Diabetes Is on the Rise in Zambia. What's Driving It?

For many years, Zambia's biggest health concerns have largely centred on infectious diseases. But another health challenge has been growing quietly in the background.

Diabetes is becoming increasingly common among Zambians.

And the reasons may be closer to home than many people realise.

Zambia's first-ever national survey of chronic disease risk factors, conducted by the Ministry of Health in 2017, found that 90.4 percent of adults surveyed were not eating enough fruit and vegetables.

At the same time, obesity is rising, physical activity is declining and diets are increasingly high in sugar, salt and cooking oil.

Together, these trends are creating conditions in which diabetes and other non-communicable diseases can thrive.

What the numbers show

The Ministry of Health's 2017 STEPS survey, Zambia's first nationally representative study of non-communicable disease risk factors, found that 6.2 percent of adults had diabetes.

The survey also recorded:

18.9 percent with hypertension

24.4 percent who were overweight or obese

19.5 percent with low physical activity

10.7 percent reporting daily tobacco use

Nearly half of those surveyed, 48.2 percent, had between two and three chronic disease risk factors.

Women were also found to be 24 percent more likely than men to carry a higher number of these risk factors overall.

However, estimates of diabetes prevalence in Zambia vary depending on how and where the disease is measured.

A separate clinical study comparing Zambia with South Africa's Western Cape province found an age-standardised diabetes prevalence of 3.5 percent, based on directly measured blood glucose rather than self-reported data.

Meanwhile, international modelled estimates from the World Bank and International Diabetes Federation put adult diabetes prevalence closer to 10 to 12 percent.

The difference reflects the methods used to measure and estimate the disease.

But researchers broadly agree on one thing: diabetes is rising in Zambia, and the trend is expected to continue as the risk factors become more common.

A changing Zambian diet

Public health researchers describe this shift as part of a broader "nutrition transition" taking place across sub-Saharan Africa.

As economies grow and more people move to urban areas, what people eat and how active they are can change significantly.

A qualitative study conducted in Mumbwa District identified excessive consumption of sugar, salt and cooking oil as defining features of the local diet.

Researchers linked these patterns to changing food availability and, in some communities, cultural preferences for larger body sizes, which can sometimes be associated with prosperity and good health.

The study also found that being overweight or obese was strongly associated with high blood pressure, abnormal cholesterol and higher blood sugar readings.

Yet many residents did not consider their own weight to be a health risk.

Research from other parts of sub-Saharan Africa shows a similar pattern.

Studies in Sierra Leone and Benin have linked urban living to higher rates of diabetes, obesity and hypertension. Researchers have associated this with lower fruit and vegetable consumption, increased salt intake and reduced physical activity.

One review found that, unlike wealthier countries where diabetes is more concentrated among people over 60, the diabetic population in sub-Saharan Africa is considerably younger.

It is particularly concentrated among people aged 30 to 45 — the very population that forms much of the region's economically productive workforce.

Many cases are being diagnosed too late

The growing number of cases is only part of the problem.

The Zambia-Western Cape comparison study found that 34.5 percent of Zambians who tested positive for diabetes had never been diagnosed.

Among those who had already been diagnosed, 66 percent were not receiving treatment.

More than a third of those who were receiving treatment still had blood glucose levels above recommended levels.

Researchers point to low rates of routine screening as one of the major challenges.

Blood sugar and cholesterol testing is not routinely carried out during ordinary visits to primary healthcare facilities, meaning some people only discover they have diabetes after complications have developed.

Treatment remains difficult for many

Getting diagnosed does not always mean getting the treatment needed.

A survey of 99 private pharmacies across three Zambian provinces found low or very low availability of insulin, including both branded and biosimilar forms.

The study also found that diabetes medicines were frequently priced beyond what a typical household could afford under the country's poverty line.

Access advocacy group T1International says only about half of Zambians in rural areas have access to a health facility of any kind, compared with 99 percent of urban residents.

It also notes that not all public hospitals stock insulin free of charge, leaving some rural patients to pay out of pocket for a medicine they may need for the rest of their lives.

Some efforts are already underway

There are, however, efforts to improve diabetes care.

The World Diabetes Foundation is supporting a project in Kalulushi District, Copperbelt Province, aimed at strengthening diabetes services for the district's roughly 75,000 residents.

The project includes training health workers at six facilities, providing basic diagnostic equipment and integrating diabetes care into Zambia's national NCD patient registry.

Public health advocates see the initiative as an example of what more systematic investment in screening, diagnosis and treatment could look like nationally.

But the bigger challenge remains addressing the factors driving the disease.

A diet increasingly high in sugar, salt and cooking oil, declining physical activity and inadequate fruit and vegetable consumption continue to put more Zambians at risk.

With nine in 10 adults failing to meet basic fruit and vegetable intake recommendations, researchers warn that without greater public awareness and stronger health system responses, Zambia's diabetes burden could continue to grow — perhaps long before many people realise how serious the problem has become.