1 47% of the global population has little to no access to diagnostics. 2 Diagnostics are central and fundamental to quality health care. This notion is underrecognised, leading to underfunding and inadequate resources at all levels. 3 The level of primary health care is the diagnostic so-called last mile and particularly affects poor, rural, and marginalised communities globally; appropriate access is essential for equity and social justice. 4 The COVID-19 pandemic has emphasised the crucial role of diagnostics in health care and that without access to diagnostics, delivery of universal health coverage, antimicrobial resistance mitigation, and pandemic preparedness cannot be achieved. 5 Innovations within the past 15 years in many areas (eg, in financing, technology, and workforce) can reduce the diagnostic gap, improve access, and democratise diagnostics to empower patients. 6 As an example of the potential impact, 1•1 million premature deaths in low-income and middle-income countries could be avoided annually by reducing the diagnostic gap for six priority conditions: diabetes, hypertension, HIV, and tuberculosis in the overall population, and hepatitis B virus infection and syphilis for pregnant women. 7 The economic case for such investment is strong. The median benefit-cost exceeds one for five of the six priority conditions in middle-income countries, and exceeds one for four of the six priority conditions in low-income countries, with a range of 1•4:1 to 24:1.Given the depth and breadth of the problems, sustained access to quality, affordable diagnostics will require multi-decade prioritisation, commitment, and investment.Incorporating diagnostics into universal health coverage packages will begin this process.

OBJECTIVE -The purpose of this study was to assess glycemic control and complications of type 1 diabetes in children and adolescents in Tanzania. RESEARCH DESIGN AND METHODS -This demographic and clinical survey in-cluded 99 children aged between 5 and 18 years attending Muhimbili National Hospital Clinic for Diabetes. A structured questionnaire was used for evaluating socioeconomic data and for estimation of the prevalence of acute complications occurring over the last 6 months. The prevalences of retinopathy and diabetic nephropathy were determined by fundus ophthalmoscopy and by microalbuminuria, respectively.RESULTS -All of these children were treated with a conventional insulin regimen. The mean Ϯ SD duration of diabetes was 4.76 Ϯ 3.58 years. Only 1 child (1%) had good glycemic control (A1C Ͻ7.5%), 60 children (60.6%) had moderate glycemic control (A1C 7.5-10%), 14 children (14.1%) had poor glycemic control (A1C Ͼ10 -12.5%), and 24 children (24.2%) had very poor glycemic control (A1C Ͼ12.5%). At onset of diabetes, 75% of children presented with diabetic ketoacidosis (DKA); 89 children (89.80%) had at least one episode of DKA, and 55 children (55.67%) had symptomatic hypoglycemic episodes. Microalbuminuria was present in 29 (29.3%) and retinopathy in 22 (22.68%) children.CONCLUSIONS -Although there are some methodological limitations, this survey highlights the difficulties of achieving good metabolic control and the high prevalence of acute and chronic complications in Tanzanian children with type 1 diabetes. These results clearly show that major efforts are needed to improve quality of care in children with type 1 diabetes in Tanzania. Diabetes Care 30:2187-2192, 2007T ype 1 diabetes is one of the most frequent chronic disease in children and represents a public health challenge globally. Its burden is huge in developing countries owing to the lack of a basic means for reaching reasonable glycemic control. Because of the unavailability of reliable epidemiological data, the natural history of type 1 diabetes, including its complications, is largely unknown (1). With the few data available on subSaharan African children, incidence in Tanzania was estimated to be 1.5/ 100,000 (2), and an increase in incidence in Sudan from 9.5/100,000 in 1991 to 10.3/100,000 in 1995 has been reported (3). The prevalence is higher in Western countries (4,5), suggesting the possibility of missed diagnosis in sub-Saharan Africa. In fact, the problem of missed diagnosis of childhood diabetes, although not unique to developing countries (6), is certainly much more common than in developed countries (7). In a Sudanese study, it was reported that 10% of children were not admitted at the time of diagnosis, being admitted only after they developed diabetic ketoacidosis (DKA) or hypoglycemia (3). This situation contributes to omission of patients in the registry as well as to the possibility of death before diagnosis, especially for those aged Ͻ5 years. In sub-Saharan Africa, most children present with DKA at the time of diagnosis (8,...

The prevalence of some noncommunicable diseases (NCDs) in East Africa is beginning to match that in high-income countries. Though the epidemiologic, demographic, and nutritional transitions are well under way in low-income countries, investment and attention in these countries remain focused largely on communicable diseases. We discuss existing infrastructure in communicable disease management as well as linkages between noncommunicable and communicable diseases in East Africa. We describe gaps in NCD management within the health systems in East Africa. We also discuss deficiencies in addressing NCDs from basic science research and medical training to health service delivery, public health initiatives and access to essential medications in East Africa. Finally, we highlight the role of collaboration among East African governments and civil society in addressing NCDs and advocate for a robust primary healthcare system that focuses on the social determinants of health.

Tanzania has made considerable progress towards reducing childhood mortality, achieving a 57% decrease between 1980 and 2011. This epidemiological transition will cause a reduction in the contribution of infectious diseases to childhood mortality and increase in contribution from noncommunicable diseases (NCDs). Haemoglobinopathies are amongst the most common childhood NCDs, with sickle cell disease (SCD) being the commonest haemoglobinopathy in Africa. In Tanzania, 10 313 children with SCD under 5 years of age (U5) are estimated to die every year, contributing an estimated 7% of overall deaths in U5 children. Key policies that governments in Africa are able to implement would reduce mortality in SCD, focusing on newborn screening and comprehensive SCD care programmes. Such programmes would ensure that interventions such as prevention of infections using penicillin plus prompt diagnosis and treatment of complications are provided to all individuals with SCD.

Strengthening Primary Health Care Systems is the most effective policy response in low-and middle-income countries to protect against health emergencies, achieve universal health coverage, and promote health and wellbeing. Despite the Astana declaration on primary health care, respective investment is still insufficient in Sub-Sahara Africa. The SARS-CoV-2019 pandemic is a reminder that non-communicable diseases (NCDs), which are increasingly prevalent in Sub-Sahara Africa, are closely interlinked to the burden of communicable diseases, exacerbating morbidity and mortality. Governments and donors should use the momentum created by the pandemic in a sustainable and effective way by pivoting health spending towards primary health care.