Prospects of Diabetes in Sudan

Mohamed Ali Eltom

Summarize the past

Rescale the present

Predict the future

Sudan after 9 July

National Diabetes Survey 1993

0.1% Type 1 Diabetes 3.4% Crude prevalence 2.1% Unknown Diabetics 5.5% in the Northern State 8.3% in Dongla 14 % in Argo 6.0 % in Khartoum State 4.0 % in Gezeira State 1.0 % in North Kurdofan State

Diabetes prevalence

Diseases Frequency Valid Percent

Valid

Hypertension 429,651 22.0

Diabetes 235,446 12.0

Heart Disease 46,443 2.4

Cancer 5,115 0.3

Epilepsy 18,137 0.9

Asthma 179,287 9.2

Thyrotoxicosis 67,509 3.4

Hypothyroidism 57,736 3.0

Glaucoma 105,928 5.4

Cataract 110,060 5.6

Mental Health 59,220 3.0

Others 585,691 29.9

DK 23,162 1.2

Missing 33,663 1.7

Total 1,957,048 100.0

Missing System 28,108,952  

Total 30,066,000  

Sudan Household Health Survey 2006

Percentage of Raised blood glucose (≥7mmol/l)

19.20%

80.80%

Raised BG

non raised BG

Poor glycaemic control, adequate control only in 12%

Low quality of life

Acute and long-term complications are common (67%)

High mortality rates among children

Natural History of Diabetes

Micro vascular complications

Retinopathy 43% Nephropathy 22% Neuropathy 37%

Macrovascular complications

Cardiovascular disease 28% Peripheral vascular disease 10% Cerebrovascular accidents 5.5%

Deficient patients awareness and compliance

Unaffordability and unavailability of drugs and monitoring equipment

Reduced level of well organized diabetes care

Poor health service organization

Factors Related to Poor Metabolic Control

Challenges to diabetes care in Sudan

Inadequate Financial Resources

Insufficient Health care system

Professionals

Patients

Difficulties experienced in diabetes care

Patients

Limited access to care : less than 20% of patients have access to minimum standards of care + urban/rural differences

Insulin, other medications and supplies for testing metabolic control

Involvement of patients and families

Difficulties experienced in Diabetes Care

Patients, cont.

Lack of awareness and the challenge of self- management Reluctance to become empowered and self- managing Standards and materials for education

Education is offered by doctors in a busy clinic atmosphere

Diabetes educator has not been integrated in diabetes management

No national diabetes patient education programs to define patient goals, monitor progress and evaluate achievement

Lack of educational materials and equipment

Diabetes Education Facilities

Income Group

high incomelow income

Nu

mb

er

of

Pa

tie

nts

80

70

60

50

40

30

20

10

0

Diabetes control

Poor

Good

Diabetes Control Among Low and High Income Parents

Ketone bodies in urine: 45.6%

Hypoglycemia that needed special

attention: 37%

Acute Complications of Diabetes

56.6 % admitted at least once to

the hospital within a year

Hospital Admission

Diabetic ketosis: 71.8%

Hypoglycemia: 5.9%

Malaria: 10.6%

Other medical disorders

or surgical intervention: 9.4%

Main causes

Families pay a considerable part of their income and receive insignificant support other than that from relatives and friends

The direct cost of diabetes care requires 23% of the available economic resources of the parents

The low costs reflect the minimal care given to the diabetic patients

The present organization of diabetes care does not provide the patient with empowerment, knowledge and self-care ability

Well-trained diabetic teams and education programs may improve this situation

Prevalence 2025

Estimate 16% (more than 3 Million Diabetic)

Action

Primary prevention programs

Organized educational programs and proper medical services

Federal and state governments have identified priorities and agreed on an approach to:

Diabetes prevention, early detection,

management and treatment

In partnership with key organizations and

service providers

www.diabetesinsudan.org

National Diabetes Policy

Areas of Development

Primary prevention strategies Approved guidelines Optimum practice models for service delivery

Partnerships between the different stakeholders in the diabetes sector

Alternative methods of funding for diabetes prevention and management

Integrated Approach to Prevention and Care

1. Promotion of Healthy Life-Styles

2. Raising Community Awareness

3. Primary Prevention at onset

4. Screening for Type II DM

5. Development of National Strategy

Optimum Practice Models for Service Delivery

Quality Care Diabetes Facilities (QCDF)

MDC in 25% of Primary Health Care Centers

(1 MDC for a catchment area of 4000 diabetic)

1 Diabetes Referral Unit for every 4 MDC

Distribution of QCDF in the Country According to Prevalence Levels

Prevalence MDC Unit

High 60 15

Moderate 40 10

Low 20 5

International Relations

Regional Relations

Arab

African

Gulf States

• Egypt•Jordan Syria•Lebanon•Libya•Algeria•Morocco•Iraq• Palestine

• Sudan • Yemen• Djibouti• Somalia• Mauritania

Research Training Education MaterialHuman Resources PhilanthropiesCivil Societies

Middle income Low income

High income

Cardiovascular risk factors (%) among adults in four Arab countries 2005

Country Diabetes Hypertension High Cholesterol

Egypt 16 33 24

Jordan 16 25 26

Kuwait 16 24 19

Sudan 12 23 19

Cardiovascular risk factors (%) among adults in four Arab countries

Country Smoking Overweigh & Obese

Low physical activity

Egypt 22 76 50

Jordan 29 67 ?

Kuwait 16 ? 92

Sudan 12 54 87

الصعيد من التدخين موضة

إلى الســـــود

ان

Bilateral Relations

Egypt

Jordan

Saudi Arabia

Sweden

Diabetes Care in the Nile Valley

رمضان كريم