Diabetes care in southern Malawi

Objectives

Many cases of diabetes go undiagnosed for years in Malawi. Consequently, many are not identified and referred for treatment until it is too late - when the complications have become irreversible.

This is especially the case with diabetic retinopathy. Far too often patients are identified too late and coupled with the fact that laser treatment is virtually not available the vast majority eventually become blind.

Poorly organised diabetes care at district level, lack of knowledge and skills about diabetes care amongst health professionals and low awareness about diabetes and its complications in the general population are responsible for the sorry state of affairs in Malawi as in the rest of the developing world.

The objective of the project is to establish diabetes clinics at district hospitals and develop diabetic retinopathy management in Southern Malawi.

Approach

The College of Medicine at the University of Malawi will implement the project in collaboration with the Ministry of Health, Lions Eye Hospital, the National Prevention of Blindness Committee and the Diabetes Association of Malawi.

The project will be implemented in the Southern region of Malawi, which is believed to have approximately 30,000 people living with diabetes, most of them undiagnosed and therefore there is great need for such an initiative.

First of all, 21 diabetes clinics will be established at existing district hospitals and at major health centres in collaboration with the Ministry of Health and district health officers. These clinics will be run on a monthly basis initially. To provide appropriate care and run these clinics, at least 100 health care providers from the district hospitals will be trained on diabetes diagnosis and management. The clinics will be provided with basic equipment to diagnose diabetes and screen for complications. Diabetes primary care clinical practice guidelines developed by the International Diabetes Federation (IDF), Africa will be adapted and implemented.

In order to improve the management of diabetic retinopathy, which is one of the most common complications associated with diabetes, the health care providers will receive training on screening for diabetic retinopathy and protocols for this will be developed. Those with suspected diabetic retinopathy will be referred to the Lions Eye Hospital in Blantyre for further assessment and treatment. Guidelines for referral pathways will be developed and implemented and the Lions Eye Hospital will be equipped with a laser unit and the staff trained to use it.

Moreover, to raise the awareness about diabetes among the public, an awareness campaign will be organised. The key component of the campaign will be community meetings, which will be announced on the radio and at the hospitals and health centres. The meetings will be a combination of awareness, sensitisation and education, and will also inform the public about the newly established diabetes clinics.

Results at completion

• 14 diabetes clinics have been established with more than 6,000 patients registered in total
• 98 doctors or clinical officers, 92 nurses and 18 paramedics have been trained (total of 208 health care providers).
• Guidelines adapted and implemented.
• Diabetic retinopathy screening initiated and referral system established, with treatment facility in operation at referral level and with more than 300 patients provided laser treament
• 14 awareness camps have been conducted.
• Community activities initiated and integrated across Southern Region Malawi also as an outcome of the strengthening of Diabetes Association Malawi (DAM).
• Foot care and surgery have been established at district and referral level.
• GDM survey has been conducted including screening of more than 2,000 women (with results to be published in a recognised journal).