Monday, April 23, 2007

Delivering Diabetes care in Africa

Delivering diabetes care in Africa

Diabetes is a difficult disease to treat even with the best drugs and support, and in most parts of Africa the problems are enormous. Even regular supplies of insulin are often difficult to maintain. The range of tablets is limited, and self-monitoring equipment absent. Specialist doctors are few, as are nurse educators, chiropodists, and dieticians. Glycosylated haemoglobin (HbAlc) – ‘the gold standard’ test for overall glycaemic control – is usually too difficult and expensive to provide, and specialist services for complications are well beyond health budget capabilities, (e.g. laser photocoagulation, dialysis, and

Unsurprisingly, most people with diabetes in the African continent rely on rudimentary services from local doctors or nurses, or, if they are fortunate, may be able to access a Diabetic Clinic - usually only available at major teaching centres. Even at these hospitals, the services offered are severely hampered by the shortages described above.

There have, however, been recent attempts to improve Diabetes care delivery in some parts of Africa by a variety of partnership projects, eg. The London-based Tropical Health and Education Trust (THET) has been supporting devolved care of diabetes, and other non-communicable diseases, in the Gondar area of Ethiopia. In South Africa, the Liverpool School of Tropical Medicine has been linking with Hlabisa Hospital in Kwazulu Natal to promote nurse-led protocol-based diabetes care at both central and primary health clinic (PHC) levels.

In a recent issue of the British Medical Journal, Kaushik Ramaiya reports on a larger and more ambitious diabetes care delivery system from Tanzania. External support has been provided mostly by Novo Nordisk’s World Partnership Programme, but the Tanzanian Ministry of Health has also given help. Diabetes clinics have been established in all major hospitals in the country, as well as on the offshore islands of Zanzibar and Pemba. The Tanzanian Diabetes Association has also played a major part in the reorganisation, including the establishment of healthcare worker training programmes.

Ramaiya points out that current predictions suggest that within the next 20 v-ears non-communicable disease mortality will exceed infective deaths. The setting up of appropriate and efficient diabetes care delivery systems now will help to combat this growing problem.

African Health: Medicine Review – Delivering Diabetes care in
Africa. Medical Education Resource Africa MERA, May 2005, p.25.
Ramaiya K. Tanzania and Diabetes – a model for developing countries?
British Med J 2005; 330: 679.

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