Diabetes prevention, early detection, management and treatment In
Download
Report
Transcript Diabetes prevention, early detection, management and treatment In
Prospects of Diabetes
in Sudan
Mohamed Ali Eltom
Summarize the past
Rescale the present
Predict the future
Sudan after 9 July
Diabetes prevalence
National Diabetes Survey 1993
0.1%
3.4%
2.1%
5.5%
8.3%
14 %
6.0 %
4.0 %
1.0 %
Type 1 Diabetes
Crude prevalence
Unknown Diabetics
in the Northern State
in Dongla
in Argo
in Khartoum State
in Gezeira State
in North Kurdofan State
Sudan Household Health Survey 2006
Diseases
Valid
Missing
Frequency
Valid Percent
Hypertension
429,651
22.0
Diabetes
235,446
12.0
Heart Disease
46,443
2.4
Cancer
5,115
0.3
Epilepsy
18,137
0.9
Asthma
179,287
9.2
Thyrotoxicosis
67,509
3.4
Hypothyroidism
57,736
3.0
Glaucoma
105,928
5.4
Cataract
110,060
5.6
Mental Health
59,220
3.0
Others
585,691
29.9
DK
23,162
1.2
Missing
33,663
1.7
Total
1,957,048
System
28,108,952
Total
30,066,000
100.0
Percentage of Raised blood glucose (≥7mmol/l)
19.20%
Raised BG
non raised BG
80.80%
Natural History of Diabetes
Poor glycaemic control, adequate control
only in 12%
Low quality of life
Acute and long-term complications are
common (67%)
High mortality rates among children
Micro vascular complications
Retinopathy 43%
Nephropathy 22%
Neuropathy 37%
Macrovascular complications
Cardiovascular disease 28%
Peripheral vascular disease 10%
Cerebrovascular accidents 5.5%
Factors Related to Poor Metabolic
Control
Deficient patients awareness and
compliance
Unaffordability and unavailability of drugs
and monitoring equipment
Reduced level of well organized diabetes
care
Poor health service organization
Challenges to diabetes care in
Sudan
Inadequate Financial Resources
Insufficient Health care system
Professionals
Patients
Difficulties experienced in diabetes
care
Patients
Limited access to care : less than 20% of
patients have access to minimum standards of
care + urban/rural differences
Insulin, other medications and supplies for
testing metabolic control
Involvement of patients and families
Difficulties experienced in
Diabetes Care
Patients, cont.
Lack of awareness and the challenge of
self- management
Reluctance to become empowered and
self- managing
Standards and materials for education
Diabetes Education Facilities
Education is offered by doctors in a busy
clinic atmosphere
Diabetes educator has not been integrated in
diabetes management
No national diabetes patient education programs
to define patient goals, monitor progress and
evaluate achievement
Lack of educational materials and equipment
Diabetes Control Among Low and
High Income Parents
80
70
60
50
40
30
20
Diabetes control
10
Poor
0
Good
low income
high income
Income Group
Acute Complications of Diabetes
Ketone bodies in urine: 45.6%
Hypoglycemia that needed special
attention: 37%
Hospital Admission
56.6 % admitted at least once to
the hospital within a year
Main causes
Diabetic ketosis: 71.8%
Hypoglycemia:
5.9%
Malaria:
10.6%
Other medical disorders
or surgical intervention:
9.4%
Families pay a considerable part of their income and receive
insignificant support other than that from relatives and friends
The direct cost of diabetes care requires 23% of the available
economic resources of the parents
The low costs reflect the minimal care given to the diabetic
patients
The present organization of diabetes care does not provide the
patient with empowerment, knowledge and self-care ability
Well-trained diabetic teams and education programs may
improve this situation
Prevalence 2025
Estimate 16%
(more than 3 Million Diabetic)
Action
Primary prevention programs
Organized educational programs and
proper medical services
National Diabetes Policy
Federal and state governments have identified
priorities and agreed on an approach to:
Diabetes prevention, early detection,
management and treatment
In partnership with key organizations and
service providers
www.diabetesinsudan.org
Areas of Development
Primary prevention strategies
Approved guidelines
Optimum practice models for service delivery
Partnerships between the different
stakeholders in the diabetes sector
Alternative methods of funding for diabetes
prevention and management
Integrated Approach to Prevention
and Care
1. Promotion of Healthy Life-Styles
2. Raising Community Awareness
3. Primary Prevention at onset
4. Screening for Type II DM
5. Development of National Strategy
Optimum Practice Models
for Service Delivery
Quality Care Diabetes Facilities (QCDF)
MDC in 25% of Primary Health Care Centers
(1 MDC for a catchment area of 4000 diabetic)
1 Diabetes Referral Unit for every 4 MDC
Distribution of QCDF in the Country
According to Prevalence Levels
Prevalence
MDC
Unit
High
60
15
Moderate
40
10
Low
20
5
International Relations
Health Diplomacy
IDF
WDF
World Summit
Regional Relations
Arab
African
Arab World
High income
Gulf States
Middle income
• Egypt
•Jordan Syria
•Lebanon
•Libya
•Algeria
•Morocco
•Iraq
• Palestine
Low income
Research
Training
Education Material
Human Resources
Philanthropies
Civil Societies
• Sudan
• Yemen
• Djibouti
• Somalia
• Mauritania
Cardiovascular risk factors (%) among
adults in four Arab countries 2005
Country
Diabetes
Hypertension
High
Cholesterol
Egypt
16
33
24
Jordan
16
25
26
Kuwait
16
24
19
Sudan
12
23
19
Cardiovascular risk factors (%) among
adults in four Arab countries
Country
Smoking
Overweigh
& Obese
Low
physical
activity
Egypt
22
76
50
Jordan
29
67
?
Kuwait
16
?
92
Sudan
12
54
87
موضة التدخين من الصعيد
إلى الســـــودان
Bilateral Relations
Egypt
Jordan
Saudi Arabia
Sweden
Diabetes Care in the Nile Valley
شكرا
رمضان كريم