DM control in people with tuberculosis, Sudan

Objectives

The prevalence of diabetes in Sudan is estimated to be 7.74 %. However, the prevalence might be higher especially in rural communities. Furthermore, an estimated 700,000 people are undiagnosed which indicates a need for improvement of diabetes detection.

The health care system in Sudan is furthermore challenged by the excessive burden of communicable diseases such as TB. The prevalence of TB in Sudan is estimated to be 207 per 100,000 population.
The known link between TB and diabetes and the high prevalence of diabetes and TB are a matter of growing concern for Sudan.

The goal of the project is to improve the detection of diabetes in patients with TB by introducing diabetes screening among TB patients and promote a collaborative TB and diabetes strategy.

Approach

The project will build upon the structures laid out by the former WDF projects in Sudan WDF03-061, WDF06-164, WDF08-350, WDF08-359, WDF10-518 and WDF12-726.

The project will be implemented in East Sudan Kassala, Gedarif and Red Sea States. The majority of the population in this area is the Beja people. The project has four main project activities:
1. Training in diabetes management
2. Detection of DM in people with TB
3. Establishment of special clinics for TB patients with diabetes
4. Collaborative framework for care and control of TB and DM

Firstly, training in diabetes management strives to develop knowledge and skills to train health care professionals in both diabetes and TB management. The teaching staff is academics from University of Khartoum. There will be twenty health workers participating from the diabetes centres and TB treatment centres of Kassala, Gedarif, Khartoum and Red Sea States. Secondly, the diabetes management training aims to train medical practitioners working in the diabetes mini clinics established by WDF12-726 and TB treatment centres. The training strives to develop knowledge and skills to treat patients with both DM and TB. Lastly, the training in diabetes management consists of training of TB health workers in detection and management of diabetes.

After the training in diabetes management the health care professionals, medical practitioners and TB health workers will screen for DM in people with TB. The individuals with high random glucose readings will be transferred to be treated and followed up at the nearest special diabetes clinic for people with tuberculosis
The project will ensure establishment of special clinics for TB patients with diabetes located in the diabetes mini clinics at the primary health care centres. Project WDF12-726 is establishing 100 diabetes mini clinics (DMC in accordance to guidelines developed by IDF and supported by WDF. This project will build upon these DMCs and once a week run a special diabetes clinic for TB patients in six of the DMCs across three states.

In order to stress the importance of a joint approach to TB and DM the project will develop a collaborative framework for care and control of TB and DM. This includes advocacy and awareness activities e.g. on national and local TVs, radio and meetings with partners, sponsors and high level officials.

Given the absence of international guidelines on a joint management control of TB and diabetes a two day workshop will be organized every year for three years. The workshop is for TB and diabetes stakeholders and experts to strengthen partnership between them. The main objective is to identify a strategy for developing a joint collaboration and set a framework that guide national programs, clinicians etc., and how to establish a coordinated response to both diseases at organizational and clinical level.

Results at completion

- Trainers, medical practitioners and health care workers trained in DM/ DM diagnosis and TB management
- 250 TB patients screened for diabetes, accumulated 1,500 TB patients
- 410 patients were diagnosed with diabetes and referred for treatment
- Awareness and mobilisation campaigns conducted sensitising 50,000 people, accumulated 18 campaigns sensitising 300,000 people
- 1,000 people screened for diabetes during awareness campaigns, accumulated 4,000 people
- 3 workshops to develop a joint collaborative TB and DM strategy and plan