Wad Medani paediatrics teaching hospital Integrated Management of Diabetes in Children (lMDC)

The number of diabetic children attending Wad Medani children hospital on regular bases is 150. This obviously is not the true number as many children living in the northern part of the state visit the children hospitals in Khartoum and the rest either looked after by the private sector or other heath facilities in Medani and the nearby district hospitals. The service offered to diabetic children in Sudan as in all underdeveloped countries is hospital based; there is no community set-up to look after them when they go home or in the schools. This is the reason why all diabetic children admitted to the hospital are in state of DKA. Even in the hospital there is no agreed policy for the management of diabetes, each unit is treating children in a different way.

Mission :Improve the care given to diabetics at hospital and community level.

Objectives:
-Determine the prevalence of diabetes mellitus among children in Wad Medani and Gezira state.
Management and follow-up of children with diabetes
-Development of evidence based guidelines for the clinical management of diabetes and its complications
-Provision of investigation tools for the children at home (Strips and glucometers)
-Provision of special dietary services for them with special emphasis on local food items.
-Provision of psychological services and support for the children and their families.
-

Strategies
-Regular follow-up of diabetics through establishment of diabetes special clinic.
Provision of insulin and other provision of insulin and other consumables in collaboration with diabetes control programmes, diabetics societies and NGOs.
Health education progammes for the children, families and the community (face to face sessions, posters, panflits, ect..)
Training of health personnel in diabetes special management.
. Training of teachers in diabetic care in the schools.
Conduction of dietary education sessions for children and families.
Provision of psychological support for children and families. .

Diabetes special clinic: Personn el (Consultant, Registrar, 2 Medical Officers, Senior House Officer, Diabetic Nurse, Dietician and Child Psychologist)
Consultation process : Include the following in any diabetes consultation.
1.Welcome:
Friendly greeting of the individual and early establishment of rapport 2.Problem review
Understanding of any recent events disturbing the person life style
Enquiry after general well-being and identification of new difficulties.
Review of self monitoring results and discussion of their meaning.
Review of dietary behaviors and physical activity
Review of diabetes educations, skills, and foot care
Review of insulin therapy and experience of hypoglycemia
Review of other medical conditions and therapy affecting diabetes
Management of complications and other problems identified at annual review
3.Analysis and planning
Summary of an agreement on main points covered in consultation
Agreement on targets for future months
Agreement on, and explanation of, changes in therapy
Agreement on interval to next consultation
4.Organization of clinical monitoring
A schedule for clinical monitoring is given in the table below

A salient goal for diabetes care is to enable each person with diabetes to lead the health –care team involved in the management of their diabetes
5. Assessment of empowerment
Assess whether the person with diabetes:
Has the knowledge . Behavioral skills and sense of awareness necessary for optimum self care.
Makes early and effective responses to everyday problems
Has the confidence to obtain the best input from the diabeties health-care team.
6-Patient education
The aims of education and training are provide information in an acceptable form, in order that peoples with diabetes develop the knowledge to self-manage their diabetes and empower them to make informed choices in their life.
Patient education targets
Aim to optimize :
- Knowledge of diabetes , and the aims of its management
- Motivation
- Attitudes to self-care
- Behaviors which interact with diabetes management
Empowerment in handling health-care and other professionals
7- Assessment of blood glucose control
Measure glycated haemoglobin - 2-4 monthly in every patient (depending how stable)

Glucose control assessment levels

Think of hypo glycaemia if glycated haemoglobin level is normal or close to normal or close to normal Use the assessment levels
Attention to the non- metabolic target of diabetes interfering little with the patient general and social well- being will help metabolic control
8- Life - style - issues - living with diabetes
- Schooling
- Psychological support
9- Providing eating and drinking advice

Through dietician depending on local, available food.
10- Physical exercises

11- Recording
- • Completion of a structured record patient - held record of the consultation

Diabetes Special Clinic Card
- Name
- Date of birth
- Age of diagnosis
- Consultant
- Address
- Tel.
- File number
- Date of next visit
Diabetes Special Clinic Base-Line data
- Name
- Date of birth
- Age of diagnosis
- Address
- Tel.
- Type of insulin soluble zinc mixed
- Dose schedule Source of insulin
- Insulin storage
Past history:
- Place of diagnosis
- The presenting symptoms
- History of admission/s
- History of DKA
- History of hypoglycemia
Nutritional History
- No. of Meals
- Type of Meals
Developmental History
-Milestones
-School performance
Physical examination:
-Height centile
-Weight centile
-Head circumference centile
-BMI
-P.R
-R.R
-B.P

Investigations:
-Urine
-RBS
-RFT
-LFT
-Lipid
-Glycoslaed HbA

Regular visit checklist

Daily follow-up of Urine Sugar and Acetone Month ...

Diabetes clinic needs
-Clinical Care Guidelines
-Urine Strips for glucose/ketones/proteins
-Blood glucose meter with appropriate strips
-Weight Scale and Height measure
-Tape measure
-Tuning Fork and pateller hammer Ophthalmoscope
-Snellen chart
-Biochemistry analyzers for glucose, lipids, renal function and Glycosylated hemoglobin
-Stationeries and forms
- Computer with appropriate software.

References
-Clinical Practice Guidelines and Standards of Care of Diabetes Mellitus in Sudan, FMOHlWHO, November 2005.
-World Diabetes foundation website.
-Medical follow-up Records, Health services, University of Khartoum.
-National diabetes pogramme publications, FMOH.

Integrated Management of Diabetes -Eye Care- Project (IMDP)

PROJECT PERIOD

Goal:
The Goal of this project is to help establish a national model and reference clinic for eye screening in Sudan.

Objectives:
-To initiate an eye care service for children and adults with diabetes in Sudan, to complete the range of care given to the diabetics.
-To help prevent blindness due to diabetic retinopathy in type 1 and type 2 diabetic patient.
-To improve the quality of life for patients with diabetes who develops retinopathy.
-To develop the capacity of health personnel in the eye care unit who are dealing with diabetic patients.

The activities in this project will be as follows:
Activity 1:
Conduction of workshop for 60 persons, the aim of which is to strengthen the already established partnership in diabetes care in Gezira state and to ensure the commitments of new partners, the workshop also will aim at having a consensus of the road map of the clinic and to endorse the guidelines of eye care in diabetes and to agree on the health education plan.
Activity 2:
Establishment of the eye care reference clinic: the proposed unit - equipped with proper equipments- will provide eye screening to the children and adults according to the guidelines, those who have no changes will be screened annually, if any changes detected then a meticulous follow-up will be done, every 3-6 month to determine the time for interference. If any treatment required will applied immediately.
Activity 3:
Training of health personnel: training will be for three ophthalmologists on interpreting the screening results and the management guidelines aiming at centre of excellence in the eye care in diabetes, training of specialized two nurses for better care and training for two technicians for better running the unit equipments.
Activity 4:
Health Education campaigns and activities to help the patients better understanding their conditions and to increase the public awareness about the eye care in diabetes.
These activities will include Lectures conducted with experts in the field with abilities to health educate people using the suitable techniques for this, we will make use of the health education programmes (through the health education department in the State Ministry of Health) in the local television and radio stations in Gezira state to implements a full package of health education regarding diabetes and retinopathy.
In collaboration with the media department in the University of Gezira, articles in the newspapers will be written for health education.
Brochures, Booklets, posters and Exhibitions will be produced and to be used in the direct health education of patients in the clinics, the eye campaigns held by Elsain Hospital and the NGOs working the field and to use in the health education programmes through the community-based education programmes in the University of Gezira.
All these activities will be planned for and followed up by a committee of experts from the FMUG, SMoH, medical students association and experts in media production.

PROJECT DESIGN, TIME SCHEDULE AND RESOURCES
Indicate the design of your programme and personnel needed including quantitative data, e.g. number of subjects

1- The expected number of diabetic children who will benefit from this project is about 400. (40% of the registered children in IMDC are above 12 years old and 25% have diabetes for more than 4 years.). This number is expected to increase due to the increase in the incidence and prevalence. And a similar number of adults with type 2 diabetes will receive the care.
2- Training of three ophthalmologists, 2 nurses and 2 technicians.
3- Increase awareness in the community.
4- Development of Guidelines for eye care in Diabetes.

إتصل بنا