Objectives & approach
Many developing countries are experiencing a rapid urbanisation and Nigeria is no exception. People experience immense changes when moving from rural to urban areas. The shift from rural lifestyle and food patterns to an urban environment with limited physical activity and changes is contributing to an increase in the risk of obesity and hypertension and consequently in the incidence of non-communicable diseases like diabetes.
According to IDF, almost 3 million people live with diabetes in Nigeria. The number of cases has increased too quickly for the health system to adapt. Many people are living with the condition unaware of it, unaware of the seriousness of the disease and its consequences. Those diagnosed are often poorly managed due to lack of resources or because the health care professional who care for them have poor knowledge about diabetes and how to provide good care. This ignorance both amongst the public and the health professionals has serious consequences for the people living with diabetes.
The project seeks to improve diabetes and hypertension care in Oyo State with the aim of preventing or delaying complications caused by diabetes.
The project is being implemented by a former project partner in Nigeria, Strategies for Improving Diabetes Care (SIDCAIN) team, in the department of Medicine, Olabisi Onabajo University. The project builds on the experience gained through the project WDF08-321 also funded by WDF.
This project is focusing on two aspects; 1) to improve diabetes and hypertension care by training health care professionals and establishing NCD clinics and 2) to enhance awareness through health promotion in school children by forming health clubs in secondary schools with the aim of changing behavior and address future prevention.
Initially, the baseline knowledge of diabetes and hypertension care amongst health care professionals will be assessed by using a structured questionnaire, the same questionnaire as used in WDF08-321. Six months after implementation of the clinics, the questionnaire will be distributed to reassess the knowledge of diabetes among health care workers.
In order to improve health care workers' knowledge of diabetes care, a team of two doctors, three nurses, a pharmacist, a laboratory technician and a dietician will be selected to participate in a four week training period. The training will commence with a five day training session on basic diabetes management of senior cadre health care workers. Middle cadre health care workers will receive the same training and additionally a three day training session. They will be trained using the guidelines developed in WDF08-321 with inspiration from the IDF Africa Diabetes Care Clinical Practice Guidelines. Two years after the first training session, the middle cadre health care workers will be offered a refresher course in a two day advanced training session.
After the health care workers have received training, they will establish 33 clinics (one per local government in Oyo state). The clinics will be equipped with an "NCD clinic pack" containing the necessary medical equipment to provide care for and treatment of people with diabetes.
In addition to provide regular diabetes care, the clinics will also facilitate events to increase the awareness of diabetes in the surrounding area. Community awareness activities, screening, information meetings, workshops, exhibitions, sport events together with events for children and adolescents will be organised quarterly. Furthermore, awareness will be raised through posters and leaflet campaigns and through articles in news papers. The newly trained team at the clinics will be in charge of organising these activities.
Lastly, 40 health clubs will be formed in secondary schools. The health clubs are aimed at making the youth aware of NCDs and their risk factors, and thereby encourage them to lead a healthy life style. Membership will be free and students as well as teachers are invited to engage in the health clubs. Several approaches including education on healthy life style, physical activity, seminars, health quizzes, competitions, debates etc will be used to actively engage the children in the clubs.
• 66 doctors trained in care and prevention of diabetes.
• 99 nurses trained in care and prevention of diabetes.
• 33 laboratory staff, 33 pharmacists and 33 dieticians trained in care and prevention of diabetes.
• 33 clinics strengthened in NCD care
• Each clinic will screen 2,000 people quarterly - 800,000 people screened during the project period.
• 40 health clubs formed in secondary public schools.
Results at completion
• 34 clinics established in NCD care with 3,104 new people with diabetes registered.
• 160 doctors, 348 nurses and 295 paramedics trained in care and prevention of diabetes.
• 350,859 people screened for diabetes. Of these, 14,981 (4.3%) found to be at high risk (high blood glucose level or FINDRISK score above 14).
• 91 health clubs formed in 40 secondary public schools and 51 private schools. 1721 students are members of the health clubs.
• Large awareness-raising campaigns conducted reaching over 5 million people, including World Diabetes Day events in 2011-2012, SIDCAIN Conferences with around 350 HCPs attending, Journalist Action Against Diabetes Initiative, and competitions among secondary school students.
• Clinic and school educational materials and poster developed.
• On 28th May 2013 the Federal Ministry of Health declared free treatment for all children with Type 1 diabetes – a decision which came a few days after a SIDCAIN organised conference.