Healthcare delivery for paediatric and adolescent diabetes in low resource settings: Type 1 diabetes clinics in Uganda

ABSTRACT

The management of type 1 diabetes (T1DM) includes setting up organised follow-up clinics. A programme for establishing such clinics in Uganda commenced in 2009. The clinics were established along the chronic care model and were integrated into the health structure of other chronic diseases. Web-based electronic medical records were utilised to establish a centralised registry. All children with diabetes below 18 years of age were encouraged to enrol into the programme by attending the nearest established T1DM clinic. At the commencement of the programme, there were 178 patients with T1DM receiving care in various health facilities but without organised follow-up T1DM clinics. These patients were subsequently enrolled into the programme and as of June 30, 2018, the programme had a total of 32 clinics with 1187 children; 3 with neonatal diabetes. Challenges encountered included difficulties in timely diagnosis, failure to provide adequate care in the remote rural areas and failure to achieve pre-defined glycated haemoglobin (HbA1c) goals. Despite these challenges, this observational study demonstrates that healthcare delivery for T1DM organised along the chronic care model and supported by web-based electronic medical records is achievable and provides care that is sustainable. Addressing the encountered challenges should result in improved outcomes for T1DM.

KEYWORDS:

• Type 1 diabetes
• Uganda
• healthcare
• low-income
• diabetes clinic
• chronic care model

Acknowledgments

The authors thank the Uganda Government, the World Diabetes Foundation, Novo Nordisk and Roche Diabetes Health Care for the financial and material support to implement this project. The authors extend special thanks to Imelda Kemeza, PhD for her extensive review of the educational curriculum, Stella Neema, PhD for her work in determining what is best approach with community engagement and Agnes Ssebayigga, MSc for the advice on handling T1DM in school. We thank the parents and children for the valuable in put in shaping the model of care.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Silver Bahendeka http://orcid.org/0000-0001-8080-7872

Additional information

Funding

The type 1 diabetes clinics were supported by the consortium of funding from World Diabetes Foundation, Novo Nordisk, Roche Diagnostics and the Uganda Government, Ministry of Health.