“Non-communicable diseases (NCDs) are a rapidly growing health burden in Uganda, and many other low and middle income countries. I call upon the Government of Uganda to fund research in NCDs. Most people with NCDs do not know that they are suffering from NCDs such as diabetes, high blood pressure, cancer, or heart diseases. For diabetes, about half of the people with diabetes in Uganda do not know that they have it,” said Prof. Rhoda Wanyenze, Dean of Makerere University School of Public Health.

According to the World Health Organisation (WHO) report of 2016, deaths from NCDs were on the rise, with developing countries hit hardest. NCDs are the leading cause of death globally. In 2016, they caused 71% of all deaths (40.5 million) up from 60% in 2000.

Opening the SMART2D Research Dissemination Workshop to various stakeholders held on 21st March 2019, Prof. Wanyenze applauded researchers from Makerere University School of Public Health for teaming up with other partners to undertake a multi-country four year research project aimed at identifying strategies to better prevent and manage Type-2-Diabetes, one of the NCDs.

She commended the research team headed by the Uganda co-Principal Investigator, Prof. David Guwatudde for not only describing problems, but also providing prevention and management strategies for Type-2-Diabetes.

The co-Principal Investigator of SMART2D, Prof. David Guwatudde emphasized that the primary aim of the four year research was to strengthen capacity for both prevention and management of Type-2-Diabetes.

“Health systems in most parts of the world were struggling to diagnose and manage Type-2-Diabetes especially in low and middle income countries. More than 50% of people with diabetes in Uganda are undiagnosed. They are not aware that they have diabetes. Further in Uganda, only about 30% of people with diabetes have ever had their blood tested for high blood sugar,” he said.

Funded by the European Union (EU) and Government of Sweden through the Swedish International Development Cooperation Agency (Sida), the SMART2D research presents a people-centered approach through Self-Management and Reciprocal Learning for the Prevention and Management of Type-2-Diabetes.

Prof. Guwatudde revealed that Type-2-Diabetes is more of a lifestyle disease, which can be prevented if we modify our lifestyle and behaviour. The nutrition aspect is one of the factors leading people to get diabetes.

According to Dr. Juliet Kiguli, co-Investigator on the SMART2D, some of the factors putting one at the risk of getting diabetes included: consumption of unhealthy foods (eating sweet things, too much oil, alcohol); physical inactivity (not exercising); Worrying; and ignoring the advice from medical personnel.

With Dr. Elizabeth Ekirapa sharing statistics that diabetes wields a tremendous economic burden on society (to patients and the economy at large); and further revelation from Dr. Roy William Mayega that most of the patients the research team interviewed, could not afford the drugs and equipment to monitor their blood sugar, yet often there are stock-outs of these at Government health centers.  He emphasized that SMART2D advocates for strategies aimed at prevention and effective management of diabetes. “Prevention is better than cure. Since diabetes can be prevented and the prevalence of pre-diabetes is high, preventive efforts should be stepped up so as to save lives as well as resources that are going to be spent on treatment.”

For those living with diabetes, Prof. David Guwatudde emphasized that if they follow the advice of the medical personnel and take the prescribed medicines; they can live a normal life. “It is not true that when they diagnose you with diabetes you die soon. If you take the prescribed medicines and follow the advice from medical personnel, you will live with diabetes and still live a normal life.”

The SMART2D research team consists of the following researchers: Prof. David  Guwatudde, Dr. Juliet Kiguli, Dr. Roy William Mayega, Dr. Barbara Kirunda Tabusibwa, Dr. Elizabeth Ekirapa Kiracho, Dr. Francis Xavier Kasujja, Dr. Anthony Muyingo, Mrs. Max Walusimbi, Ms.  Gloria Naggayi, Mr. Edward Ikoona, and Mr. Kusolo Ronald.

Some of the challenges in the prevention and management of NCDs include: Inadequate prevention strategies; a large proportion of people with NCDs are undiagnosed; lack of funds to buy the recommended medicines; and poor retention into care.

To address the four challenges, the SMART2D research team came up with a set of Facility and Community interventions.

Minimal improvements in organization of facility-based care significantly improved the percentage of patients with diabetes that are retained into care by over 30%. It also improved control of the disease in the patients by over 10%, and prevented the development of diabetes among people at high risk by over 50%.

In line with WHO report published in 2002 titled Innovative Care for Chronic Conditions: Building Blocks for Action which noted that a community has a crucial role to play in chronic care, Dr. Francis Xavier Kasujja reiterated that peer groups were instrumental in the ongoing support to diabetes patients in Iganga and Mayuge communities.

Delivering a personal testimony, one of the patients with diabetes said that they significantly benefited from the engagement and trainings received during the SMART2D project.
However, with the end of the project, most of the patients were worried because they cannot afford the cost of treatment for management of diabetes.

Presenting the implications of their findings on policy, Dr. Roy William Mayega highlighted the following recommendations:

•    Health Centres from level III+ should be supported to establish diabetes care and prevention services and accredited in a phased way
•    Roll-out of a minimum package of equipment, and essential drugs from Health Centre III and above, supported by a regular supply, inclusive of hypertension medicines
•    Need to roll out lean clinical guidelines and a care algorithm to all facilities
•    Scaled training (pre- and -in-service), supervision and clinical mentorship of nurses and clinical staff on care and prevention
•    Strengthen the information system for chronic care including appointments, clinical records and follow-up
•    A simple health education and coaching approach and manuals should be rolled out to facilities targeting patients and people at high risk
•    A task shifting approach should be scaled up where stable patients are managed by nurses
•    Need to strengthen self-care so that patients can manage themselves

Representing the Ministry of Health, Dr. Gerald Mutungi the Senior Medical Officer in Charge on Non-Communicable Diseases shared with workshop participants some of the strategies being undertaken:  The Ministry of Health has a technical working group on NCDs; ongoing research aimed at studying the effectiveness of the integration of HIV/AIDS and NCDs into the chronic care clinic; and Government entering into a strategic partnership with Novartis, an NCD drugs manufacturer, to ensure that drugs for NCDs are available at all Government health facilities.

Some of the key stakeholders who attended the SMART2D Research Dissemination workshop include: Dr. Gity Behravan,1st Secretary and Senior Research Advisor, Swedish Embassy- Kampala,  Dr. Fred Makumbi-Deputy Dean of Mak School of Public Health, Dr. Esther Buregyeya, Dr. Noah Kiwanuka and officials from the World Health Organisation, Ministry of Health, NCD platforms, diabetic associations, lung and heart institutions, district health workers, patients from Iganga and Mayuge, Makerere University Directorate of  Research and Graduate Training, and among others.

Written by:  Ritah Namisango, Mak Public Relations Office