Obstacles of optimum care for diabetic children in Palestine
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Obstacles of optimum care for diabetic children in Palestine
Prepared by Dr.Intisar Al-Alem
November 2008
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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
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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.
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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
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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
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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
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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
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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
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Obstacles of optimum care for diabetic children in Palestine
Political Obstacles
National Obstacles
Obstacles (MOH)
Psychosocial obstacles
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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
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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
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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
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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.
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Psychosocial obstacles
Financial barriers (healthy food, gluco-strips, clinic visits)
Denial & non-adherence to therapy (insulin injections, snacks, home monitoring, diet, exercise ®ular visits to clinic)
Stigma like delay in marriage or reduced job opportunities
Lack of knowledge (family & school members)
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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)