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In Sudan, as in many parts of the developing world, the services offered for children with type 1 diabetes are hospital-based.
A general lack of awareness of the disease among health care professionals as well as parents and school teachers results in poor diabetes control and entails that many children are admitted to hospital in a state of keto-acidosis; many not to be saved.
National guidelines for treatment of children with type 1 diabetes are non-existent and as a result each health facility treats the children in a non-standardised manner.
Objective
The project seeks to improve care given to children with type 1 diabetes through their schools and families and the health care system in order to decrease the high number of children admitted to hospital with keto-acidosis.
Approach
Faculty of Medicine, University of Geziera is responsible for implementation in collaboration with the Federal Ministry of Health, the State Ministry of Health in Geziera State as well as the Wad Medani Paediatrics Hospital (WMPH). Also, the Rahma Charity Society and the Ministry of Education of Geziera State are partners in the project.
The project comprises four main components:
Firstly, a specialised referral diabetes unit with a well-equipped laboratory will be established in WMPH. The diabetes unit builds on a comprehensive and integrated approach whereby children with diabetes are provided with clinical, nutritional, educational and psychological care and management.
As the diabetes unit in WMPH will be a reference clinic for a number of mini-clinics, an information system is established to ensure that patient records follow the patients referred from the mini-clinics.
Secondly, the health care professionals at WMPH are trained in accordance with the standards set by the International Diabetes Federation.
Thirdly, school teachers receive training in how to deal with children with type 1 diabetes. The training course will provide the teachers with a basic knowledge on diabetes, how to handle the disease and how to support the affected children.
Lastly, children who come for regular follow-up in the diabetes clinic will be offered monthly training sessions along with their mothers/care takers. This training will include education in insulin storage, diet, physical activity and daily management of the condition.
Medical students from University of Geziera will be addressing diabetes as part of their regular health education programmes in the communities, thereby reaching out with awareness not only to the families of the children, but also to their local communities.
Expected impact
- 200 school teachers trained
- 100 health care providers trained (doctors, medical assistants, dieticians and paediatric psychologists)
- 1,500 children having access to better quality diabetes care
- Reference paediatric diabetes clinic established in Wad Medani Paediatrics' Hospital
- Information system and nutritional unit established in the reference clinic
Results to date
- 180 teachers from the Wad Medani and Southern Gezira Locality schools have been trained.
- 110 doctors, nurses, dieticians and psychologists have been trained in the management and education of children with diabetes.
- Children: 732 children are registered at Wad Medani Paediatrics Teaching Hospital.
- Health education: 300 families in 22 villages have received health education from medical students.
- A nutritional unit has been established in which 10 training sessions have been held, 15-40 mothers of children with diabetes attended each session.
- Health education materials in Arabic have been developed.
- The number of children admitted with diabetic ketoacidosis has been reduced by 30%, of which none where admitted due to lack of insulin.
- From a cohort study of 100 children, the impact on HbA1c levels showed that the percentage of children with poor control (>9%) has fallen from 66% to 38% and the group in good control (<7.5%) has increased from 16% to 24%.
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