Turning the Tide in Sierra Leone and Across Africa

By Dr. Manal Ghazzawi, BPharm, PharmD, MPH, FPCP (232news)

Diabetes is no longer a distant concern—it’s here, it’s growing, and it’s preventable. Across Africa, 25 million adults live with diabetes and about 18.25 million/73% of the African population do not know they have diabetes. In 2024 alone, diabetes was responsible for ~216,000 deaths on the continent.

Sierra Leone at a glance

Latest international estimates show Sierra Leone has ~159,000 adults (20–79 years) living with diabetes, with about 73% undiagnosed. Diabetes was linked to ≈1,168 deaths in 2024. Beyond those already affected, impaired fasting glucose (a “prediabetes” state) is 7.7% and impaired glucose tolerance is 9.5% among adults—signalling a large group at risk.

Prediabetes: the warning light we must not ignore

Worldwide, prediabetes is now counted in hundreds of millions of adults. Recent syntheses and the International Diabetes Federation updates put impaired glucose tolerance around 464–636 million and impaired fasting glucose roughly 298–488 million, together exceeding 1.1 billion adults at high risk in 2024. The trend is rising. Africa mirrors this climb, with ~57 million adults already showing impaired glucose tolerance.

“Is insulin resistance behind everything?”

Insulin resistance (IR) sits at the heart of type 2 diabetes and often travels with high blood pressure, abnormal lipids and fatty liver disease. Insulin resistance means your body’s cells don’t respond properly to insulin, causing sugar to build up in the blood instead of being used for energy. The evidence linking IR to multiple chronic conditions is strong, but scientists caution against calling it the single root cause of “many diseases”; it’s a key driver within a broader web that includes genetics, environment, diet, physical inactivity and ageing.

Major Diseases Linked to Insulin Resistance

1. Type 2 Diabetes Mellitus

This is the most direct outcome. When the body becomes resistant to insulin, blood sugar levels stay high, and over time, this leads to type 2 diabetes.

1. Heart and Blood Vessel Diseases (cardiovascular disease)

IR is closely tied to high blood pressure, high triglycerides, low “good” HDL cholesterol, and plaque buildup in arteries — all of which raise the risk of heart attack and stroke.

1. Non-Alcoholic Fatty Liver Disease (NAFLD)

Excess insulin and fat storage in the liver can cause fatty liver, which may progress to liver inflammation or cirrhosis.

1. Polycystic Ovary Syndrome (PCOS)

In women, IR can worsen hormonal imbalances that cause irregular periods, acne, and difficulty conceiving.

1. Obesity and Metabolic Syndrome

IR often goes hand in hand with abdominal (belly) obesity and is a key part of the metabolic syndrome — a cluster of risk factors that increase chances of heart disease and diabetes.

1. Certain Cancers

Some studies suggest IR and high insulin levels may be linked to a higher risk of colon, breast, and pancreatic cancers, likely due to insulin’s growth-promoting effects on cells.

1. Sleep Disorders (e.g., Sleep Apnoea)

Poor sleep and sleep apnoea can worsen IR, and IR can make these conditions worse in return — a two-way relationship.

1. Cognitive Decline and Alzheimer’s Disease

Some researchers call Alzheimer’s “type 3 diabetes” because IR in the brain may interfere with memory and thinking.

 Risk factors in the Sierra Leone context

Urbanisation, lower physical activity, energy-dense diets and limited screening all raise risk. Sierra Leone’s own STEPS data show low physical activity is common (≈14–19%), with 87% reporting no recreational activity—a pattern that fuels both obesity and diabetes risk.

Diet matters too. Our staple foods are rice and cassava, with palm oil and fish as mainstays. National food-based dietary guidelines encourage more vegetables (e.g., cassava/potato leaves), beans/groundnuts, and diverse staples—and moderation with oils and added sugars. These are practical, local levers for prevention that fit how people already eat.

What prevention looks like (simple, doable, local)

1) Move more—on purpose

• Aim for 150–300 minutes/week of moderate activity (e.g., brisk walking, dancing, cycling, football, farming work done at a steady, faster clip) or 75–150 minutes vigorous activity.
• Add muscle-strengthening activities at least 2 days/week (lifting weights, body weight moves, water-carrying, resistance bands, squats/chair-stands).
  Small bouts (10–15 minutes) add up—walk to the market, take the stairs, join a community dance/football group, or do short strength sessions at home.

2) Eat smart—with Sierra Leonean foods

• Make rice portions modest; when possible, mix with brown rice or bulgur/maize/millet; fill half the plate with leafy greens (cassava or potato leaves, krain-krain, okra) and non-starchy vegetables (leafy greens, cucumber, egg plant, cabbage etc).
• Add beans/legumes/groundnuts several times per week for fibre and satiety. High fiber is great for your gut bacteria which been proven to prevent or treat lots of diseases.
• Choose fish often; keep palm oil to modest spoonfuls; prefer grilling/steaming over deep-frying.
• Cut sugary drinks (soft drinks, sweet teas/coffee, juices), drink safe water.
• Keep fruits as snacks/dessert (pawpaw, mango in season, citrus), minding portions if blood glucose is high.

3) Know your numbers—catch it early

• Get fasting glucose or HbA1c (your blood glucose control for the past 3 months) checked if you’re over 35, have a family history, high blood pressure, you are overweight/obese, or had diabetes in pregnancy.
• Ask about waist measurement and blood pressure—cheap, informative screenings that flag metabolic risk.

Why this matters—right now

Diabetes strains families and the health system with avoidable complications: kidney failure, vision loss, amputations and heart disease. Yet many cases—and much suffering—can be prevented or delayed with early detection and everyday habits tailored to local realities.

A call to action for World Diabetes Day

• Government & partners: Expand community screening; ensure steady supply of basic tests/medicines; integrate diabetes education into primary care and antenatal services; design walkable markets/safe play spaces.
• Workplaces & schools: Build short activity breaks into the day; offer water first, limit sugary drinks; support healthy canteens, pack your own healthy meals.
• Communities & families: Organise walking/dance groups; swap extra rice for extra greens; make checking blood pressure/glucose as normal as checking weight.

Sierra Leone has the tools, foods and community spirit to act. If we move together—literally and figuratively—we can bend the curve.

7-Day Sierra Leonean Meal Plan

Day 1

Breakfast: Oats porridge cooked with low-fat milk or water, topped with small pieces of banana or pawpaw.
Lunch: Brown or parboiled rice with steamed cassava leaves and grilled fish.
Snack: Handful of groundnuts or one orange.
Dinner: Vegetable soup (okra, garden eggs, krain krain) with a small piece of boiled yam or plantain.

Day 2

Breakfast: Whole-wheat bread with boiled egg and cucumber slices; black tea or lemon water.
Lunch: Boiled cassava with beans and a side of sautéed greens.
Snack: One small mango or a few cashew nuts.
Dinner: Steamed potato leaves with grilled chicken and small portion of rice.

Day 3

Breakfast: Millet or sorghum porridge (unsweetened) with a spoon of groundnut paste.
Lunch: Rice with okra stew and smoked fish; cabbage salad on the side.
Snack: Fresh coconut pieces or watermelon slices.
Dinner: Boiled plantain with bean stew and a side of boiled garden eggs.

Day 5

Breakfast: Corn pap made with skimmed milk or water; add a little groundnut paste.
Lunch: Rice and beans with palm-oil sauce (small amount) and green leafy vegetables.
Snack: One small apple (or local orange).
Dinner: Grilled fish with boiled plantain and tomato/pepper sauce.

Day 6

Breakfast: Oatmeal with cinnamon and diced pawpaw.
Lunch: Cassava leaves with brown rice and lean meat or fish.
Snack: Handful of roasted chickpeas or groundnuts.
Dinner: Vegetable soup with small portion of yam; cucumber and tomato salad.

Day 7

Breakfast: Vegetable omelette (egg with onions, peppers, spinach) and a slice of bread.
Lunch: Boiled rice with okra stew and beans.
Snack: Fresh fruit (orange, watermelon, or guava).
Dinner: Light soup with boiled sweet potato and fish.

Want a comprehensive diabetes diet plan? Visit us at Citiglobe pharmacy at 6, Campbel Street to grab your copy.

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