Projects

Improving diabetes screening among tuberculosis patients WDF12-621

WDF12-621
This project builds further on the previously WDF funded project (WDF08-314) - Model for Diabetes management in primary health care in Indonesia and seeks to improve capacity for collaborative activities for diabetes and tuberculosis management in provinces in Indonesia.

Ojectives & approach

Diabetes is increasing rapidly in Indonesia  while tuberculosis (TB) continues to be endemic. It has been shown that diabetes significantly increases the risk of developing active TB. In addition, diabetes negatively affects TB treatment outcomes including high rates of fatality during treatment and the risk of recurrent TB, particularly in patients with poor diabetes control. The increasing number of people with diabetes in Indonesia may adversely affect the TB eradication programme as well as put greater burden for diabetes care in many areas of the country.

Every year, 450,000 new cases of TB occur in Indonesia resulting in 64,000 deaths due to TB. Furthermore, Indonesia is ranked number six in terms of diabetes cases and number four in TB cases in the world. Indonesia has implemented the WHO-DOTS strategies, but the guidelines do not contain an explicit intervention for people with diabetes and TB.

The University of Indonesia, Department of Community Medicine is coordinating the project in collaboration with the Indonesian Society of Endocrinology and Department of Pulmonology and Respiratory Medicine. It is an extension of a previous collaboration which was implemented in three provinces; North Moluccas, East Kalimantan and Jakarta (project WDF08-314). This project will include Jakarta and North Moluccas as well as three new provinces: North Sulawesi, West Java and East Nusa Tenggara, which in a 2007 research were identified as some of the provinces with the highest diabetes prevalence.

Objectives
The aim of this project is to improve capacity for collaborative activities for diabetes and tuberculosis management in targeted provinces of Indonesia.

Approach
The project will establish a collaborative framework for diabetes and TB care at provincial and district level. This will include a set of round table discussions of the existing diabetes care programme and the existing TB control program including results and challenges in reaching the goals and how to replicate to other provinces. Furthermore, collaboration between the local government, NGOs and the community will be established with programmes on both diseases at district level to ensure sustainability of the program. To achieve collaboration with NGOs working in the area of TB control a workshop will be held on World TB Day with the National Tuberculosis programme.

Two sets of guidelines will be developed:
1) Diabetes management including TB prevention and identification
2) Diabetes screening among TB patients and treatment when a patient has both diseases.

There are currently no existing guidelines for these areas, so the guidelines will be developed through literature review, workshops with experts, the draft guidelines will then be tested in health centres and after adjustments will be finalised and disseminated. A training module will be developed to meet the needs of the diabetes and TB patients. Finally, health education materials for people with diabetes and TB will be developed.

The project will train health personnel in the primary health centres. 30 future trainers from 5 provinces will be selected. The trainers will  further train 480 health personnel including doctors, nurses and other medical personnel.

The training material developed will comprise posters and patient’s handbooks and 1,800 health cadres and community leaders will be trained to use the material to inform and advice patients with DM and TB.

Finally, the project will continuously do screening of diabetes among TB patients and screening of TB among people with diabetes. The screening will be done by the primary health care staff. The screening procedure of diabetes to be used in TB patients will be those developed by a previous project (WDF08-314) and the screening procedure for TB in people with diabetes will be established during the development of the guidelines.

Expected results

  • A collaborative network of diabetes and TB care established at provincial and district health offices
  • Guidelines developed at primary care settings for screening of diabetes in TB patients, and screening and treating TB in people with diabetes, and family education
  • A training module for primary health centre developed
  • Health education materials (leaflets and posters) developed
  • 510 health personnel trained 

Results at completion 

  • 2,657 TB patients screened for diabetes, 569 diagnosed with diabetes (21%)
  • 670 diabetes patients screened for TB, 62 diagnosed with TB (9%)
  • 465 health care providers trained in TB/DM management and care.
  • A collaborative network of diabetes and TB care has been established at provincial and district health offices
  • Guidelines developed at primary care settings for screening of diabetes in TB patients, and screening and treating TB in people with diabetes, and family education
  • A training module for primary health centre developed
  • Health education materials (leaflets and posters) developed
 

Project information

Project nr.: 
WDF12-621
Project Status: 
Completed
Primary focus area: 
Region: 
Western Pacific
Address of head office: 
Indonesia
Partners: 
University of Indonesia, Department of Community Medicine
Project responsible: 
Indah S. Widyahening, MD
Project start date: 
2011
Project budget: 
USD 475,719
WDF contribution: 
USD 400,325

Results at completion 

  • 2,657 TB patients screened for diabetes, 569 diagnosed (21%)
  • 670 diabetes patients screened for TB, 62 diagnosed (9%)
  • 465 health care providers trained in TB/DM management and care
  • Network of diabetes and TB care established at provincial and district health offices
  • Guidelines developed at primary care settings 

+ more