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By Annonciata Byukusenge
As non-communicable diseases (NCDs) such as diabetes continue to rise globally, Rwanda is taking bold steps to combat this growing public health challenge. 589 million adults (20-79 years) are living with diabetes worldwide, 1 in 9. The total number of adults with diabetes is predicted to rise to 853 million by 2050. 1 in 8; 4 in 5 adults with diabetes (81%) live in low- and middle-income countries.
Edson Hirwa wakes up at 7 am every morning. His main activity consists of cleaning and sanitation at home, where he lives with his grandmother, located in Rukira, a remote rural village in Huye District in southern Rwanda.
The 17-year-old young man never envisioned that he would live an unhappy life due to a setback in his life and a diabetes diagnosis that caused him to drop out of school.
“Children with diabetes face various problems because when parents are not aware of their child’s illness, they treat them without knowing what the problem is. Doctors also do not immediately think that even minor illnesses can be caused by diabetes. This leads to the child being given medications that are not appropriate for the disease, causing the child to drop out of school, as happened to me.” Said Hirwa.
A 2021 survey conducted by the Ministry of Health in collaboration with the World Health Organization revealed that 2.9% of Rwanda’s population, approximately 203,344 people, live with diabetes. Alarmingly, many remain undiagnosed, presenting a significant public health challenge.
Hirwa was born without any chronic diseases. When he was in third primary school, he began to feel unwell, but the cause of his illness was not immediately known.
In an interview with The Forefront Magazine, Hirwa was with his grandmother. His grandmother raised him since he was five years old because his biological mother had separated from his father.
“Because of the difficult living conditions in our family, his father could not take care of him. He would wake up early in the morning to go and get food for the child and return home in the evening. I immediately started raising this child so that he would not suffer from malnutrition or become weak due to lack of care.” Said his grandmother.
Hirwa continued his studies in primary school; they continue to treat him, but the disease has not yet been identified. When he was in the fifth primary school, he was 13 years old. The doctor told his father, who was taking him to the hospital, that the test results showed that Hirwa had diabetes.
Hirwa started taking diabetes medication because he had been treated for an unknown disease 8 years ago.
“Because we didn’t have enough food, we gave Hirwa diabetes medication, and he would be late to school because the medication was too much for him. The teacher would immediately call a neighbor and tell him to go and pick up the child, who was seriously ill.” Said his grandmother.
In 2022, Hirwa took the national exam and passed it with good grades, going on to study at secondary school.
When he was at school, he continued to suffer from illness and returned home several times during the semester, which prevented him from attending classes properly.
Hirwa said, “Because of the food the doctor told my father that I should eat, I didn’t see it at school; I ate what others ate. The food had salt in it, and they forbade me to eat it; the school snacks or tea had sugar in them, and they forbade me to drink them. My father couldn’t afford to give money to the school so they could buy and cook for me.”
After one year in 2023, Hirwa dropped out of school due to a lack of food and treatment for his illness because when he went to the doctor, his measurements did not change but rather regressed.
“After I left school, my grandmother and father did everything they could to provide me with food that would help with my illness and not give me sugar and salt, as the doctor had said.”
Symptoms
Symptoms of diabetes may occur suddenly. In type 2 diabetes, the symptoms can be mild and may take many years to be noticed.
Symptoms of diabetes include:
- feeling very thirsty
- needing to urinate more often than usual
- blurred vision
- feeling tired
- losing weight unintentionally
Over time, diabetes can damage blood vessels in the heart, eyes, kidneys, and nerves.
It is not just young people who are particularly susceptible to diabetes, as there are also children under the age of five who suffer from diabetes.
According to the Prevalence and Incidence of Clinically Recognized Cases of Type 1 Diabetes in Children and Adolescents in Rwanda, Africa, the prevalence of known Type 1 diabetes in seven districts in Rwanda for ages < 26 years was 16.4 [95% CI 14.6–18.4]/100 000 and for < 15 years was 4.8 [3.5–6.4]/100 000. Prevalence was higher in females (18.5 [15.8–21.4]/100 000) than males (14.1 [11.8–16.7]/100 000; P = 0.01), and rates increased with age. The annual incidence rate for those < 26 years was stable between 2007 and 2011, with a mean incidence over that time of 2.7 [2.0–3.7]/100 000 (< 15 years = 1.2 [0.5–2.0]/100 000). Incidence rates were higher in females than in males and peaked in males at ages 17 and 22 years and in females at age 18 years.
Diane Mwizerwa is a mother who lives in the Mwiri sector, Kayonza district. She has a kid of 14 months old.
After giving birth, Mwizerwa made an effort to take care of her child because she is her firstborn. For three months.
“When my baby was three and a half months old, she started showing signs of being stunted because she wasn’t gaining weight or growing taller, and I was breastfeeding her properly. This prompted the pediatrician to recommend that I start her on medication and run tests to determine what the problem was. I have diabetes, but when my baby was born, they tested her and found that she didn’t have it.”
She added that the child is being properly monitored because she stopped breastfeeding her at 6 months old, as told by a doctor.
Estimated global deaths from diabetes
According to Santé Diabète, the estimated global deaths from diabetes in 2024 were 3.4 million, which is equivalent to one death every six seconds.
2021: 1.62 million deaths where diabetes was the primary cause, and a larger number when it was a contributing factor.
2017: Approximately 5 million deaths were attributed to diabetes in the 20–99 year age range.
Challenges
Hirwa’s grandmother says that the biggest challenge they face is the high cost of diabetes medication and limited resources.
She says, “We are lucky that diabetes medication is included in the health insurance (Mituweli), and we can buy it at a low price.” Hirwa takes two types of medication every month, which cost 15,000 Rwandan francs. This is a lot of money for a poor family.”
She added that parental involvement is very important because some parents think that their children are poisoned by their neighbors because they are not aware of diabetes.
For Hirwa, diabetes caused him to drop out. “I need to go back to school, but my father is not able to pay my school fees. If there is any support from them, I am ready to go back to school, because the results of my illness are good.”
To address this growing issue, Rwanda’s Ministry of Health, in partnership with key stakeholders, in November 2024 launched a nationwide awareness campaign with the theme “Baho Neza Wirinda Diabete: Isuzumishe,” or “Live Well, Prevent Diabetes: Get Screened.”
The campaign has three core objectives
1. Raising awareness about diabetes and other NCDs.
2. Promoting early diagnosis and prevention efforts.
3. Engaging community leaders to support multi-sectoral initiatives aimed at combating NCDs.
Nationwide Activities for Awareness and Prevention
A central component of the campaign is offering free screenings for diabetes and other NCDs across the country. This initiative aims to promote early detection, which is vital for effective management and the prevention of complications. Rwanda Intensifies Fight Against Non-Communicable Diseases.
National NCD settled the Strategy 2020-2025 plan. A successor to the 2014-2019 strategy, it aims to reduce premature mortality from NCDs by 25% by 2025. It explicitly focuses on improving access to high-quality NCD services for all Rwandans, which includes diabetes care for young people.
Global trends and incidence of diabetes in children and adolescents
Globally, the incidence of diabetes among children and adolescents has demonstrated a significant annual increase over the past 32 years, rising from 25.77 per 100,000 in 1990 to 49.99 per 100,000 in 2021, reflecting an approximate 94.0% increase. The total number of diabetes cases escalated from 581,949 in 1990 to 1,317,669 in 2021. The prevalence of both type 1 and type 2 diabetes has increased, with type 2 diabetes rates surpassing those of type 1 diabetes (Supplementary Figure S1). According to the Analysis of the global burden of diabetes and attributable risk factors in children and adolescents across 204 countries and regions from 1990 to 2021
An estimated 9.5 million people are living with T1D globally (compared to 8.4 million in 2021, a 13% increase), with 1.0 million of these aged 0–14 and 0.8 million aged 15–19 years. In lower-income countries, prevalent cases increased by 20% from 1.8 million in 2021 to 2.1 million in 2025. Incident cases in 2025 are an estimated 513,000 (164,000 aged 0–14 and 58,000 aged 15–19 years), with incidence increasing by 2.4% in the last year. Premature deaths are estimated at 174,000, with 17.2% of these due to non-diagnosis soon after clinical onset. The estimated remaining life expectancy of a 10-year-old child diagnosed with T1D in 2025 varies between countries from 6 to 66 years. There are still no data available for 119 countries. The projected T1D population for 2040 is estimated to be 14.7 million. Global type 1 diabetes prevalence, incidence, and mortality estimates for 2025: Results from the International diabetes Federation Atlas, 11th Edition, and the T1D Index Version 3.0
The Cabinet meeting held on January 17, 2025, approved health sector strategies that include increasing the coverage of critical medical services by the Mutual Health Insurance Scheme known as Mituweli to improve the health of Rwandans. These include cancer treatment, heart disease, dialysis, and kidney replacement; advanced surgeries using technology, such as hip, knee, spine, and other surgeries; as well as prosthetics and prosthetics. The prices also had changed, but for diabetes medication, the price is still challenging for people with diabetes.
