Tackling air pollution is a key step in reducing diabetes cases in Ghana, say experts.

Teshie, Accra – In his late 20s Seth Osabukley was living a regular life as a photojournalist here in Ghana’s capital, with his wife and five young children. But in the year 2014 all that changed.

Seth fell ill with general body weakness and fever. At first he believed he was dealing with a simple case of malaria. He sought relief from a herbal mixture at a pharmacy. But when his symptoms persisted, Seth went to the Nungua Polyclinic for a more thorough examination.

Doctors were alarmed. Seth’s blood test showed his blood sugar was three times the normal level. A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours means a person has diabetes. Seth’s life was at risk.

 “When the doctor saw my result, she was deeply worried,” he remembers. “I was admitted immediately.”

This episode marked the start of a grueling medical journey that has seen Seth shuttle between health facilities ever since. His blood sugar has fluctuated, peaking and declining in a harrowing cycle that requires constant injections of the hormone insulin to keep his blood sugar under control.

Spikes or dips in blood sugar can lead to heart and kidney problems, deteriorating eyesight, and nerve issues like neuropathy. If left unmanaged diabetes can cause severe complications – damaging blood vessels, kidneys, foot ulcers, heart complications and digestive problems, stroke and even death, according to Dr George Ansong of the Tamale Teaching Hospital.

Doctors say potential signs to watch out for include weight loss despite adequate food intake, frequent urination, excessive thirst, fatigue, and ants gathering at urine sites due to sugar excretion.

One in 10 adults now has diabetes with numbers rising

In Ghana there are 2.4 million people living with diabetes. Approximately 7.5 per cent of adults have type 2 diabetes, some requiring daily insulin injections or very close monitoring by doctors to prevent complications. Doctors fear many more people have not been diagnosed.

The World Health Organisation estimates that one in ten adults worldwide has diabetes and 90 per cent of diabetics have type 2 diabetes which happens because your pancreas does not make enough insulin, your body does not use insulin properly, or both. The disease is preventable. (This is different from Type 1 diabetes, which happens when an autoimmune attack on your pancreas, often in childhood, results in a total lack of insulin production.)

The number of people with diabetes has doubled over the past 30 years to more than 800 million worldwide, according to a recent international study. The global analysis published in leading medical journal The Lancet found that rates of diabetes in adults doubled from about 7 per cent to 14 per cent between 1990 to 2022, with the largest increase in low and middle-income countries like Ghana.

Experts say diabetes is the only so-called non communicable disease (NCD) for which the risk of dying early is increasing, rather than decreasing. (A non-communicable disease is one that is not transmissible directly from person to person.) Major NCDs in Ghana include diabetes, hypertension, heart disease and stroke, chronic respiratory diseases such as asthma, Chronic Obstructive Pulmonary Disease (COPD) bronchitis and cancer.

In his quest to stabilise his condition, Seth sought guidance from a dietician and adjusted his eating habits. To prevent diabetes doctors recommend people eat more foods high in fibre such as raw fruits, vegetables and whole grains. They encourage people to cut back on food with high levels of glucose and processed sugars.

Seth has enjoyed moments of reprieve. By 2020 his insulin levels normalised. He had improved blood sugar control and no longer needed medication.

But such periods were short-lived. Just last year, his blood sugar levels spiked once more, soaring to nearly three times the normal level, again placing him in a dangerous situation. 

Air pollution a growing cause of diabetes

Experts say the rising prevalence of diabetes is caused by poor diet, lack of exercise and genetic issues. But another factor is emerging in densely populated cities like Accra: air pollution.

The smallest particles of air pollution can enter the bloodstream where they exacerbate problems in the heart, blood and nervous systems. They particularly impact already vulnerable populations like children and older people and those battling respiratory illnesses like asthma.

Accra’s air pollution levels have risen to concerning levels in recent years according to the Environmental Protection Agency (EPA). Earlier this year, the EPA issued a public warning, urging the public to wear nose masks to mitigate exposure.

Dr Ansong urges government to work harder to bring environmental pollution under control to reduce the incidence of NCDs.

Children and undiagnosed among those facing biggest risks

Dr Efua Commey, Programme Manager for NCDs at the Ghana Health Service, says Ghana records an average of more than 200,000 cases of diabetes at outpatient health facilities annually. Patients present with symptoms such as fatigue, frequent urination and blurred vision.

Dr Commey says doctors are concerned with the rising number of children who are diagnosed with the disease. The requirements of managing diabetes can seriously limit their opportunities and quality of life.

Dr Commey also worries that there are many who walk around with the condition without knowing about it. Infections impacting the pancreas, like pancreatitis, may act as triggers. Diabetes can develop without symptoms, making regular health checks vital for early diagnosis. Late diagnosis can make treatment more difficult.

“Many patients present with these symptoms, and further tests often reveal that the disease has already progressed significantly,” Dr Commey says. “This is sometimes because diabetes can be asymptomatic in its early stages, with noticeable signs only appearing when the condition has advanced.”

Costs of diabetes care can be too high for many Ghanaians

The costs of managing diabetes can put a huge strain on patients and their families. Care includes regular visits to a diabetologist, nephrologist (kidney specialist), and foot specialist, for holistic monitoring of potential complications such as chronic kidney diseases and severe foot ulcers.

These are costs that many Ghanaians cannot afford. Seth receives treatment at the Korle Bu Teaching Hospital Diabetes Centre yet he candidly admits, “For one year, my sugar levels stayed high without any improvement because I could not afford all the medications. It was extremely difficult.” 

Seth receives some assistance from the National Diabetes Centre, but he often misses appointments due to costs. Medications covered by the National Health Insurance Scheme are not always available. If he takes GH₵1,000.00 ($US63) to the hospital, it is still not enough for all the drugs he needs to keep his insulin level normal. With a post-deduction salary of GH₵1,100.00 and the responsibility for caring for his five children, Seth has resorted to bank loans to cover his medical expenses.

He attributes his recent ability to stay healthy to a disciplined diet and being cautious of his environment, but he remains fearful.

“I keep my nails long, not because I want to, but because I am scared of cuts that might not heal. Diabetes can significantly impact the body’s ability to heal wounds quickly,” he explains.

He underscores that prevention is paramount. “People must be interested in knowing their health status and risk factors. Early detection and adherence to medical advice can allow people to live long, healthy lives despite a diabetes diagnosis.”

But he says Seth’s story highlights the pressing need for governments to tackle air pollution more seriously in order to save Ghanaian lives.

This story was in collaboration with the New Narratives. Funding was provided by the Clean Air Fund. The funder had no say in the content of the story.

BY RAISSA SAMBOU