Coordinated DM-TB services in Cambodia

Objectives

Cambodia is a largely rural country with only 18 % of the population living in urban areas and the economy is driven by agriculture. Like in other similar countries there is a lack of access to health care, especially among the rural population. Health care resources for diabetes care are no exception and are primarily focused in the capital.

According to the WHO Cambodia is well-underway in the epidemiological transition with falling prevalence of HIV and malaria and high rates of diabetes and hypertension. However, the burden of tuberculosis (TB) is still high and Cambodia is listed as one the 22 high TB burden countries in the world. The IDF has estimated that around 10 % of TB cases can be attributed to diabetes.

Improving prevention, early case detection and quality of care for persons with diabetes and TB

Approach

The project will seek to strengthen the public health system capacity in diabetes diagnosis and management. In that process a series of workshops will be held with relevant stakeholders. The main outcome of the workshops is the development of new guidelines for the co-morbidity of TB and diabetes covering detection, referrals, treatment, monitoring etc. Referral mechanisms will be established to ensure a continuum of care.

The first stage of the project will be to train the future trainers from the national TB and diabetes programs who will be responsible for providing training for health care workers throughout the whole program. Training and continuous, in-service education will be provided to the health providers in target facilities on diabetes/TB service delivery and the associated communication and reporting.

Diabetes screening will be integrated with TB services and TB screening integrated with diabetes services, which means that all TB patients manifesting diabetes symptoms will be screened for diabetes and vice versa. Suspected cases will be referred to the diabetes or TB clinics for follow up. Patients diagnosed with the diabetes/TB co-morbidity will have their treatments adjusted appropriately, receive frequent monitoring of glucose levels, counselling on lifestyle changes and support to self-management. A follow-up mechanism will be developed between the NTP and Department of NCDs to ensure that appropriate treatment has been initiated for the newly identified disease and existing treatment takes the co-morbidity into account.

Quarterly meetings will be held to do patient reviews and different strategies to increase the knowledge of diabetes patients about TB and diabetes co-morbidity and to encourage them to seek early care for diabetes services will be tested.

Finally patient awareness about TB/diabetes co-morbidities will be increased through patient education sessions.

Results at completion

• Technical working group established with strong presentation from both diabetes and TB areas.
• Draft guidelines on TB and diabetes developed in collaboration with the Department of NCDs and NTP.
• Referral protocols developed.
• 2,785 TB patients screened, and a total of 267 cases were diagnosed with diabetes
• 1,582 diabetes patients screened, and a total of 108 cases were diagnosed with TB