Effectiveness of the Diabetes Prevention Program in Urban Bamako, Mali: Small Steps, Big Rewards - Project Abstract
As African countries rapidly urbanize, they face new service delivery challenges to address the rapid rise of non-
communicable diseases in cities, where women bear an exceptional portion of this burden. While access to
medical management of these conditions is receiving attention, culturally appropriate approaches are needed to
address the behavioral components including changes to diet and physical activity habits. We propose an
innovative adaptation of the Centers for Disease Control and Prevention’s Diabetes Prevention Program “Power
to Prevent” program, which we will develop and pilot in the low-income peri-urban neighborhoods of Bamako,
Mali. This program is well-suited to delivery by the city’s community health workers already supporting families
in improving maternal and child health outcomes. First, we will use participatory research methods to engage
them and community residents in making adaptations to the community health worker’s guidelines and tools for
recommended activities so that they are linguistically and culturally appropriate, including guidelines for food
consumption using locally available foods. These adaptations will use more graphics and photographs, so they
are appropriate for low-literacy participants. Second, another key innovation is the explicit orientation to
couples, where only one may have a diagnosed cardiovascular disease. Our adaptation will provide tools
the women can use in negotiating for changes to the family’s meals and her daily routine. Third, we will conduct
a comparative effectiveness study at 6 community health centers with high rates of CVD, recruiting adults
recently diagnosed with diabetes or hypertension. Based on the random allocation of their community health
center, participants will be assigned to one of three groups of 150 each: Couples, with at least one meeting the
eligibility criteria; Individuals, men and women, both eligible; Comparison, men and women with CVD. Trained
community health workers and diabetic peer educators will use the adapted DPP materials with the Couples and
Individuals groups over a period of 12 months. At the conclusion of this pilot we will assess the levels of
adoption of recommended cardiovascular risk reduction behaviors and changes in obesity,
hypertension, and diabetes control, comparing differences in outcomes between the three groups. Our
work will enable Mali to incorporate diabetes and hypertension risk reduction into their already deployed networks
of community health workers. A successful pilot will be followed by a larger scale study with full integration into
the Malian health care system, potentially then reaching women and their families. The Malian DPP adaptation
will also be suitable for Francophone West Africa, where customs and lifestyles are similar among the millions
of families confronting the burdens of cardiovascular disease.
