Global declines in poverty mean people eat better in developing countries. Populations there also are increasingly centred in cities, where a variety of services (such as electricity and public transportation) makes daily life easier. These trends are extremely positive overall, but there is a downside: rates of diabetes in low- and middle-income countries are climbing rapidly, and the illness is now one of the world’s leading causes of premature death. Some 90% of those who suffer from this non-contagious disease have Type 2 diabetes, which is largely caused by excess body weight and lack of exercise. The results can include heart problems, strokes, blindness, kidney failure, and damage to the feet that can require amputation.
Treatment is essential, but in less-wealthy countries knowledge about the diabetes lags its prevalence – in Senegal, for example, it is estimated that there are 400 000 diabetics but only 60 000 have been diagnosed. Matters in that country often come to a head during the annual Ramadan holiday, when the largely Muslim population fasts during the day. This disruption of normal eating patterns plays havoc with blood sugar levels, especially when people eat heartily in the evenings and typically indulge in sweet foods that provide quick energy. During Ramadan, hospital emergency rooms see a sharp increase in patients suffering from symptoms of acute diabetes.
An imaginative and effective Be He@lthy Be Mobile programme now aims at teaching diagnosed diabetics in Senegal how to manage the disease during Ramadan. It also spreads news about the illness to those who may not realize they have it.
Mariama Diallo, a diabetic in her sixties, recently received mobile phone messages during Ramadan as part of an “mRamadan” effort aimed at helping persons with the illness cope with the challenges posed by the holiday. The project, set up by the Senegalese Ministry of Health and Social Action in cooperation with WHO and ITU, sent frequent messages throughout the month-long period to more than 12,000 diagnosed diabetics. The effort was the first phase of a national “mDiabetes” project. Members of the country’s diabetic patient association, along with health professionals and the general public, were encouraged to sign up to receive the free text messages. The reach of this method of information is extensive: 83% of Senegalese have mobile phones. Among the timely advice offered was “Drink one litre of water every morning before you begin fasting”; “Take care not to overeat and watch out for foods high in sugar such as dates”; and “Ask your doctor to adapt the dose and timing of your diabetes medication before you fast.”
Baye Oumar Gueye, national secretary of the Senegalese Diabetic Support Association and a diabetic himself, describes the programme as “an essential and welcome initiative that allows people with diabetes to observe the holy month of Ramadan while avoiding the risk of complications.”
A follow-up survey of 100 persons receiving the messages in five regions of the country found that 90% considered the strategy useful enough that they changed their management of the illness through such steps as control of sugar intake and shifts in eating habits, and that 60% passed on the information they received to others who were either known diabetics or showed symptoms of the disease. Hence the text-message campaign had a significant “multiplier” effect.
A second round of the mRamadan campaign was carried out in July 2015, with the total number of persons receiving phone messages exceeding 12,000. The reach of the programme was expanded through word of mouth and through advertising posted on public transport. The country is now expanding content of the messages to cover such issues as prevention, management, and health-worker training for treating diabetes and such secondary complications such as “diabetic foot.” At the same time, the effort is increasing the public and political visibility of mobile phones as standard components of the health system.
The details of the programme, and lessons learned through its operation, are being shared with the Be He@lthy Be Mobile international office, as the approach shows high promise for use elsewhere. WHO estimates that 347 million people have diabetes worldwide, many of them undiagnosed, and that such targeted information and accompanying publicity have the potential to save thousands of lives and to reduce many thousands of lesser – but still severe – health complications.