Although relatively less common type 1 diabetes is none the less increasing. Normally affecting young children it can quickly become fatal if not treated properly, regularly and timely. In low income, resource constrained countries with limited health care facilities children with type 1 diabetes still continue to have low survival rates due to poor access to care, unawareness, poor knowledge and challenge of managing a complex life long illness requiring multiple daily tasks such as insulin injection, measuring blood glucose levels and balancing physical activity, food intake with the amount of injected insulin.Due to low health care personnel capacity to diagnose and treat diabetes, limited availability of insulin and monitoring equipment, lack of storage facilities for insulin, cost of insulin etc., life expectancy of a child diagnosed with diabetes in Africa is as low as one year. Poor family households in Africa, where families often are forced to choose between treatment for one child and food for the rest of the family, also contributes to the somber future for children with type 1 diabetes.The objective of the project is to improve systematic management of children with type 1 diabetes by strengthening the existing health care system as well as self-care management skills.
Tanzania Diabetes Association (TDA) will establish this project using a "hub-and-spoke" concept. It will be in line with other projects funded by World Diabetes Foundation with similar objective and co-funders: WDF10-507 in Cameroon, WDF09-459 in DR Congo, WDF10-457 in Uganda and WDF10-491 in Guinea. The project will strengthen the management of diabetes in children by establishing a network of clinics, training health care personnel and educating children with type 1 diabetes and their parents about self-care management skills. The clinics will be established as a "hub-and-spoke" concept that will improve the system for managing children with type 1 diabetes.In order to strengthen the health care system and improve management of children with type 1 diabetes, six new clinics will be established and six already existing clinics will be strengthened. Seven of the clinics will work as "hubs" and the remaining five clinics will work as "spokes". The hubs will be main clinics and work as referral clinics, whereas the spokes are smaller clinics. The aim of establishing smaller clinics is to improve access by reducing the distance required to be travelled to get qualified diabetes care for the children.When children and their parents have to travel long distances to receive diabetes care, they skip their appointments when it's not convenient or monetarily possible for them to take the long trip. In order to avoid this dilemma, an outreach service will be established where a mobile van, fully equipped with all the necessary materials for diabetes management, will visit districts far away from hubs or spokes. The mobile van will additionally be used for screening people for type 2 diabetes at district hospitals and conduct awareness activities as well as bring equipment and diagnostic tests to screen for complications of diabetes amongst the children.With the purpose of improving management of children's diabetes, health care personnel will be trained in diabetes management and care for children with type 1 diabetes. Existing knowledge and training material will be surveyed by an expert group which will lead out to development of pre and post training system where 100 health care personnel will receive training. The training will ensure that the personnel are capable of diagnosing the children correctly and provide better care and management of diabetes.One of the most important tasks of the health care personnel is to encourage both children and their parents to be involved in the management of diabetes. To help facilitate this objective, appropriate education for both groups in the form of education materials will be developed and distributed. Additionally, awareness activities will be conducted at the clinics. Moreover, the project partner expects to conduct one camp for children with diabetes yearly at three different sites.Furthermore, the community and policy makers will be informed of the program and the outcomes to encourage integration with the public health system.Apart from providing logistics and financial support Novo Nordisk and Roche Pharmaceuticals will provide free insulin, glucometers and strips for the clinics. The proposal is a part of Novo Nordisk's "Changing the future for children with diabetes" program.
• 5 new clinics established as "spokes" • 3 new clinic established as a "hub" • 6 already existing clinics strengthened as "hubs" • 350 health care providers trained in management of type 1 diabetes• 1,000 children registered and treated at the involved clinics