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

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.

Figure 1.

Deep ulceration and exudate in the caecum of a patient with amoebic colitis.

Figure 2.

Extensive inflammation in the sigmoid colon of a patient with amoebic colitis.

Figure 3.

Circumferential ulceration and inflammation in the caecum in a patient with intestinal tuberculosis.

Figure 4.

An endoscopic procedure being performed in the GI clinic at University Teaching Hospital, Lusaka, Zambia.

Figure 5.

Endoscopy session at Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria.