Type 1 diabetes care updates: Tanzania

Muze, Kandi; Majaliwa, Edna

doi:10.4103/2230-8210.155348

Cited by 16 publications

(25 citation statements)

References 1 publication

(1 reference statement)

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“…These deficiencies in T1D care have profound impacts. Mortality rates are very high in children and adolescents, and for those who do survive, blood glucose control is poor and early chronic diabetes complications are frequent . These stark differences in outcomes compared to well‐resourced countries are tragic for patients and families and deeply distressing for health professionals.…”

Section: Introductionmentioning

confidence: 99%

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Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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Optimal care for children and adolescents with type 1 diabetes is well described in guidelines, such as those of the International Society for Pediatric and Adolescent Diabetes. High‐income countries can usually provide this, but the cost of this care is generally prohibitive for lower‐income countries. Indeed, in most of these countries, very little care is provided by government health systems, resulting in high mortality, and high complications rates in those who do survive. As lower‐income countries work toward establishing guidelines‐based care, it is helpful to describe the levels of care that are potentially affordable, cost‐effective, and result in substantially improved clinical outcomes. We have developed a levels of care concept with three tiers: “minimal care,” “intermediate care,” and “comprehensive (guidelines‐based) care.” Each tier contains levels, which describe insulin and blood glucose monitoring regimens, requirements for hemoglobin A1c (HbA1c) testing, complications screening, diabetes education, and multidisciplinary care. The literature provides various examples at each tier, including from countries where the life for a child and the changing diabetes in children programs have assisted local diabetes centres to introduce intermediate care. Intra‐clinic mean HbA1c levels range from 12.0% to 14.0% (108‐130 mmol/mol) for the most basic level of minimal care, 8.0% to 9.5% (64‐80 mmol/mol) for intermediate care, and 6.9% to 8.5% (52‐69 mmol/mol) for comprehensive care. Countries with sufficient resources should provide comprehensive care, working to ensure that it is accessible by all in need, and that resulting HbA1c levels correspond with international recommendations. All other countries should provide Intermediate care, while working toward the provision of comprehensive care.

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Section: Introductionmentioning

confidence: 99%

“…Mean HbA1c declined from 11.2% (99 mmol/mol) at baseline to 10.2% (88 mmol/mol) at 1 year and 9.8% (84 mmol/mol) at 2 years. In Tanzania, mean HbA1c fell from 14% (130 mmol/mol) in 2005 to 10% (86 mmol/mol) in 2012 to 2013 as care improved …”

Section: Introductionmentioning

confidence: 99%

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

et al. 2018

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“…In 2006, a position statement from the Lyon joint meeting of all pediatric endocrine societies set out a statement of minimal acceptable care for children with pediatric endocrine disorders and diabetes [44]. Since then, while major progress has taken place, many patients remain undiagnosed, the prevalence and severity of diabetes complications are staggering, and early mortality is unacceptably high [11, 12, 34, 45]. …”

Section: Discussionmentioning

confidence: 99%

“…The PETCA program has also led to the foundation in 2009 of the African Society for Paediatric and Adolescent Endocrinology (ASPAE), which aims at promoting “the highest levels of knowledge, research, education and clinical practice of paediatric endocrinology and metabolism throughout Africa” [10]. While these initiatives have contributed to a marked increase in the number of children appropriately diagnosed with endocrine conditions and diabetes in Africa [11-13], they have also shed light on the regional difficulties faced by patients and physicians in accessing the medicines needed to treat these conditions.…”

Section: Introductionmentioning

confidence: 99%

Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

Rowlands

Ameyaw²,

Rutagarama

et al. 2018

Horm Res Paediatr

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Background: Access to essential medicines in pediatric endocrinology and diabetes is limited in resource-limited countries. The World Health Organization (WHO) maintains two non-binding lists of essential medicines (EMLs) which are often used as a template for developing national EMLs. Methods: We compared a previously published master list of medicines for pediatric endocrinology and diabetes with the WHO EMLs and national EMLs for countries within the WHO African region. To better understand actual access to medicines by patients, we focused on diabetes and surveyed pediatric endocrinologists from 5 countries and assessed availability and true cost for insulin and glucagon. Results: Most medicines that are essential in pediatric endocrinology and diabetes were included in the national EMLs. However, essential medicines, such as fludrocortisone, were present in less than 30% of the national EMLs despite being recommended by the WHO. Pediatric endocrinologists from the 5 focus countries reported significant variation in terms of availability and public access to insulin, as well as differences between urban and rural areas. Except for Botswana, glucagon was rarely available. There was no significant relationship between Gross National Income and the number of medicines included in the national EMLs. Conclusions: Governments in resource-limited countries could take further steps to improve EMLs and access to medicines such as improved collaboration between health authorities, the pharmaceutical industry, patient groups, health professionals, and capacity-building programs such as Paediatric Endocrinology Training Centres for Africa.

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“…There have been reports of poor control and outcome in children with diabetes in most developing countries and several factors have been stated as reasons for this poor outcome amongst which are lack of insulin, lack of blood glucose monitoring and high cost of care [5] [6] [7]. The contribution to poor outcome based on care in schools have attracted little attention with no or lack of awareness of regulations on care for chronic disease management in most developing countries as obtains in most developed countries.…”

Section: Introductionmentioning

confidence: 99%

The Management in a Developing Country of Children with Type 1 Diabetes Mellitus at School: A Review of Attitude of Parents

Jaja¹

2018

IJCM

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Background: Optimal glycaemic control is essential in preventing diabetes related complications in children with diabetes. The school is an important component of care and support to achieve good outcome as children spend a considerable time in school. In some developed countries, there are guidelines and regulations on support and care of children with chronic diseases such as Type 1 Diabetes Mellitus (Type 1 DM). In most developing countries where these regulations are not in place, parents have an important role to play in encouraging optimal care for their wards while at school, which include informing school authority, submission of care plan in collaboration with the healthcare team and providing equipment necessary for care task at school. Aim and Objectives: The aim of this study was to review the attitudes of parents in a developing country towards management of their children with Type 1 Diabetes Mellitus (DM) at School. Methods: Parents of all children with Type 1 DM seen at the endocrine unit of the University of Port Harcourt Teaching Hospital were invited to participate. Data were collected using a questionnaire. Information on bio data, details of care in school and challenges experienced were documented and HbA1c was done for all children. Results: The Parents of eighteen children and adolescents with Type 1 DM participated in the study. The age range of the children was between 5 and 17.3 years, mean age of 12.37 ± 4.2 years. Mean duration of DM 3.37 ± 2.6 years and mean HbA1c was 10.02% ± 2.5%. All children except one attended school as day students. Two parents (11.1%) did not inform the school of child's diabetes. No parent gave a written plan of diabetes care/treatment of hypoglycaemia in school and 4 parents (22.2%) did not make contact with school when child was in school. No child had a glucometers or took insulin

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Type 1 diabetes care updates: Tanzania

Cited by 16 publications

References 1 publication

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

Levels of type 1 diabetes care in children and adolescents for countries at varying resource levels

Insights from the WHO and National Lists of Essential Medicines: Focus on Pediatric Diabetes Care in Africa

The Management in a Developing Country of Children with Type 1 Diabetes Mellitus at School: A Review of Attitude of Parents

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