Nigeria’s silent crisis: Missteps in tackling hypertension and diabetes

There is a growing number of hospital deaths and complications from long-standing illnesses, with hypertension and diabetes consistently identified as leading risk factors. So prevalent are these conditions that healthcare professionals can often predict their involvement when hearing of sudden deaths, strokes, kidney failure, or vision loss among Nigerians. Hypertension typically tops the list, closely […]

There is a growing number of hospital deaths and complications from long-standing illnesses, with hypertension and diabetes consistently identified as leading risk factors. So prevalent are these conditions that healthcare professionals can often predict their involvement when hearing of sudden deaths, strokes, kidney failure, or vision loss among Nigerians. Hypertension typically tops the list, closely followed by diabetes mellitus, with increasing numbers of newly diagnosed cases daily. Importantly, both conditions are largely preventable, and when present, can be effectively managed when detected timely, with proper medical care. Despite the existence of documented evidence highlighting the significant death toll and complications caused by these diseases, major challenges continue to hinder effective management. These include issues with accurate and timely diagnosis, delays in seeking medical care, poor health-seeking behavior, socio-economic constraints, and the burden of out-of-pocket expenses for treatment.

A major concern is the limited public understanding of well-established risk factors for hypertension and diabetes, such as obesity, processed high-fat diets, increasing age, gender, family history, physical inactivity, smoking, alcohol consumption, and high-fat diets. It is important for the public to realise that these conditions are typically influenced by multiple factors, making it difficult to attribute them to a single cause. For instance, age may be the key risk factor for one person, while for another, it might be a combination of genetic predisposition and a sedentary lifestyle. Unfortunately, there is a widespread misconception—shared even by some healthcare workers—that links hypertension primarily to stress, worry, or excessive thinking. However, such emotional triggers may only lead to temporary spikes in blood pressure, not chronic hypertension, as confirmed by scientific evidence.

Another major challenge is the widespread claim by herbalists and spiritual healers that they can cure long-standing illnesses such as hypertension and diabetes. This, in addition to other factors, contributes significantly to the burden of death and complications from these preventable diseases. In reality, even in advanced healthcare settings, only certain forms of conditions, like hypertension resulting from urinary tract obstruction or diabetes related to pregnancy, can be cured through proper management of the underlying causes. These general cure claims are highly misleading and significantly contribute to the continued burden of these diseases. For instance, effective diabetes management, even in a well-equipped tertiary facility under the supervision of an endocrinologist, requires a comprehensive, multidisciplinary approach. This includes laboratory monitoring, dietary guidance, regular follow-ups, and coordinated interventions tailored to the patient’s needs. Therefore, it is both unrealistic and potentially harmful for anyone to assert that they can single-handedly provide a cure without the support of qualified medical professionals. To protect the public and ensure safe healthcare practices, there is an urgent need to put in place strong regulatory measures to oversee and control the activities of such unverified practitioners.

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According to the Nigerian National Health Policy, every Nigerian citizen should have access to primary, secondary and tertiary healthcare services through a well-functioning referral system. An essential aspect of effective diagnosis and management lies in the competence available at each level of care. Primary healthcare falls under the responsibility of local governments, while secondary and tertiary services are managed by state and federal governments, respectively. At the local government level, care is largely provided by community health workers, who often lack adequate training in managing conditions such as hypertension and diabetes. This highlights the urgent need for dedicated medical officers at the secondary level. Among other responsibilities, should run hypertension and diabetes clinics at least twice a week. Such clinics can play a significant role in detecting new cases, managing ongoing treatment, and reviewing referrals from the primary care level.

Similarly, tertiary healthcare facilities should handle referrals from secondary care, particularly for complex cardiac cases where specialised expertise is limited. Establishing a strong, two-way referral system would enhance the overall management of these conditions. However, this can only be achieved if skilled personnel are adequately deployed across all levels of care. Additionally, all tiers of the healthcare system should regularly conduct community outreach programs aimed at screening and linking individuals with appropriate services for further management.

There are instances where timely diagnosis and appropriate management of these conditions are provided by qualified personnel. However, maintaining consistent care—including regular investigations, medications, follow-up visits, and dietary guidance—often poses a significant financial burden, particularly for the majority of the population. To address this, a key strategy should focus on implementing community-based health insurance schemes, with substantial support from the government and other relevant stakeholders. Additionally, collective community involvement and sustained health promotion efforts—especially through mass media—can foster positive health-seeking behaviors. Regular public risk communication is also essential to encourage lasting behavioral change.

In light of the above, it is critically important that hypertension and diabetes mellitus receive the necessary attention from the government. Early screening and effective management of these conditions can significantly reduce the healthcare costs associated with treating complications such as end-stage renal disease, stroke, and sudden death—all of which are far more expensive than preventive care. While the federal government’s ongoing initiatives, such as the national surveys and the community-based screening program “Know Your Numbers” are commendable, it is essential to adopt sustainable strategies that are accessible to all Nigerians.

Equally, strengthening the capacity of healthcare workers in the accurate diagnosis and effective management of these diseases should be prioritized. Academic institutions and researchers should also support government efforts by developing long-term, practical frameworks for disease prevention. In areas like Yobe, Jigawa, and Borno states, where end-stage kidney disease is increasingly reported, research should focus on identifying and ruling out these leading risk factors. While other conditions, such as sickle cell disease, drug use, and exposure to heavy metals from food, water, or air, can also impair kidney function and contribute to secondary hypertension, it is crucial to understand their role and interaction with existing risk factors.

Through these combined efforts, we can begin to curb the growing burden of morbidity and mortality linked to hypertension and diabetes in Nigeria.

 

Dr Ibrahim is with Rasheed Shekoni Federal Teaching Hospital, Dutse, e-mail: [email protected]