Association between urban-rural location and prevalence of type 2 diabetes and impaired fasting glucose in West Africa: a cross-sectional population-based epidemiological study

doi:10.1136/bmjopen-2022-063318

. 2023 Sep 21;13(9):e063318.

doi: 10.1136/bmjopen-2022-063318.

Association between urban-rural location and prevalence of type 2 diabetes and impaired fasting glucose in West Africa: a cross-sectional population-based epidemiological study

Affiliations

¹ School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation (IHT), Faculty of Health, Deakin University, Geelong, Victoria, Australia aissaka@deakin.edu.au.
² Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
³ Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, Geelong, Victoria, Australia.
⁴ School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation (IHT), Faculty of Health, Deakin University, Geelong, Victoria, Australia.
⁵ National School of Senior Technicians Training in Public Health and Epidemiological Surveillance, University of Parakou, Parakou, Borgou, Benin.
⁶ Department of Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Haut-Bassin, Burkina Faso.
⁷ Directorate of Population Health Protection (DPSP) of Burkina Faso, Ministry of Health, Ouagadougou, Burkina Faso.
⁸ Republic of Liberia Ministry of Health, Congo Town, Monrovia, Montserrado, Liberia.
⁹ Laboratory of Epidemiology of Chronic and Neurological Diseases (LEMACEN), Faculty of Health Sciences, University of Abomey Calavi, Cotonou, Benin.
¹⁰ Non-Communicable Diseases and National Directorate of Health, Ministry of Health and Public Hygiene, Bamako, Mali.

PMID: 37734888
PMCID: PMC10514614
DOI: 10.1136/bmjopen-2022-063318

Association between urban-rural location and prevalence of type 2 diabetes and impaired fasting glucose in West Africa: a cross-sectional population-based epidemiological study

Ayuba Issaka et al. BMJ Open. 2023.

. 2023 Sep 21;13(9):e063318.

doi: 10.1136/bmjopen-2022-063318.

Authors

Affiliations

¹ School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation (IHT), Faculty of Health, Deakin University, Geelong, Victoria, Australia aissaka@deakin.edu.au.
² Non-Communicable Diseases and Implementation Science Unit, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
³ Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, Geelong, Victoria, Australia.
⁴ School of Health and Social Development, Global Obesity Centre (GLOBE), Institute for Health Transformation (IHT), Faculty of Health, Deakin University, Geelong, Victoria, Australia.
⁵ National School of Senior Technicians Training in Public Health and Epidemiological Surveillance, University of Parakou, Parakou, Borgou, Benin.
⁶ Department of Public Health and Research, West African Health Organisation, Bobo-Dioulasso, Haut-Bassin, Burkina Faso.
⁷ Directorate of Population Health Protection (DPSP) of Burkina Faso, Ministry of Health, Ouagadougou, Burkina Faso.
⁸ Republic of Liberia Ministry of Health, Congo Town, Monrovia, Montserrado, Liberia.
⁹ Laboratory of Epidemiology of Chronic and Neurological Diseases (LEMACEN), Faculty of Health Sciences, University of Abomey Calavi, Cotonou, Benin.
¹⁰ Non-Communicable Diseases and National Directorate of Health, Ministry of Health and Public Hygiene, Bamako, Mali.

PMID: 37734888
PMCID: PMC10514614
DOI: 10.1136/bmjopen-2022-063318

Abstract

Objectives: We investigated the association between urban/rural location and both type 2 diabetes mellitus (T2DM) and pre-diabetes among populations of five West African countries.

Design: Cross-sectional studies, using the WHO Stepwise (STEPs) survey data.

Setting: National representative data of both urban and rural areas from Benin, Burkina Faso, Ghana, Liberia and Mali.

Participants: Adults comprising 15 468 participants (6774 men and 8746 women; 7663 urban and 7805 rural residents) aged between 25 and 64 years.

Results: The age and sex-adjusted prevalence of T2DM was 6.2% for urban areas and 2.5% for rural areas. The prevalence of impaired fasting glucose (IFG) was 6.6% for urban areas, and 3.0% for rural areas. No differences by sex were observed. The crude relative risk (RR) and 95% CI of T2DM and IFG in urban compared with rural areas were 2.69 (1.85 to 3.91) and 2.37 (1.53 to 3.66), respectively. This reduced to RR: 2.03, 95% CI (1.34 to 3.08) and RR: 2.04, 95% CI (1.27 to 3.28), respectively, after adjusting for covariables.

Conclusion: The prevalence of both T2DM and IFG was more than two times as high in urban areas compared with rural areas in West Africa. Behavioural risk factors are common among urban populations, with ongoing urbanisation expected to drive increases in the prevalence of T2DM. These results could guide planning for T2DM screening, preventive strategies and resource allocation in West Africa.

Keywords: DIABETES & ENDOCRINOLOGY; EPIDEMIOLOGIC STUDIES; EPIDEMIOLOGY; PUBLIC HEALTH.

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Conflict of interest statement

Competing interests: None declared.

Figures

**Figure 1**
Simplified directed acyclic graph (DAG) causal mechanism between T2DM risk factors and T2DM adjusting for age, sex, and socioeconomic status (education and profession). HBP, high blood pressure; T2DM, type 2 diabetes mellitus.

See this image and copyright information in PMC

References

1. IDF diabetes Atlas . International Diabetes Federation 9th ed. Brussels, 2019. Available: https://wwwdiabetesatlasorg/upload/resources/material/20200302_133351_ID... [accessed 8 May 2022].
1. IDF Diabetes Atlas . International diabetes Federation. 10th edn. Brussels, 2021. Available: https://diabetesatlas.org/idfawp/resource-%20files/2021/07/IDF_Atlas_10t... [accessed 29 Nov 2022].
1. Gouda HN, Charlson F, Sorsdahl K, et al. . Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the global burden of disease study 2017. Lancet Glob Health 2019;7:e1375–87. 10.1016/S2214-109X(19)30374-2 - DOI - PubMed
1. Mbanya JCN, Motala AA, Sobngwi E, et al. . Diabetes in sub-Saharan Africa. Lancet 2010;375:2254–66. 10.1016/S0140-6736(10)60550-8 - DOI - PubMed
1. Moriconi-Ebrard F, Heinrigs P, Trémolières M. Africa’s Urbanisation Dynamics 2020: Africapolis, Mapping a New Urban. Geography: OECD Publishing, 2020.

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[1] IDF diabetes Atlas . International Diabetes Federation 9th ed. Brussels, 2019. Available: https://wwwdiabetesatlasorg/upload/resources/material/20200302_133351_ID... [accessed 8 May 2022].

[2] IDF diabetes Atlas . International Diabetes Federation 9th ed. Brussels, 2019. Available: https://wwwdiabetesatlasorg/upload/resources/material/20200302_133351_ID... [accessed 8 May 2022].

[3] IDF Diabetes Atlas . International diabetes Federation. 10th edn. Brussels, 2021. Available: https://diabetesatlas.org/idfawp/resource-%20files/2021/07/IDF_Atlas_10t... [accessed 29 Nov 2022].

[4] IDF Diabetes Atlas . International diabetes Federation. 10th edn. Brussels, 2021. Available: https://diabetesatlas.org/idfawp/resource-%20files/2021/07/IDF_Atlas_10t... [accessed 29 Nov 2022].

[5] Gouda HN, Charlson F, Sorsdahl K, et al. . Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the global burden of disease study 2017. Lancet Glob Health 2019;7:e1375–87. 10.1016/S2214-109X(19)30374-2 - DOI - PubMed

[6] Gouda HN, Charlson F, Sorsdahl K, et al. . Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the global burden of disease study 2017. Lancet Glob Health 2019;7:e1375–87. 10.1016/S2214-109X(19)30374-2 - DOI - PubMed

[7] Mbanya JCN, Motala AA, Sobngwi E, et al. . Diabetes in sub-Saharan Africa. Lancet 2010;375:2254–66. 10.1016/S0140-6736(10)60550-8 - DOI - PubMed

[8] Mbanya JCN, Motala AA, Sobngwi E, et al. . Diabetes in sub-Saharan Africa. Lancet 2010;375:2254–66. 10.1016/S0140-6736(10)60550-8 - DOI - PubMed

[9] Moriconi-Ebrard F, Heinrigs P, Trémolières M. Africa’s Urbanisation Dynamics 2020: Africapolis, Mapping a New Urban. Geography: OECD Publishing, 2020.

[10] Moriconi-Ebrard F, Heinrigs P, Trémolières M. Africa’s Urbanisation Dynamics 2020: Africapolis, Mapping a New Urban. Geography: OECD Publishing, 2020.

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Association between urban-rural location and prevalence of type 2 diabetes and impaired fasting glucose in West Africa: a cross-sectional population-based epidemiological study

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Association between urban-rural location and prevalence of type 2 diabetes and impaired fasting glucose in West Africa: a cross-sectional population-based epidemiological study

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