**1.1 Sub-Saharan Africa and diabetes**

Sub-Saharan is the term used to describe the area in the continent of Africa that is below the southern border of the Sahara Desert. It is a savanna grassland with some trees. Sub-Saharan Africa has about 42 countries and 5 islands, which are different geographically and culturally. It has a landmass of 23,890,896.1 sqm as o 2020 with 1.17 billion people. The annual population growth is 2.6%, and the GDP per capita is 1.92 (World Bank 2020). The number of prevalent (existing) cases of type 1 diabetes is 1,211,900. The number of incident (new) cases of type 1 diabetes per year is 149,500.

Diabetes mellitus used to be a disease of the developed countries, more so in children. However, the recent global data shows that about 536.6 million adult people with diabetes live in Africa, with the projection of 783.2 million people in 2045. In children up to 19 years, the number is at 1.2 million, with 184,100 new diagnoses each year (IDF Atlas). Among these, 1,211,900 are children aged 0–19 years with type 1 diabetes and 149,500 are those diagnosed yearly with type 1 diabetes. All of these are affected by missed diagnosis, which reaches to about 53.6% of the population in Africa, which is 72 million people (IDF). Few studies have been done on the prevalence and incidences of diabetes in children in Africa, and most of the prevalence studies are hospital based. The few incidence studies that have been carried out range from 1.9 to 11.2/100,000 population (**Table 1**) [6, 7].

There is variation in the incidence of diabetes in children in sub-Saharan Africa by region, with the population in the horn of Africa (e.g., Eritrea 11.2/100,000 population and Sudan 10.3/100,000) [6, 8] more affected compared to western regions (e.g., Nigeria 3.1% and Cote devoir 0.4%) [10, 11]. Probably, these are the regions that have more of missed diagnosis and early deaths, or it is true that there is less incidence of diabetes in those areas.
