No sugarcoating diabetic care for women in West Africa

Across West Africa, women with diabetes often balance clinic care with traditional beliefs. Costs, culture, and limited access can delay treatment and worsen complications.

Women in West Africa with diabetes often balance clinic care with traditional beliefs. Photo: Odonti Photography

“It was over 10 years ago when I first felt the sickness in my body,” Amina* explains. “We have this [practice] of tasting our urine for diseases. If it’s sweet, it means you might have diabetes. I did it [for] myself.”

Amina, now in her 50s, is a resident of Accra New Town, a district of Ghana’s capital. She lives with type 2 diabetes that has left her feet swollen and painful. There are days she cannot even get out of bed.

Over the years, Amina has moved between orthodox medicine and herbal decoctions, including neem leaves and lemongrass. She felt a sense of "general wellbeing" when following prescriptions from local healers. At times, she admits, she stopped hospital visits altogether. “The traditional treatment helped at first,” she says, explaining that she then returned to the hospital in crisis, her blood sugar levels dangerously high.

Amina developed a swollen left foot and her doctor recommended cutting it open to promote healing; the procedure left her foot with a wound that requires regular dressing. She now uses insulin therapy to manage her blood sugar.

In Ghana—and across much of West Africa—such experiences are common. Faith and tradition shape how illness is understood, when treatment is sought, and whom patients turn to for care.

“Diseases and spiritual or cultural beliefs are quite difficult to separate,” explains Dr Nana Fredua-Agyeman, a physician and public health specialist in Ghana. “From the moment of diagnosis through treatment and compliance, it is always a struggle.”

The scale of the problem

Diabetes prevalence is increasing rapidly in Africa, where health systems are simultaneously managing infectious diseases and a growing burden of chronic illness. Across the continent, 24 million adults were living with diabetes in 2021, a figure projected to reach 55 million by 2045. Crucially, more than half remain undiagnosed, the highest proportion anywhere in the world, according to the International Diabetes Federation (IDF).

In Ghana, estimates vary, but the IDF data put adult prevalence at around 6–7%, with more than half undiagnosed. “Some reports suggested up to about 10% of adults in Ghana as having diabetes,” says Dr Muhiydeen Bashir, a physician specialist with the Ghana Health Service. “But under-reporting and undiagnosed cases remain a huge issue.”

“Many patients are walking around with diabetes without knowing it, until they come to us with complications like ulcers or kidney problems. That’s when we often make the first diagnosis.”

The true numbers may be even higher, adds Fredua-Agyeman. “Many patients are walking around with diabetes without knowing it, until they come to us with complications like ulcers or kidney problems. That’s when we often make the first diagnosis.”

Clinical data suggest that women appear more frequently in hospital statistics than men. “About two-thirds of hospitalisations resulting from diabetes and its complications are among women,” notes Bashir. He links this to gendered behaviour: “When it comes to health-seeking behaviour, although not optimal, women are doing better than men… They make an effort to come to the hospital and report their symptoms, which allows us to identify some of these conditions relatively early.”

From Liberia, physician Dr Flinway Hessou-Dickson echoes this assessment: “Usually women and children are the ones who come to the hospital. Men only come when they are actually at a critical stage.”

In this country, further west to Ghana, the health system continues to rebuild after years of conflict and epidemics. WHO data show that 35% of all deaths are now caused by non-communicable diseases (NCDs), including diabetes. Urbanisation, changing diets, and rising obesity are accelerating the trend across the sub-region.

Interpreting symptoms through belief

Type 2 diabetes, which accounts for over 90% of cases globally, develops when the body becomes resistant to insulin or when insulin production gradually declines. Women with diabetes have a higher risk of serious complications like cardiovascular disease, kidney disease, vision loss, skin problems, and depression. For patients, daily life entails monitoring blood glucose, following dietary restrictions, taking oral medications or insulin, and managing the constant risk of complications.

As Hessou-Dickson puts it: “It’s not just a pill. It’s daily choices—what you eat, how you move, whether you can afford the [prescription] refill. For many patients, that burden never stops.”

Across West Africa, diabetes symptoms are not always interpreted in medical terms. Burning feet, numbness, or stubborn ulcers—well-known complications of the disease—can be seen as spiritual afflictions.

“When women have burning sensations in their limbs, they ask: why should they feel fire when there’s no flame nearby? They believe it is spiritual, not physical,” says Bashir. He recalls patients with kidney-related swelling in their legs who confidently trace it to stepping on something cursed in the market, for example.

“Most patients first go to the herbalist, then to the church, for spiritual healing. By the time they reach the hospital, it is late.”

Hessou-Dickinson has similar observations. “Most patients first go to the herbalist, then to the church, for spiritual healing. By the time they reach the hospital, it is late.”

For Ama*, who lives in Accra’s Lapaz district and was diagnosed 25 years ago, the initial years were filled with experiments. “Every time someone said ‘take this’—moringa or other things—I did. I was desperate, looking for a cure. I did it along with my [usual] medication,” she recalls. Moringa leaves, rich in minerals and vitamins, are a popular form of herbal medicine in Ghana. 

Such stories echo wider patterns. A national survey found that 73.5% of Ghanaians report lifetime use of traditional and complementary medicine, driven by accessibility, affordability, and cultural acceptance.

“Traditional remedies vary but largely rest on the use of self-directed mixtures of ground or boiled herbs,” says Fredua-Agyeman, noting that families often play a key role in decisions relation to women's health. “It is likely that women will gear towards herbal or traditional remedy if their husband or family is a firm believer in traditional remedy.” 

The burden of cost and access

For many women who seek out orthodox medicine, the biggest challenge is not whether they seek care for diabetes, but whether they can sustain it. The cost of consultations, lab tests, and medication can be prohibitive—forcing them to turn to cheaper and more accessible traditional medicine.

“Some patients cannot afford the labs or even a two-month drug refill,” says Fredua-Agyeman. “The financial burden pulls the whole family down.”

Beyond the illness itself, women carry the added burden of paying for diabetes treatment and travelling long distances for routine care. Photo: MamaYe!

Ama says her expenses in recent years have spiralled. She was transferred from a local clinic to Accra Newtown Islamic Hospital for dialysis after developing kidney disease linked to poorly controlled diabetes and herbal usage. “Since Covid, I haven’t been well. Cost has been a problem. I went to a specialist. I didn’t want to do dialysis. The drugs are expensive.”

Geography compounds the issue. Rural communities often lack facilities nearby, forcing patients to travel long distances for routine checks. In Liberia, Hessou-Dickson notes: “Even when patients are willing, the nearest hospital might be hours away. By the time they arrive, their condition is often advanced.”

In some households, women are responsible for caring for children and managing food preparation, making it harder to dedicate time and resources to their own health.

Fredua-Agyeman says it is also common for patients to stop treatment midway. “We lose many patients to follow-up. They start treatment, but after a few months the cost becomes unsustainable. They disappear, and then return years later in crisis. That cycle is one of our biggest challenges.”

Cultural expectations can add another layer. In some households, women are responsible for caring for children and managing food preparation, making it harder to dedicate time and resources for their own health. The result is delay—not because women do not want to seek care, but because daily realities make it harder to do so consistently.

Herbal medicine and the risks of delay

Herbal medicine remains an important part of care for many women. Clinics frequently see patients who have alternated between prescribed treatment and traditional remedies—applied topically or consumed orally—that in some instances can worsen their condition.

“Unapproved or unauthorised herbal medications tend to make the disease worse,” says Fredua-Agyeman. “Not only are they not treating the diabetes, but they can also damage the kidneys.”

The consequences are clear in Ama’s experience. She tried every home remedy recommended to her—moringa, herbs, bitter root, powders—while still on medication. “I was desperate, looking for a cure,” she recalls. “Those things were not good. I regret listening to people.”

The Ghanaian state has long recognised this reality. The Centre for Plant Medicine Research in Mampong, established in 1975, works with traditional practitioners to study and develop plant-based treatments. But outside formal institutions, regulation remains weak, and risks remain high.

Shifting mindsets and working with beliefs

Clinicians know that dismissing cultural and spiritual beliefs outright is counterproductive. “We don’t tell patients their beliefs are untrue,” says Hessou-Dickson. “We explain that this disease also affects people abroad; here is another way to look at it.”

Respectful communication—explaining symptoms in plain language, linking them to visible processes, and validating patients’ beliefs while offering biomedical alternatives—can shift perspectives. “Healing is not just biological,” adds Fredua-Agyeman. “You cannot treat anyone without the psychological and social bit.”

Hessou-Dickson says education must be constant. “If you only visit once, people go back to what they know. But when they see us regularly, and we explain again and again, the mindset begins to change.”

This approach is reshaping outreach. In Ghana, health teams invite pastors and imams for in-service training on diabetes. “Once the spiritual leaders understand, they give us permission to address their congregations,” says Bashir. “Sometimes we even move clinics into prayer camps—setting up tables, screening for diabetes and hypertension, and starting treatment.”

“If we incorporate diabetes screening into antenatal visits, we capture the majority of women—since almost all pass through maternity care.”

In Liberia, community-based programmes have combined church networks, traditional leaders, and local health workers to expand access. A national NCD program trained more than 1,800 health workers and volunteers and screened over 311,000 people for diabetes, while supporting self-help groups and new rural clinics.

Notably, tailor-made approaches designed specifically for women are yet to be developed. One of the most concrete proposals for reaching women earlier comes from Bashir: “If we incorporate diabetes screening into antenatal visits, we capture the majority of women—since almost all pass through maternity care.”

Gestational diabetes is a known risk for future type 2 diabetes. Antenatal care offers a chance to screen, counsel, and normalise conversations about chronic disease. The World Health Organization (WHO) and IDF have both called for integrating diabetes services into primary care and reproductive health.

Building bridges in care

Clinicians in Ghana and Liberia converge on the same lesson: health systems make more progress when they work with people’s beliefs instead of against them. Whether inviting pastors and imams to training sessions, moving clinics into prayer camps, or adding blood sugar checks to antenatal visits, the strategies that stick are the ones that meet people where they are.

For women, that balance is lived every day. Amina reaches for both prayer and pills when her pain flares. “You need patience and resilience to go through this,” she says. “And you need faith. God gives hardship, and He gives relief.”

Ama’s experience tells a different part of the story. After years of trying herbal remedies alongside her prescriptions, she has come to accept diabetes not as something to cure, but something to manage. “I wanted to be cured,” she says. “I didn’t know I had to manage.”

*Names changed at interviewees’ request.