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Obstacles of optimum care for diabetic children in Palestine

Obstacles of optimum care for diabetic children in Palestine. Prepared by Dr.Intisar Al-Alem November 2008. What is Type 1 DM ?. Type 1 DM (T1DM) is used to denote childhood diabetes associated with autoimmunity and absolute insulin deficiency

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Obstacles of optimum care for diabetic children in Palestine

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  1. Obstacles of optimum care for diabetic children in Palestine Prepared by Dr.Intisar Al-Alem November 2008

  2. What is Type 1 DM ? • Type 1 DM (T1DM) is used to denote childhood diabetes associated with autoimmunity and absolute insulin deficiency • Type 1 diabetes is a condition in which the pancreas makes so little insulin that the body can't use blood sugar for energy • Type 1 diabetes must be controlled with daily insulin shots

  3. Management of Diabetic Children • Diabetic children should be offered an ongoing integrated package of care by a multidisciplinary paediatric diabetes care team (optimum care & reduction of complications) • Diabetic children and their families should be offered 24-hour access to advice from the diabetes care team.

  4. Epidemiology of Type 1 DM • Globally, about 500,000 children under the age of 15 with T1DM • Every day 200 children develop T1DM • Every year, 70,000 children under the age of 15 develop T1DM • T1DM is increasing in children at a rate of 3% each year • T1DM is increasing fastest in pre-school children, at rate of 5% per year • In Palestine until now we havnt true statistics

  5. Diabetic children in government PHC diabetic clinics , West Bank (2006)

  6. Distribution of reported new registered cases of diabetic children in government PHC diabetic clinics , West Bank 2007

  7. Distribution of reported new registered cases of diabetic children in government PHC diabetic clinics , West Bank 2007

  8. Diabetic clinics in Palestine Specialized diabetic clinics began in 1987 • now there are 10 clinics one in each district & also many small clinics in villages (4 in Nablus, 9 in Jenin & 4 in Hebron) which are operating according to an organized program • These clinics provide medical services for about 20000 diabetic patients in the west bank • There is coordination between central clinic in the city ,those in the villages & also between diabetic clinic & governmental hospitals. • Diabetic children are followed-up with other diabetics

  9. Obstacles of optimum care for diabetic children in Palestine • Political Obstacles • National Obstacles • Obstacles (MOH) • Psychosocial obstacles

  10. Political Obstacles • Lack of communication between Gaza &west bank • Siege &check points make access to clinics difficult, especially for those who are living in far areas • Economic problems

  11. National Obstacles • Lack of cooperation & coordinated between health providers • Lack of national treatment guidelines • Shortage of human and financial resources • Lack of important specialists • Lack of screening and early detection activities • There is no statistical information and studies to estimate the real side of the problem

  12. Obstacles (MOH): • Until now there are no specialized clinics for care of diabetic children in MOH & those patients are followed-up among others • Shortage of well trained medical staff who provide care for diabetic children • Lack of some important specialties pediatric endocrinologists, vascular surgeons, ophthalmologists, podiatrists, chiropodists, health educators and dieticians • Trained physicians &nurses are not enough for this number of patients. • Because of work over load there is no enough time or space to provide appropriate health care or education

  13. Obstacles (MOH): • Lack of materials, drugs and equipments necessary for proper management • Lack of Guidelines &protocols for management of diabetic children • Lack of educational & entertainment programs • Because of the lack of home visiting program, disabled patients deprived from proper health care, also follow-up after hospital discharge is lacking.

  14. Psychosocial obstacles • Financial barriers (healthy food, gluco-strips, clinic visits) • Denial & non-adherence to therapy (insulin injections, snacks, home monitoring, diet, exercise &regular visits to clinic) • Stigma like delay in marriage or reduced job opportunities • Lack of knowledge (family & school members)

  15. Suggestion for optimum care of diabetic children • Establishment of special clinic • Training of physicians &nurses externally &locally • Training of new important specialties • Development &implementation of guidelines &protocols • Continuous education programs for patients & their relatives (families &teachers)

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