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Editorials
N. I. Osman, C. R. Chapple Department of Urology, Royal Hallmashire Hospital, Sheffield, UK Email: [email protected]
References 1 Irwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50: 1306–14. 2 Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 167–78. 3 Rosier BJ. A prospective study to find evidence for the ICS definition of urgency. Neurourol Urodyn 2006; 25: 517–8. 4 Chapple CR, Artibani W, Cardozo LD et al. The role of urinary urgency and its measurement in the overactive bladder symptom syndrome: current concepts and future prospects. BJU International 2005; 95: 335–40. 5 Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol 2006; 175: 191–4.
6 Coyne KS, Zhou Z, Thompson C, Versi E. The impact on health-related quality of life of stress, urge and mixed urinary incontinence. BJU International 2003; 92: 731–5. 7 Coyne K, Wein A, Nicholson S, Kvasz M, Chen C, Milson I. Comorbidities and Personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract 2013; 67: 1015–33. 8 Stevens JA, Hasbrouck LM, Durant TM et al. Surveillance for injuries and violence among older adults. MMWR CDC Surveill Summ 1999; 48: 27– 50. 9 Dallosso HM, Matthews RJ, Mcgrother CW, Donaldson MM, Shaw C. The association of diet and other lifestyle factors with the onset of overactive bladder: a longitudinal study in men. Public Health Nutr 2004; 7: 885–91. 10 Khasriya R, Sathiananthamoorthy S, Ismail S et al. The spectrum of bacterial colonisation associated with urothelial cells from patients with chronic
lower urinary tract symptoms. J Clin Microbiol 2013; [Epub ahead of print] 11 Molinuevo B, Batista-Miranda JE. Under the tip of the iceberg: psychological factors in incontinence. Neurourol Urodyn 2012; 31: 669–71. 12 Coyne KS, Sexton CC, Kopp ZS, Ebel-Bitoun C, Milsom I, Chapple C. The impact of overactive bladder on mental health, work productivity and health-related quality of life in the UK and Sweden: results from EpiLUTS. BJU international 2011; 108: 1459–71. 13 Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU international 2008; 101: 1388–95. doi: 10.1111/ijcp.12206
EDITORIAL
Diabetes in sub-Saharan Africa: an economic and public health emergency Linked Comment: Assaad-Khalil et al. Int J Clin Pract 2013; 67: 1144–50.
Age-specific estimates of prevalence for African urban centres are already higher than for their Western counterparts: this situation is already serious and predicted to deteriorate significantly
Sub-Saharan Africa has changed a great deal over the last couple of decades and many countries have experienced ‘unprecedented high, sustained economic growth’ (1). This growth has, for the main, translated positively into improvements in health indicators in the region. African child mortality is now decreasing at twice the rate it was only 10 years ago. In addition, there has been a substantial reduction both in new HIV infections and HIV-related mortality over the same period (2). These are extremely encouraging signs. Despite this economic growth, maybe even because of it, the future is not rosy for all sub-Saharan inhabitants. Non-communicable ‘diseases of affluence’ including heart disease, stroke and diabetes are forcing their way onto the scene with a disturbing vigour. Diabetes mellitus, in particular, is already recognised as a global epidemic, and developing countries are expected to bear an increasing share of this burden as urbanisation increases (3). Age-spe-
cific estimates of prevalence for African urban centres are already higher than for their Western counterparts: this situation is already serious and predicted to deteriorate significantly (4). In many ways, this is reminiscent of the challenge posed by the HIV pandemic. Like HIV, diabetes has the potential both to devastate individual’s lives and to negatively impact the very economic growth currently driving population-wide health improvements (5). Burgess and his co-authors highlight the almost impossible challenge presented by diabetic retinopathy in sub-Saharan Africa and the costs of both action and inaction on this front (6). Specifically, the economic costs arise from time lost because of permanent disability and from premature mortality from diabetes in the working population of sub-Saharan Africa. Despite the social impact that diabetes is forecast to have, the outlook does not have to be bleak. Diabetic retinopathy screening and glycaemic control for diabetics have been shown to be cost-
ª 2013 John Wiley & Sons Ltd Int J Clin Pract, November 2013, 67, 11, 1069–1075
Editorials
effective in the sub-Saharan Africa region, in terms of disability adjusted life years (DALYs) averted (7). Ultimately, the order of the day must be a combination of both treatment and prevention. In this context, the WHO forecasts that the prevention of chronic disease in resource-poor environments can contribute significant increases to national economic growth (8). Diabetes is a complex disease to manage, and outcomes are affected by the interplay of many wide-ranging influences. In this context, Assad-Khalil et al. have sought to determine which factors that physicians in the region consider important barriers to good diabetic outcomes. Such work has the potential to identify gaps in diabetes care that can then inform the design of effective and relevant interventions. There is an urgent need for African governments to prioritise the development and implementation of chronic disease policies (5). As the authors admit, the results are not representative of any of the healthcare systems in the countries surveyed. However, one thousand doctors is not an
References 1 International Monetary Fund. Regional Economic Outlook: Sub-Saharan Africa, Maintaining Growth in an Uncertain World. www.imf.org/external/pubs/ft/ reo/2012/afr/eng/sreo1012.htm (accessed 18 May 2013). 2 UNAIDS. Regional Fact Sheet 2012. Sub-Saharan Africa: A Decline in New HIV Infections and HIV Related Deaths. http://www.unaids.org/en/media/ unaids/contentassets/documents/epidemiology/2012/ gr20 12/2012_FS_regional_ssa_en.pdf (accessed 18 May 2013).
ª 2013 John Wiley & Sons Ltd Int J Clin Pract, November 2013, 67, 11, 1069–1075
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unsubstantial number to survey and as a minimum can help identify overall trends that may ultimately lead to improvements in diabetes care. Whether African countries are able to address the issues raised and then translate these into effective improvements in diabetes treatment and prevention remain to be seen. However, one thing is certain: failure to effectively address diabetes may lead to the advances of recent years in tackling other diseases being undone.
Disclosure None. P. Flinders, M. Alexander, J. V. Patel Academic Medicine Society, School of Medicine, University of Nottingham Medical School, Royal Derby Hospital, Derby, UK Email: [email protected]
3 Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa. Lancet 2010; 375: 2254–66. doi: 10.1016/S0140-6736(10)60550-8 4 International Diabetes Federation. Diabetes Atlas: Africa. http://www.idf.org/diabetesatlas/5e/africa (accessed 18 May 2013) 5 de-Graft Aikins A, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: from the local to the global. Glob Health 2010; 6: 5. 6 Burgess PI, Msukwa G, Beare NA. Diabetic retinopathy in sub-Saharan Africa: meeting the challenges of an emerging epidemic. BMC Med 2013; 11: 157.
7 Ortegon M, Lim S, Chisholm D, Mendis S. Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 2012; 344: e607. 8 World Health Organization. Rethinking Diseases of Affluence: The Economic Impact of Chronic Diseases. http://www.who.int/chp/chronic_disease_report/ media/Factsheet4.pdf (accessed 18 May 2013) doi: 10.1111/ijcp.12256
Editorials
N. I. Osman, C. R. Chapple Department of Urology, Royal Hallmashire Hospital, Sheffield, UK Email: [email protected]
References 1 Irwin DE, Milsom I, Hunskaar S et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006; 50: 1306–14. 2 Abrams P, Cardozo L, Fall M et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 167–78. 3 Rosier BJ. A prospective study to find evidence for the ICS definition of urgency. Neurourol Urodyn 2006; 25: 517–8. 4 Chapple CR, Artibani W, Cardozo LD et al. The role of urinary urgency and its measurement in the overactive bladder symptom syndrome: current concepts and future prospects. BJU International 2005; 95: 335–40. 5 Hashim H, Abrams P. Is the bladder a reliable witness for predicting detrusor overactivity? J Urol 2006; 175: 191–4.
6 Coyne KS, Zhou Z, Thompson C, Versi E. The impact on health-related quality of life of stress, urge and mixed urinary incontinence. BJU International 2003; 92: 731–5. 7 Coyne K, Wein A, Nicholson S, Kvasz M, Chen C, Milson I. Comorbidities and Personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract 2013; 67: 1015–33. 8 Stevens JA, Hasbrouck LM, Durant TM et al. Surveillance for injuries and violence among older adults. MMWR CDC Surveill Summ 1999; 48: 27– 50. 9 Dallosso HM, Matthews RJ, Mcgrother CW, Donaldson MM, Shaw C. The association of diet and other lifestyle factors with the onset of overactive bladder: a longitudinal study in men. Public Health Nutr 2004; 7: 885–91. 10 Khasriya R, Sathiananthamoorthy S, Ismail S et al. The spectrum of bacterial colonisation associated with urothelial cells from patients with chronic
lower urinary tract symptoms. J Clin Microbiol 2013; [Epub ahead of print] 11 Molinuevo B, Batista-Miranda JE. Under the tip of the iceberg: psychological factors in incontinence. Neurourol Urodyn 2012; 31: 669–71. 12 Coyne KS, Sexton CC, Kopp ZS, Ebel-Bitoun C, Milsom I, Chapple C. The impact of overactive bladder on mental health, work productivity and health-related quality of life in the UK and Sweden: results from EpiLUTS. BJU international 2011; 108: 1459–71. 13 Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU international 2008; 101: 1388–95. doi: 10.1111/ijcp.12206
EDITORIAL
Diabetes in sub-Saharan Africa: an economic and public health emergency Linked Comment: Assaad-Khalil et al. Int J Clin Pract 2013; 67: 1144–50.
Age-specific estimates of prevalence for African urban centres are already higher than for their Western counterparts: this situation is already serious and predicted to deteriorate significantly
Sub-Saharan Africa has changed a great deal over the last couple of decades and many countries have experienced ‘unprecedented high, sustained economic growth’ (1). This growth has, for the main, translated positively into improvements in health indicators in the region. African child mortality is now decreasing at twice the rate it was only 10 years ago. In addition, there has been a substantial reduction both in new HIV infections and HIV-related mortality over the same period (2). These are extremely encouraging signs. Despite this economic growth, maybe even because of it, the future is not rosy for all sub-Saharan inhabitants. Non-communicable ‘diseases of affluence’ including heart disease, stroke and diabetes are forcing their way onto the scene with a disturbing vigour. Diabetes mellitus, in particular, is already recognised as a global epidemic, and developing countries are expected to bear an increasing share of this burden as urbanisation increases (3). Age-spe-
cific estimates of prevalence for African urban centres are already higher than for their Western counterparts: this situation is already serious and predicted to deteriorate significantly (4). In many ways, this is reminiscent of the challenge posed by the HIV pandemic. Like HIV, diabetes has the potential both to devastate individual’s lives and to negatively impact the very economic growth currently driving population-wide health improvements (5). Burgess and his co-authors highlight the almost impossible challenge presented by diabetic retinopathy in sub-Saharan Africa and the costs of both action and inaction on this front (6). Specifically, the economic costs arise from time lost because of permanent disability and from premature mortality from diabetes in the working population of sub-Saharan Africa. Despite the social impact that diabetes is forecast to have, the outlook does not have to be bleak. Diabetic retinopathy screening and glycaemic control for diabetics have been shown to be cost-
ª 2013 John Wiley & Sons Ltd Int J Clin Pract, November 2013, 67, 11, 1069–1075
Editorials
effective in the sub-Saharan Africa region, in terms of disability adjusted life years (DALYs) averted (7). Ultimately, the order of the day must be a combination of both treatment and prevention. In this context, the WHO forecasts that the prevention of chronic disease in resource-poor environments can contribute significant increases to national economic growth (8). Diabetes is a complex disease to manage, and outcomes are affected by the interplay of many wide-ranging influences. In this context, Assad-Khalil et al. have sought to determine which factors that physicians in the region consider important barriers to good diabetic outcomes. Such work has the potential to identify gaps in diabetes care that can then inform the design of effective and relevant interventions. There is an urgent need for African governments to prioritise the development and implementation of chronic disease policies (5). As the authors admit, the results are not representative of any of the healthcare systems in the countries surveyed. However, one thousand doctors is not an
References 1 International Monetary Fund. Regional Economic Outlook: Sub-Saharan Africa, Maintaining Growth in an Uncertain World. www.imf.org/external/pubs/ft/ reo/2012/afr/eng/sreo1012.htm (accessed 18 May 2013). 2 UNAIDS. Regional Fact Sheet 2012. Sub-Saharan Africa: A Decline in New HIV Infections and HIV Related Deaths. http://www.unaids.org/en/media/ unaids/contentassets/documents/epidemiology/2012/ gr20 12/2012_FS_regional_ssa_en.pdf (accessed 18 May 2013).
ª 2013 John Wiley & Sons Ltd Int J Clin Pract, November 2013, 67, 11, 1069–1075
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unsubstantial number to survey and as a minimum can help identify overall trends that may ultimately lead to improvements in diabetes care. Whether African countries are able to address the issues raised and then translate these into effective improvements in diabetes treatment and prevention remain to be seen. However, one thing is certain: failure to effectively address diabetes may lead to the advances of recent years in tackling other diseases being undone.
Disclosure None. P. Flinders, M. Alexander, J. V. Patel Academic Medicine Society, School of Medicine, University of Nottingham Medical School, Royal Derby Hospital, Derby, UK Email: [email protected]
3 Mbanya JC, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa. Lancet 2010; 375: 2254–66. doi: 10.1016/S0140-6736(10)60550-8 4 International Diabetes Federation. Diabetes Atlas: Africa. http://www.idf.org/diabetesatlas/5e/africa (accessed 18 May 2013) 5 de-Graft Aikins A, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: from the local to the global. Glob Health 2010; 6: 5. 6 Burgess PI, Msukwa G, Beare NA. Diabetic retinopathy in sub-Saharan Africa: meeting the challenges of an emerging epidemic. BMC Med 2013; 11: 157.
7 Ortegon M, Lim S, Chisholm D, Mendis S. Cost effectiveness of strategies to combat cardiovascular disease, diabetes, and tobacco use in sub-Saharan Africa and South East Asia: mathematical modelling study. BMJ 2012; 344: e607. 8 World Health Organization. Rethinking Diseases of Affluence: The Economic Impact of Chronic Diseases. http://www.who.int/chp/chronic_disease_report/ media/Factsheet4.pdf (accessed 18 May 2013) doi: 10.1111/ijcp.12256
