As I recollect my 2018 journey to Gaborone, Botswana, I reflect on a journey deep-rooted in history, culture, education, good governance, among others, and the kindred spirit of Batswana (in plural, meaning Botswana people). I remember feeling at home—in Africa, the place of my lineage, the place where the fabric of my existence comes from. I traveled to the capital of Botswana—Gaborone, the largest city in the country (pronounced hab-ah-ro-nee) on a journey unlike any other journey I have experienced before in traveling around the world. This journey was different and left a lasting imprint in the collection of my experiences, both as a researcher and a muse to traveling abroad. I had the opportunity to network with academicians, practitioners, policy makers/government officials, and researchers on discussions surrounding socioeconomic matters, political affairs, good governance, education, health and wellness, and other discussions that I found exemplary and that which gave meaning to the importance of partnerships and capacity building. Each moment of my experience leveraged my ability, as a researcher, to build opportunities that enhance the significance of my research interests in health promotion and disease prevention. As a PhD scholar at Howard University, my specific interests in research is to examine gene-expressions in the pathophysiology of Type 2 Diabetes Mellitus (T2DM) and to essentially identify nutritional imbalance on biomarkers of genetic risk factors for T2DM in Africans and African-Americans, a population most disproportionately affected by the disease.
The purpose of my trip was to present my research paper, “Globalization and Nutrition in Botswana to Combat Type 2 Diabetes Mellitus” at the University of Botswana during the 11th International Conference of the Consortium for International Management, Policy and Development (CIMPAD). CIMPAD is a United States-based organization headquartered in Washington, DC and its mission is to develop public-private partnerships in public administration, public management, public policy, and leadership development among practitioners and academicians in various African countries and the African Diaspora which it has done over the last 20 years. I authored my research paper during my first year as a PhD student at Howard University, during the 2017-2018 academic year. I became affiliated with CIMPAD when I presented a research paper at Howard University during an annual CIMPAD meeting in 2016. My presentation then focused on my Master of Science graduate studies at George Mason University which drew emphasis on global health issues and prevention collaborations. This past academic year, I developed my research paper, “Globalization and Nutrition in Botswana to Combat Type 2 Diabetes Mellitus” with the goal of discussing nutrition and globalization at the country-level and in the global spectrum with a specific focus on Botswana. I chose to do research on Botswana because of the opportunity I had to travel there with CIMPAD during its conference and as a starting point to the beginning of my research activities in African countries over the next several years of my research career. My research paper covered topics on global food and nutrition policies, global diabetes prevalence, malnutrition leading to T2DM, food-based dietary guidelines, food systems management and resource integration, and nutrition interventions in the fight against T2DM.
The second arm to the purpose of my trip to Botswana was to conduct an empirical assessment of findings on dietary patterns in African countries (like Nigeria, Zambia, Namibia, South Africa, and Zimbabwe) with emphasis in Botswana. The impetus of my assessment in Botswana was to collect data about dietary patterns in a low- to middle-income developing nation to develop nutrition education programs and interventions that demonstrate the relationship between dietary patterns and obesity. This is important to understand because there are a range of factors that contribute to the onset of non-communicable diseases (NCDs) like T2DM which include diet, lifestyle, environment, and familial factors. My research activities in Botswana, together with my doctoral studies at Howard University are ultimately intended to address the pathophysiology of T2DM.
Diabetes in general is increasingly becoming a widespread disease across nations around the world and more markedly, in low- and middle-income countries according to the World Health Organization (WHO). In the global spectrum, diabetes prevalence rates increased from 104 million in 1980 to 422 million in 2014 according to the WHO. The pathology of T2DM is associated with inadequate amounts of insulin produced by the human body or when insulin resistance has developed. This leads to unregulated levels of blood glucose which, in effect, may lead to morbidity and mortality if not controlled. The short- and long-term complications of the disease include hypoglycemia, hyperglycemia, and micro- and macrovascular complications. T2DM is one category of diabetes and globally, is the one category that accounts for the greater majority of people living with the disease around the world. In particular, T2DM is positively linked to diet which is the cornerstone of an individual’s overall environment and that which has a major influence on health and disease prevention.
Nations across the world categorized as low- to middle-income nations, including some African nations like Botswana, ever and again lack resources, supportive environments, and healthcare access to help prevent or combat the onset of NCDs. Individuals and families in low- to middle-income countries thus are at the greatest risk for morbidity and mortality from these diseases. From a nutritional science perspective, understanding the dietary patterns in any community is important in understanding how to develop nutrition interventions aimed to promote health. Thus, my academic research campaign, Bridging Partnerships: US to Africa (which I created to bring awareness to diabetes and to raise funding for my travel to Botswana) sought to utilize various resources to empirically examine dietary patterns among Batswana to compare and evaluate quantitatively and qualitatively if food affects obesity rates and associated co-morbidities. The results from my empirical assessment will be prepared into a final manuscript for publication to contribute to scholarly dialogue into health promotion and disease prevention.
The discussion from my research paper at the University of Botswana on globalization and nutrition in Botswana to combat T2DM highlighted the Sustainable Development Goals (SDG) of the United Nations. Namely, SDG Goal 3: Good health and well-being. SDGs are global targets developed by the United Nations, intended to address issues on health, hunger, water, poverty, education, social justice, and other socioeconomic issues in the global sphere. My discussion touched on priorities on food and nutrition and the need for capacity building at the country-level to strategically tackle food security issues for better nutrition. I presented three provoking questions to the audience attending the 11th International Conference of CIMPAD, which were:
- What are the current trends affecting nutrition, hunger, and food security?
- Is globalization a spent force or can it still improve food security issues? and
- How can global governance structure be enhanced to better address malnutrition?
The answers to these questions were multi-faceted in addressing what needs to be done to combat these issues, which require:
- Investing more in research and innovation for food systems to make healthy food available
- Promoting cooperative and mutual learning to accelerate the end of malnutrition
- Leveraging new technologies and knowledge-sharing opportunities and
- Promoting good governance to develop and implement policies to uphold SGDs
The premise for the outcomes of my discussions were centered on nutrition education (including nutrition interventions) and the importance of good governance to develop and implement effective nutrition education programs that target how to fight against risk factors associated with T2DM.
Over the next decade or more, the WHO projects an 80% increase in diabetes diagnosis in Botswana—an abysmal growth projection. It is important to note that an increased mortality rate resulting from NCDs, like T2DM, was 21% among persons between the age of 30 and 70, according to the WHO, from 2000 to 2012 and is a growing endemic in Botswana. More striking, as reported by the WHO in 2016, in Botswana, women were more disproportionately affected by the prevalence of diabetes. Statistics revealed that women over the age of 70 were in a greater state of vulnerability. According to the WHO, mortality rates for males age 30 to 69 was n < 100 vs. females age 30 to 69 where n = 190 and for males over the age of 70, n < 100 vs. females over the age of 70 where n = 220. The number of deaths in Botswana attributable to risk factors associated with T2DM was a significant contributor—high blood glucose and in a 2016 statistical publication on high blood glucose mortality linkages, the WHO reported: males 30 to 69, n = 160 vs. females 30 to 69, n = 250 and in males over the age of 70, n = 100 vs. females over the age of 70, n = 310. My research paper revealed the risk factors linked to diabetes prevalence in Botswana, which of course includes high blood glucose as well as poor dietary patterns, overweight, obesity, and physical inactivity.
Aside from food security, resource integration, and diabetes prevalence, I discussed, in my presentation at the University of Botswana, malnutrition as a global endemic. Malnutrition is the condition, affecting nearly 1.9 billion adults worldwide and results from eating a diet where one or more nutrients are either not sufficient or are in excess such that the diet causes health problems. Adding to this burden are women of reproductive age globally who are disproportionately affected. In 2016, the United Nations promulgated its stance on combating malnutrition as declared under the United Nations Decade of Action on Nutrition 2016-2025 plan. The United Nations aims to catalyze policy commitments that result in measurable action to address all forms of malnutrition. The aim there is to ensure that all persons, irrespective of socioeconomic status, has access to healthier and more sustainable diets to eradicate all forms of malnutrition worldwide.
During my presentation, I shared insights on nutrition interventions to combat diabetes and the need for multi-sectorial global partnerships in Africa, and in Botswana in particular, to spur development and implementation efforts. By and large, multi-component interventions are necessary, viable solutions to combat T2DM requiring the formulation of behavior change in adopting healthy diets, healthy dietary patterns, and physical activity keenly designed at the individual-level and established as a life course towards prevention to fight against T2DM.