Abstract
Background
In 2024, malaria affected 282 million people, primarily in sub-Saharan Africa (SSA), where screening and care efforts have saved nearly one million lives. Another significant issue remains underdiagnosed in SSA: type 2 diabetes (T2D), with three-quarters of affected individuals unaware of their condition. Few studies have examined the social determinants of T2D screening, and none have done so while considering a malaria-endemic context. This paper aims to understand how social determinants influence T2D screening and to identify challenges and opportunities within a malaria-endemic context.
Methods
Semi-structured individual interviews were conducted with diabetic patients (n = 25) and healthcare professionals (n = 28) in Abidjan, Côte d’Ivoire. A thematic analysis was performed using QDA Miner.
Results
Knowledge about T2D, psychosocial influences, physical access, and economic access influenced T2D screening. Patient and healthcare professional narratives revealed both confusion and opportunities for screening at the intersection of malaria and diabetes. Both groups reported that T2D symptoms were sometimes attributed to malaria, delaying screening. Professionals also noted that T2D could be overlooked when malaria testing was requested without blood glucose measurement. Conversely, when blood glucose testing was integrated into examinations, it enabled differential diagnosis and the fortuitous discovery of T2D.
Conclusions
Our study suggests that interventions to strengthen T2D screening in Côte d’Ivoire should consider knowledge about T2D, psychosocial influences, physical access, and economic access. Our results also show that attributing T2D symptoms to malaria and the coexistence of both diseases are common realities. Systematically testing for T2D during malaria screening could be a promising strategy, as rapid glycemic tests are low-cost and widely available. Such integration could enable earlier T2D detection and help prevent its complications.
Key messages
• Addressing knowledge about T2D, psychosocial influences, physical access, and economic access to type 2 diabetes screenings is essential to improving diagnostic equity in Côte d’Ivoire.
• Integrating diabetes testing into malaria screening in Côte d’Ivoire offers a cost-effective strategy to enable earlier T2D detection and help prevent its complications.