Overview on main nutrition-related diseases in three countries from North Africa

The aim of this review article is to give a holistic overview on the magnitude of nutrition-related diseases in the North African region and to outline major factors associated with the prevalence of these complications. A literature analysis was performed on PubMed and Google Scholar for data relating to nutrition-related diseases published between January 2007 and March 2017. The employed keywords were; "Algeria AND Morocco AND Tunisia AND Nutrition-Related diseases". We focused firstly on the nutrition-related diseases associated to inadequate intake of nutrients and unhealthy dietary habits such as low birth weight, anaemia and micronutrient deficiencies, thereafter, diseases associated with changes in lifestyle such as obesity, diabetes and cardiovascular disease are highlighted. Factors contributing to nutritional problems vary from country to another. Low socioeconomic status, low educational levels, unhealthy eating habits, poverty and ignorance are mainly responsible for both under and over nutrition problems. Despite their alarming rates, national strategies to combat these nutritional diseases do not exist or are ineffective in North African countries. Efforts are focused on therapeutic actions, however, the scarcity or the complete lack of preventive health care services, epidemiological surveys, nutritional surveillance and lack of nutritional assessment need to be considered. Continuous and accurate analyses of the evolving situation will allow setting up a good tools, strategies and health intervention programs in North African countries. ​

Diabetic complications and glycaemic control in remote North Africa

Background: Delivery of diabetes services in resource-poor areas of Africa is difficult. Control is often poor and complications are common. However, adequate robust surveys are uncommon, particularly in remote rural areas. This makes needs assessment difficult and health-care planning impossible. Aim: To accurately assess the glycaemic control and burden of complications in a group of diabetic patients from a remote area of a resource-limited north African country. Design: Prospective cohort study. Methods: Over a 6-week period, all patients attending the diabetic clinic at Mekelle Hospital in northern Ethiopia were intensively assessed, using imported western technology as necessary. Glycated haemoglobin (HbA1c), lipid profile, serum creatinine and urinary albumin­creatinine ratio were measured. Complications were assessed as accurately as possible, including examination of fundi by an ophthalmic specialist, and biosthesiometry for neuropathy. Results: There were 105 patients, mean (± SD) age 41 ± 16 years and diabetes duration 7 ± 6 years. There were 74 (70%) males, and 69 (66%) on insulin. Median body mass index was low at 20.6 kg/m2, but mean HbA1c high at 11.3 ± 2.8% (68% had an HbA1c over 10.0%). Cataract (12%), retinopathy (21%), neuropathy (41%) and microalbuminuria (51%) were common; but nephropathy (2%) was rare, as was large vessel disease (6% had peripheral vascular disease, and none had coronary artery disease or cerebrovascular disease). Risk factors such as hypertension (5%) and smoking (2%) were uncommon, and lipid profiles were generally good. Discussion: We conclude that in this severely resource-limited area of North Africa, glycaemic control amongst diabetic patients is very poor. Neuropathy, retinopathy and microalbuminuria are common; but large vessel disease risk factors are beneficial, and macroangiopathy prevalence is low. Scattered populations, shortage of drugs and insulin and lack of diabetes team care are major factors behind these serious issues of diabetic control and complications