Helping children in Sudan

Sudan is geographically the largest country in Africa, inhabited by more than 35 million people. The most common diseases in Sudan are malnutrition, anaemia, and infections such as malaria and gastroenteritis. At times of crisis, meagre healthcare resources are often directed at communicable diseases, with chronic diseases like diabetes receiving a low priority. Diabetes is, however, the most common non-communicable disease (NCD) in the country and the biggest killer amongst the NCD’s, claiming 10% of deaths that occur at hospitals.

Years of conflict have paralysed the preventive and curative health services in Sudan and chronically obstructed the provision of humanitarian assistance to the affected populations. With armed conflicts and chronic instability, a growing number of refugees, and poor infrastructure, the conditions for improving care for diabetes in Sudan could not be more challenging. Nonetheless, a dedicated group of health care professionals have set out to overcome those obstacles and provide care for poor and disadvantaged children.

The project named “Integrated management of diabetes in children” was initiated in January, 2007 with the aim to improve care given to children with type 1 diabetes through their schools, families and the health care system and to decrease the high number of children admitted to hospital with keto-acidosis. The project is based in the Wad Medani Paediatric Hospital under the auspicious of the Ministry of Health, which forms part of the University of Gezira and functions as the main paediatric referral hospital in the State. Before the project and the clinic was established, 40 patients were registered. Today the clinic deals with 230 registered  patients. The patients are on average followed-up at the clinic every 3 months and data from a cohort of more than 100 children already shows the impact on HbA1c levels. The percentage of children with poor control has fallen from 66% to 38% and the group in good control has increased from 16% to 24%. This is of course very preliminary data, but providing a clear indication of the potential impact of the project.

The clinic consists of 5 units; a registry, nutritional unit which provides advice on diet, nurses/doctors unit, a psychology unit and laboratory. Especially the fully equipped laboratory has played a major role in closely monitoring each child. Furthermore, a small play room for children has also been established within the clinic which is a very unique and positive element in the clinic, and not seen in many African hospitals.

Programme Coordinator at the WDF, Ms Hanne Strangaard recently visited the projects in Sudan and witnessed the activities. She was very encouraged to see the initial progress;” The most striking and gratifying experience was meeting the children at the diabetes clinic. The first encounter with the children left me with a strong impression and feeling that these children were being well taken care off in all areas of diabetes care, even the psychological aspects. I also meet a very competent and dedicated medical team. While talking to one of the many children, it became evident for me how confident these children were in self management of their diabetes”, she explains.

She elaborates further; “the project is also ensuring integration of teachers and sensitizing schools to become aware of diabetes symptoms and how to manage children with diabetes in their respective schools. I believe this is an important aspect of diabetes care for children. Dr Abdalla’s approach and dedication to the project and in general towards diabetes care is truly commendable and serves as an inspiration for other health care personnel in Gezira and Sudan.”

Each patient is registered through a database and has a record book which registers/monitors their visit through each unit. In addition, each patient and family member receives education and information about diabetes by the health care staff with the developed education materials. At the psychology unit, discussions are cultivated on the benefits of providing support to the children and mothers.

Integrating families and schools into the project

Dr. Mohamed Elhassan Abdalla (in the middle) is responsible for a project in Sudan helping children who suffer from diabetes.

As an integral component of the project, family members of the children with diabetes take part in the various consultations including the visit to the psychologist. Particularly the mothers of the patients are very vulnerable as they fear for their children’s lives when they are out of their sight or in school. In order to overcome the logistical and social barriers the nurses conduct home visits as part of their family relation building which provides a much secure environment for the families and their children. Even the primary schools in Gezira have been sensitized and a questionnaire about warning signs for diabetes has been developed and distributed to 200 selected schools. At the Schools the teachers are involved in health related topics and receive 1-2 days of training on how to detect diabetes and the initial symptoms. A special training guideline has been developed for this particular purpose. To date, more than 128 teachers have been trained out of 200 potential candidates.
 
“Diabetes is one of the most common chronic diseases to affect children. It can strike children of any age, even toddlers and babies. If not detected early enough in a child, the disease can be fatal or result in serious brain damage. Yet diabetes in a child is often completely overlooked: it is often misdiagnosed as the flu or it is not diagnosed at all. Every parent, school teacher, school nurse can play a major role in supporting and monitoring children with diabetes. Anyone involved in the care of children should be familiar with the warning signs and alert to the diabetes threat. We hope this project supported by the Ministry of Health and the WDF will live up to our expectations and improve the level of care for the children and families involved”, explains Dr Abdalla, who is the project responsible at the Wad Medani Paediatric Hospital, Gezira University.

Life expectancy for a child, with diabetes in Africa is very low often just a few years. This is due to a large number of interrelated factors ranging from low health care personnel capacity to diagnose and treat diabetes, to the limited availability of insulin and monitoring equipment, lack of cold storage facilities for insulin as well as the cost of care. Statistically there are more than 38,000 children in Sub Saharan Africa living with type 1 diabetes. However, the problem is that only a few of them receive medical attention before its too late, and even fewer are properly diagnosed and provided with lifesaving insulin.

“I believe the project has already achieved most of the crucial milestones in setting up the reference clinic at the paediatric hospital. The clinic has now received full support and free insulin from the Hospital Directory and the University of Gezira. In order to ensure sustainability of the project it is utmost important that we can secure support from the newly appointed State Minister of Health of Gezira”, concludes Ms. Strandgaard.

Read more about the project