Transcript Obstacles of optimum care of diabetic children in Palestine

Obstacles of optimum care for
diabetic children in Palestine
Prepared by Dr.Intisar Al-Alem
November 2008
What is Type 1 DM ?

Type 1 DM (T1DM) is used to denote childhood diabetes
associated with autoimmunity and absolute insulin deficiency

Type 1 diabetes is a condition in which the pancreas makes
so little insulin that the body can't use blood sugar for energy

Type 1 diabetes must be controlled with daily insulin shots
Management of Diabetic Children

Diabetic children should be offered an ongoing integrated
package of care by a multidisciplinary paediatric diabetes care
team (optimum care & reduction of complications)

Diabetic children and their families should be offered 24-hour
access to advice from the diabetes care team.
Epidemiology of Type 1 DM

Globally, about 500,000 children under the age of 15 with T1DM

Every day 200 children develop T1DM

Every year, 70,000 children under the age of 15 develop T1DM

T1DM is increasing in children at a rate of 3% each year

T1DM is increasing fastest in pre-school children, at rate of 5%
per year

In Palestine until now we havnt true statistics
Diabetic children in government PHC diabetic clinics ,
West Bank (2006)
Total number of diabetics
Type1 diabetics
ALKhaleil
3187
282
Nablus
4288
197
Jenin
4381
250
Ramallah
1140
137
Bethlehem
1198
193
Tulkarm
1672
128
Al-Quds
766
36
Qalqiliah
1160
49
Salfit
862
36
Jericho
570
34
Distribution of reported new registered cases of diabetic children in
government PHC diabetic clinics , West Bank 2007
Age group
0-4
4-14
0-14
Sex
M
F
M
F
M
F
West Bank
4
4
32
24
36
28
ALKhaleil
0
1
4
3
4
4
Nablus
1
1
5
4
6
5
Jenin
1
2
6
5
7
7
Ramallah
1
0
8
1
9
1
Bethlehem
1
0
1
2
2
2
Tulkarm
0
0
3
5
3
5
Distribution of reported new registered cases of diabetic children
in government PHC diabetic clinics , West Bank 2007
Age group
0-4
4-14
0-14
Sex
M
F
M
F
M
F
Al-Quds
0
0
2
0
2
0
Qalqiliah
0
0
0
2
0
2
Salfit
0
0
1
0
1
0
Jericho
0
0
2
2
2
2
Population in
West Bank
194029
198119
330938
326970
524967
525089
Incidence rate
(per 100,000)
2.1
2.0
9.7
7.3
6.9
5.3
Diabetic clinics in Palestine
Specialized diabetic clinics began in 1987
 now there are 10 clinics one in each district & also
many small clinics in villages (4 in Nablus, 9 in Jenin &
4 in Hebron) which are operating according to an
organized program

These clinics provide medical services for about
20000 diabetic patients in the west bank

There is coordination between central clinic in the city
,those in the villages & also between diabetic clinic &
governmental hospitals.

Diabetic children are followed-up with other diabetics
Obstacles of optimum care for diabetic children
in Palestine

Political Obstacles

National Obstacles

Obstacles (MOH)

Psychosocial obstacles
Political Obstacles

Lack of communication between Gaza &west bank

Siege &check points make access to clinics difficult,
especially for those who are living in far areas

Economic problems
National Obstacles

Lack of cooperation & coordinated between health providers

Lack of national treatment guidelines

Shortage of human and financial resources

Lack of important specialists

Lack of screening and early detection activities

There is no statistical information and studies to estimate the
real side of the problem
Obstacles (MOH):

Until now there are no specialized clinics for care of diabetic
children in MOH & those patients are followed-up among others

Shortage of well trained medical staff who provide care for
diabetic children

Lack of some important specialties pediatric endocrinologists,
vascular surgeons, ophthalmologists, podiatrists, chiropodists,
health educators and dieticians

Trained physicians &nurses are not enough for this number of
patients.

Because of work over load there is no enough time or space to
provide appropriate health care or education
Obstacles (MOH):

Lack of materials, drugs and equipments necessary for
proper management

Lack of Guidelines &protocols for management of diabetic
children

Lack of educational & entertainment programs

Because of the lack of home visiting program, disabled
patients deprived from proper health care, also follow-up
after hospital discharge is lacking.
Psychosocial obstacles

Financial barriers (healthy food, gluco-strips, clinic visits)

Denial & non-adherence to therapy (insulin injections, snacks,
home monitoring, diet, exercise &regular visits to clinic)

Stigma like delay in marriage or reduced job opportunities

Lack of knowledge (family & school members)
Suggestion for optimum care of diabetic children

Establishment of special clinic

Training of physicians &nurses externally &locally

Training of new important specialties

Development &implementation of guidelines &protocols

Continuous education programs for patients
& their relatives (families &teachers)