Type 1 Diabetes as a “Tracer” condition in Developing Countries • Beran, D.¹, Yudkin J.S.¹ and de Courten M.² • ¹ International Insulin Foundation, International Health and Medical Education Centre, University College London, Holborn Union Building, Archway Campus, • 2-10, Highgate Hill, London N19 5LW, UK • www.access2insulin.org • ² 25/49 Head Street, Brighton VIC 3186 Australia
Objective: To assess the prevalence and patterns of care of type 1 diabetes in 2 sub-Saharan African countries (Mozambique and Zambia) and to relate prevalence, and estimates of life expectancy, to geographical factors and availability of insulin and monitoring equipment.
Methods: Rapid Assessment Protocol for Insulin Access (RAPIA) • Developed based on the principles of Rapid Assessment Protocols, which are used: • for applying preventive and therapeutic interventions • when information collection is needed quickly • when conventional research techniques are impractical • when there is a need to link the assessment phase with developing, enhancing or evaluating interventions • Provides a locality specific analysis of the constraints to insulin access and diabetes care • Cross checking between different data sources • Is structured as a multi-level questionnaire based assessment of the health system • Interviews with health workers, administrators, patients, etc.
Methods (2): The RAPIA provides information in the categories of: • Health service structure and functioning with regards to procurement of medicines and diabetes management • Diabetes policies written and enacted • Reported practice for Type 1 diabetes management • Observed practice for Type 1 diabetes management • Availability of insulin, syringes and monitoring equipment • Existence of distribution networks for insulin Insulin supply-related knowledge and attitudes amongst people with diabetes and their carers • Other problems that hamper the access to proper insulin and care
Results: Prevalence of type 1 diabetes
Results (2): Insulin availability is irregular in rural areas - particularly in Mozambique.
Results (3): Insulin very expensive when purchased privately
Results (4): Testing for diagnosis and management rarely available
Conclusion: Type 1 diabetes outcomes are poor especially in rural areas.
Conclusion: There is evidence that: • The Rapid Assessment process can act as a catalyst to improving diabetes care • Health worker training, combined with advocacy by patients’ associations, can impact services and outcomes • Increasing the supply of insulin alone will not lead to improved conditions for patients. • Type 1 diabetes can be used as a “tracer” condition to assess how well a health system delivers care • Improvements in health care systems, pharmaceutical supply, and health worker training are important to tackle Type 1 diabetes. These improvements will not only benefit care for Type 1 diabetes, but also for other non-communicable and communicable diseases.
About the International Insulin Foundation: The IIF is a UK registered charity which was formally established by leading academics and physicians in the field of diabetes. Its aims are to prolong the life and promote the health of people with diabetes in developing countries by improving the sustainable supply of insulin and education in its use. Next steps: The results of the RAPIA have been presented to the Ministry of Health, Diabetes Association and other stakeholders in both Mozambique and Zambia where the IIF is about to start the implementation phase of its work in collaboration with the IDF Africa Region. The IIF will also be carrying out a similar assessment in Mali.
Acknowledgements: The Rapid Assessment Tool developed by the IIF was piloted in Mozambique, thanks to a grant from the World Diabetes Foundation. Its implementation in Zambia, was made possible with the financial support of the World Health Organisation, the Diabetes Foundation and the Barnett & Sylvia Shine No 2 Charitable Trust (UK based Charities).