The prevalence of diabetes in Nepal ranges from 3% in rural areas to 15% in urban areas. As in many other countries, a swift increase in diabetes has occurred in Nepal due to rapid changes in lifestyle, migration to urban areas and increased stress levels. In Nepal, diabetes services are available in many areas; however, these tend to focus on routine treatment. Further, these services are only available to those who have been diagnosed. It is estimated that for every diagnosed person with diabetes there are often two people living with diabetes who are undiagnosed; hence there certainly is a need to identify people with diabetes and preferably at an early stage of the disease, so that proper treatment can be instituted. Due to low awareness, poor training and lack of advanced equipment for diagnosis and treatment, available services tend to focus on routine treatment, with little attention given to screening people with diabetes for complications particularly eye complications. This lack of focus proves costly as many people may loose vision affecting productivity and quality of life. The project seeks to ensure early detection and treatment of diabetic retinopathy.
The project will be implemented in eight districts in Nepal, namely Rupandehi, Kapilvastu, Nawalparasi, Palpa, Gulmi, Arghakhachi, Pyuthan and Chitwan. Together, these districts have a population of more than three million people. The Lumbini Eye Institute that will be in charge of the implementation has more than two decades of experience with community eye projects in these districts. The project will specifically target rural and underserved communities in the eight districts. Initially, attention will be given to develop clinical management protocols and IEC materials focusing on different aspects of diabetes, diabetes care and management, functioning of the eye, identification and screening for diabetic retinopathy, the risk of blindness, the importance of regular follow up and control of diabetes and prevention of diabetes including diet and physical activity. A number of different health care professionals will be trained in this project. The training will involve issues related to diabetes and diabetic retinopathy and will include lectures, field visits and on-the-job training. Doctors and nurses/paramedics will participate in a workshop focusing on the current trends in management of diabetes with special emphasis on diabetic retinopathy and its implication for blindness. In total, 240 doctors and 240 nurses/paramedics will be trained. Another 497 primary health care workers will also be trained. For the primary health care workers, focus will also be on diabetes, diabetic retinopathy and blindness. However, general health, modalities for screening and diagnosis and community based management of diabetes with particular emphasis on the need for regular follow ups and compliance with treatment will also be included in the curricula. Health facilitators and health workers play an important part in the implementation of this project and will therefore of course also receive training on diabetes and diabetic retinopathy and the management hereof. In total, eight health facilitators and 16 health workers will be recruited and trained. Each health worker will cover 30 to 35 villages under the supervision of the health facilitators. Finally, orientation training will also be given to approximately 497 traditional healers and 497 village council members in order to increase awareness in the communities and facilitate community participation in the project. When the training component is completed, community meetings will be arranged in each village in order to inform the population about the project. The health workers will then start visiting every single household to collect demographic data as well as data related to diabetes including risk factors. This door-to-door enumeration will be followed by diabetic retinopathy screening camp, where all persons aged 40 years or older will have their height, weight, blood pressure and blood sugar levels measured as well as screened for diabetes and diabetic retinopathy. The primary health care workers will lead the screening camps. Approximately 160,000 people will be screened during 400 screening camps. Those who have diabetes will be referred to a doctor who will monitor their disease and regularly check them for diabetic retinopathy. It is expected that around 8,000 people will be diagnosed with diabetes and at least 1,200 will have diabetic retinopathy. Those who have diabetic retinopathy will be referred to secondary or tertiary health care where they will receive treatment. Diabetes and diabetic retinopathy patients will subsequently be visited by a health worker, who, under the supervision of a health facilitator, will work with the patient and help and motivate him/her to bring their disease under control by promoting self care. The health care worker will also organise group meetings in the villages for people with diabetes where the patients can discuss their problems, share their experiences and learn from one another. In liaison with the health facilitators the health worker will visit people who currently do not have diabetes, but who are at high risk of developing the disease. These people will be offered general health promotion messages focusing on diet and physical activity and diabetes prevention in general. The community at large will also be exposed to health promotion messages through street plays, audio-visual sessions and community meetings that will be arranged.
• 438 doctors and 473 nurses trained • 3470 primary healthcare workers, village council members and traditional healers trained • 10 health facilitators and 16 health workers trained • An estimated 7,549 diabetes patients have been identified of whom around 1,230 have treated