Objectives and approach
The global burden of diseases is shifting from infectious to non-communicable diseases (NCDs). The Ministry of Health of Malawi in collaboration with the WHO conducted in 2009 a country wide survey to determine the magnitude of NCDs and their risk factors. The prevalence of diabetes was estimated to be 5.6% in this survey, which reinforced that NCDs and risk factors are a matter of great public health concern.
Despite the fact that NCDs were addressed in the Health Strategic Plan of Malawi, the resources available are limited. The country has been experiencing an increasing number of severe cases of eye and foot complications. Often, these cases are late referrals, which cause a heavy economic burden to the society. This is further aggravated by the poor communication between physicians, lack of proper patient education and lack of follow up.
The goal is to improve diabetes and related NCD care through strengthening of existing clinics, increasing HIP/NCDs and pregnancy awareness and reducing diabetes and other NCD related complications while also implementing health promotion and prevention activities
This project intends to reduce late referrals and complication rates by training staff from health care centres (HCCs) across the country in diabetes/NCD management and prevention of complications. Mobilisation of and support to key civil society groups and other local stakeholders have been provided by WDF through projects WDF12-714 and WDF10-563 which have targeted to increased awareness and sensitised communities and wider public about diabetes and NCDs.
WDF programme support with grant ref WDF13-842 builds on preceding pilot stage (grant ref WDF09-451) and is anchored through a partnership with the College of Medicine (and the Queen Elizabeth Central Hospital) in the Malawi Southern Region capital of Blantyre
- Strengthening the existing diabetic clinics established during the project WDF09-451 and establishing four new clinics:
A two-days training will be conducted per year for new members of staff on general management of diabetes and its complications. The training will be conducted by a clinician from the Medicine Department who will use the training curriculum and materials developed under the project WDF09-451 and the training videos developed under the project WDF12-714. All clinics will receive supervision visits focussing on general logistics of care, data collection and reporting.
- Further training of health care professionals (HCPs) in diabetic retinopathy detection and management of referrals:
A project assistant will visit each clinic at least once to convene stakeholder meetings with key personnel and district health coordinators in order to determine their needs and write an action plan to improve diabetic retinopathy management. A coordinator will be appointed to ensure that patients are screened, treated and followed up accordingly.
- Scaling up of diabetic foot treatment through the training of trainers (ToT) principle and programme:
Two key medical personnel from each of the 23 project sites will undergo a three-days training on management of the diabetic foot. The training curriculum will include topics as prevention, screening, management of foot ulcers, compliance and referrals issues and education of patients. The trained ToTs will receive a training package to support foot care trainings to their peers and using the skills and resources obtained during the training.
- Introduce the challenge related to hyperglycaemia in pregnancy (HIP) educational talks to increase awareness at the antenatal clinics:
Routine screening for gestational diabetes/hyperglycemia in pregnancy in the antenatal clinics is still not regular and to address this issue HCPs from all regions in Malawi will receive training on HIP education, screening and management.
- 60 HCPs trained in diabetes management
- 3 supervisory visits conducted
- 2 foot care annual feedback seminar conducted
- 4,000 people received enhanced foot care services
- 8,030 informational posters and flyers distributed
- 120 nurses midwives trained in GDM/NCDs in pregnancy
- 69 district level clinic supervision visits undertaken
Results at completion
- 722 HCPs trained in diabetes management
- 23 clinics strengthened for diabetes care
- 15,469 patients received general diabetes care
- 5,473 people received enhanced foot care services
- 169 feet saved through treatment
- 120 nurses midwives trained in HIP/NCDs in pregnancy
- 4 clinics strengthened for HIP