People with diabetes have a risk of developing tuberculosis (TB) 3 to 5 times higher than that of the general population. Moreover, diabetes can worsen the clinical course of TB and TB can worsen glycaemic control in people with diabetes. For these reasons, Doctors with Africa CUAMM is implementing a two year pilot project, financed by the World Diabetes Foundation, to improve diabetes and hypertension detection and treatment among TB patients  in the Luanda Province.

Tubercolosis in Angola

The still high burden of tuberculosis, with a prevalence of 474 cases per 100,000 in 2012, places Angola among TB high-risk countries, along with the low coverage of TB diagnostic and treatment services, the insufficient presence of TB laboratories, the high treatment dropout rate and the growing tendency of TB/HIV co-infection and multidrug resistant cases. More than 60,000 TB cases (all forms) were notified in the country in 2014.

Moreover, according to the International Diabetes Federation, the estimated prevalence of diabetes in 2013 is 2,2%, but changes in diet and lifestyle represent a huge risk for a higher development of diabetes cases.

The project

CUAMM’S two year project is using DOTS (Directly Observed Treatment, Short-course) as the heart of the Stop TB Strategy. Preliminary data on more than 3,000 TB patients tested in 6 DOTS Centers in Luanda – previously selected in agreement with the local health authorities – show a 5.64% prevalence of diabetes (FBS ≥ 126 mg/dl) and 22.4% prevalence of hypertension (>140/90), much higher than the general population.

These figures is a valuable result considering the quality of data collected and their value for operational research purposes. The project is reaching important results and highlights the growing number of TB patients with TB/Diabetes co-morbidity which are not covered by quality services in Luanda. The health personnel engaged in the screening has been trained by Doctors with Africa CUAMM, which provided also test materials and tools (glucometres, stick, digital sphygmomanometer).

Another added value of the intervention is the strengthening of the local Association for People with Diabetes (ASDA). The organization is carrying out of the mapping of the local districts in order to identify healthcare facilities capable of providing integrated TB/Diabetes care in Luanda. The aim is to ease the referral system to ensure high quality management of diabetes in TB patients. Doctors with Africa CUAMM and ASDA are carrying out awareness and education activities among risk groups and, possibly, the general population to inform about the interaction between these illnesses and major risk factors.

More than 300 people took part in a health education event held in the first week of September 2015, where short movies about diabetes and tuberculosis were shown . Dr. Luigi Andreoni, head of the program, reported that a sensitiation campaign about diabetes and tuberculosis will be organized in Luanda on the occasion of the World Diabetes Day, also offering the chance of testing glycemia and blood pressure for free.

Major achievements

The project major achievements till now are:

• coordination meetings with diabetes and TB national programs has been established and regular meetings are held with good participation;
• the working group on TB and diabetes has been established within the National TB Program;
• a database on diabetes’ prevalence in TB patients has been developed and are constantly updated in selected districts of the city of Luanda;
• a Monitoring and Evaluation Plan of collaborative diabetes and TB activities has been draft and it is ready to be adopted at national level;
• 35 healthcare staff of four DOT centres in Luanda have been trained to perform diabetes and blood pressure screening;
• nr. 113 supervisions to the selected DOTs centres done by Doctors with Africa CUAMM experts in the first year, in order to monitor quality, access and productivity of the centres;
• nr. 6 DOT Centres of Luanda (namely Cazenga, Kilamba Kiasi, Cacuaco, Luanda, Hospital Sanatório de Luanda, Centro Boa Nova Viana) are performing screening for diabetes and hypertension to all TB suspects.

The data collected in this project are analysed by TB experts from WHO TB department and CUAMM TB working group in order to present a survey on the best way to integrate TB and diabetes services in the Angola setting.

Doctors with Africa CUAMM in Angola

Angola is a middle income oil producer country, which is facing a rapid urbanisation. Around one-third of the Angolan population (22, 1 millions) are living in the capital Luanda, 53% of whom live in poverty.

Doctors with Africa CUAMM is present in the Country since 2002 with support to the National Tuberculosis (TB) Control Programme.

⇒ Read more about our work in Angola