Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective

Gill Watermeyer; Leolin Katsidzira; Bright Nsokolo; Olusegun Isaac Alatise; Babatunde M Duduyemi; Chris Kassianides; Phoebe Hodges

doi:10.1177/17562848231184986

Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective

Therap Adv Gastroenterol. 2023 Jul 12:16:17562848231184986. doi: 10.1177/17562848231184986. eCollection 2023.

Authors

Gill Watermeyer¹, Leolin Katsidzira², Bright Nsokolo³, Olusegun Isaac Alatise⁴, Babatunde M Duduyemi⁵, Chris Kassianides⁶, Phoebe Hodges⁷

Affiliations

¹ University of Cape Town and Groote Schuur Hospital, Anzio Road, Observatory, Cape Town 7945, South Africa.
² Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
³ School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia.
⁴ Division of Gastrointestinal/Surgical Oncology, Department of Surgery, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria.
⁵ Department of Pathology, College of Medicine and Allied Health Sciences/Teaching Hospitals Complex Highest University of Sierra Leone, Freetown, Sierra Leone.
⁶ Department of Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa.
⁷ Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK.

Abstract

With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.

Keywords: Crohn’s disease; diagnosis; endoscopy; histopathology; inflammatory bowel disease; radiology; sub-Saharan Africa; therapy; ulcerative colitis.

Publication types

Review