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

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

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.

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

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

Total number of diabetics

Type1 diabetics

ALKhaleil 3187 282

Nablus 4288 197

Jenin 4381 250

Ramallah 1140 137

Bethlehem 1198 193

Tulkarm 1672 128

Al-Quds 766 36

Qalqiliah 1160 49

Salfit 862 36

Jericho 570 34

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

Age group 0-4 4-14 0-14

Sex M F M F M F

West Bank 4 4 32 24 36 28

ALKhaleil 0 1 4 3 4 4

Nablus 1 1 5 4 6 5

Jenin 1 2 6 5 7 7

Ramallah 1 0 8 1 9 1

Bethlehem 1 0 1 2 2 2

Tulkarm 0 0 3 5 3 5

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

Age group 0-4 4-14 0-14

Sex M F M F M F

Al-Quds 0 0 2 0 2 0

Qalqiliah 0 0 0 2 0 2

Salfit 0 0 1 0 1 0

Jericho 0 0 2 2 2 2

Population in West Bank

194029 198119 330938 326970 524967 525089

Incidence rate (per 100,000)

2.1 2.0 9.7 7.3 6.9 5.3

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

Obstacles of optimum care for diabetic children in Palestine

Political Obstacles

National Obstacles

Obstacles (MOH)

Psychosocial obstacles

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

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

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

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.

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)

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)