Diabetes in Pakistan

Get usefull information and uptodate statistics about diabetes in Pakistan and India 

 Pakistan is a South-Asian country with a population of approximately 150 million. Diabetes prevalence Pakistan is high: 12% of people above 25 years of age suffer from the condition and 10% have impaired glucose tolerance (IGT).1 When one considers the associated risk factors present in Pakistani society, the large number of people with diabetes is no surprise. Obesity tops the list. Recent figures based on body mass index (BMI) show 37% of men with diabetes and 79% of women were obese. According to the waist-to-hip ratio (WHR), 79% of men with diabetes and 96% of women had central obesity. According to a Diabetic Association of Pakistan study into chronic complications (recently submitted for publication), involving 500 people with diabetes, eye damage (retinopathy) affected 43% of the people, kidney disease (nephropathy) 20%, and nerve damage (neuropathy) 40%.

Institutions specializing in diabetes care are limited in number and are concentrated in the big cities.There are no support personnel and very few dietitians. Family physicians have little time for counselling: a survey of GPs working in both rural and urban areas of Pakistan,2 showed the average time spent with a personwith diabetes was 8.5 minutes. Culture and demographicsAll these factors have been compounded by cultural practices in the country. The gender bias is verystrong. Pakistan is a male-dominated society and prejudice against women is reflected in the higher female mortality rate and low literacy rate (32% for 15 yr and above). The combination of factors is giving rise to strong negative repercussions on health. Women suffer most.They perform all the domestic chores and take care of the large extended families while gender discrimination means they enjoy only secondary status in the home and in society in general. Male children receive better nourishment and better opportunities for education. Women in the rural areas are doubly oppressed. Child marriages and lack of mobility confine the women to their homes. While they perform physical labour without remuneration, they are very often not allowed to set foot outside the home, even for medical ( ) treatment. A woman's hospital visit is often considered some kind of stigma by husbands and many women continue to die due to complications arising during childbirth. Any recommendations for the care of people with diabetes in Pakistan must be made in the wider context of the health-care system in the country. Certain key features have a direct bearing on the health-delivery system of Pakistan: the population size and distribution; the country's geography; the gender ratio, and the socio-economic development of the people. The government faces a major challenge to provide healthcare for everyone – 69% of the population is rural, spread over an area of 800 000 km 2 .

Limited resources
This difficult situation is aggravated by economic factors. Poverty is widespread – 31% of people in Pakistan are subsisting on 1 USD per day and 85% are earning less than 2 USD per day. With only 22% of the population economically active, the proportion of people officially unemployed is currently 20%. The scarcity of health-care services means that people with diabetes in Pakistan cannot be provided with the care they require. Health facilities are concentrated in the urban areas and the major services are provided by the private sector. Given the failure of the government to invest in health care (it spends only 0.7% of the GDP on the health sector), the private sector is playing an increasingly important role. However, this has made health care expensive and beyond the reach of most people. The problem is compounded by the scarcity of health-care services: a total of 91 823 doctors gives a ratio of 57 per 100 000 people; there are 37 623 nurses with none trained specifically in the field of diabetes. The 4632 Basic Health Units (BHU) located in the rural areas supposedly care for nearly 100 million people. Each unit is responsible for the health of over 21 000 people, many of whom are physically unable to attend. As a result, the people with diabetes in the country cannot be provided with the care they require. Failure to implement preventive measures has led to a growing incidence of the condition, with the rural areas being the worst affected. A call for united action Policy makers in Pakistan have failed to adequately focus on primary health care and preventive medicine. This is a priority matter which needs immediate attention. Since the rural areas have been most neglected, their need for attention is greater. Effective campaigns for healh education are essential and the low literacy rates mean that if diabetes awareness campaigns are to be successful, they must be transmitted via television and radio. Educational television programmes on health issues, promoting a healthy lifestyle, and focussing on sound dietary © Mauritius habits and exercise are urgently needed. Warnings about the hazards of diabetic complications should also be emphasized. In the past, such programmes have been effective in promoting awareness about family planning and AIDS. Producing well-pitched awareness-raising programmes would be a cost-effective method of promoting diabetes knowledge in Pakistan. The diabetic community lacks the facilities for screening and monitoring, and the drugs which can ensure a healthy, 'normal' life for people with diabetes.The 1995 National Action Plan for health placed special emphasis on diabetes and was designed to ensure the provision this care. However, the Plan was not fully implemented. Health-care measures must be backed up by a public health education campaign.

Some extraordinary measures should be taken urgently in the case of diabetes. Due to the multifaceted nature of the condition, tackling diabetes leads to the potential solution of a number of other health problems related to the complications. The first goal should be to screen people with diabetes for complications. In rural areas, where the infrastructure simply does not exist, ad hoc measures should be implemented. All BHUs should be provided with glucometers to test blood sugar, and training to ensure that they are used correctly. If these measures are to be effective, they must be backed up by a vigorous public health education campaign.
For remote areas, beyond the reach of the BHUs, mobile camps should be set up periodically. If these are subsidized, the private sector could also be welcomed into this programme.
There is also a need for subsidized insulin and syringes – presently out of the reach of poor people. In order to prevent the development of chronic diabetic complications, it is important that GPs, often the first healthcare contact for people with diabetes, are trained in screening and treatment. Stemming the diabetes epidemic in Pakistan is a major challenge. It calls for all to join hands – people affected by diabetes, health-care professionals, and health-care policy makers.

References
1. Shera AS, Rafique G, Khwaja IA, etal. Pakistan National Diabetes Survey: prevalence of glucose intolerance and associated factors in Shikarpur, Sindh Province. Diabetic Medicine 1995; 12: 1116-1121.
2. Shera AS, Jawad F, Basit A. Diabetes related Knowledge, Attitude and Practices of Family Physicians in Pakistan. J Pak Med Assoc 2002; 52: 465-470.