study, led by the University of Zimbabwe’s Department of Nutrition.

Recognizing those gaps, UNICEF in 2022 launched an initiative in five countries including Zimbabwe, to focus on NCD prevention, detection, treatment and support, particularly in children and young adults.

As part of the grant, funded by the pharma firm, Eli Lilly, Zimbabwe’s Ministry of Health received $2.5 million to educate community health workers and increase support and understanding of various NCDs including diabetes in children.

Late detection and poor management results in adult complications 

But until earlier detection and prompt treatment become more of the norm, many children will continue end up with severe complications in early adulthood, Zambezi observed.

One such case is Tariro Chiripanyanga. The youngest of four siblings, Chiripanyanga was diagnosed with Type 1 diabetes at the age of 10.

Today Chiripanyanga is now facing end-stage kidney disease, although she is only 30 years old.

“I was still too young to understand what it meant or how it would affect my life, but that’s when my life changed forever,” Chiripanyanga told Health Policy Watch.

Apart from living with diabetes since childhood, Chiripanyanga was diagnosed with kidney disease six years ago. She needs $30,000 for a kidney transplant, a financial burden neither she nor her family can bear. 

Chiripanyanga’s diabetes has already led to partial blindness, forcing her to drop out of university.

“My life depends on peritoneal dialysis which costs $1,750 monthly,” Chiripanyanga said. “I depend on dialysis until I can get money for a transplant which costs an estimated $30,000 in India.”

Image Credits: Muhidin Issa Michuzi, Jeffrey Moyo.