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The adequacy of diabetic care for children in a developing country
1Department of Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt. amalot@yahoo.com
Insights
Diabetic children in Egypt face care gaps, with insured children receiving better education and monitoring. Uninsured children experience more acute complications, highlighting a need for improved diabetes management strategies.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Quality of care for diabetic children in public hospitals in Egypt is under-evaluated.
- Diabetes management in pediatric populations requires specific attention due to growth and developmental needs.
Purpose of the Study:
- To evaluate the quality of care provided to diabetic children in public children's hospitals in Alexandria, Egypt.
- To identify disparities in care between insured and uninsured diabetic children.
Main Methods:
- A cross-sectional study was conducted over 4 months.
- Data collection involved evaluating healthcare providers, investigations, diabetes education, self-monitoring practices, and insulin regimens.
- Analysis included comparison of outcomes between insured and uninsured children.
Main Results:
- Adult diabetologists were the primary healthcare providers, with significant differences in care frequency (physical examination, investigations, education) between insured and uninsured children.
- Self-monitoring of blood glucose and urine glucose (glucosuria) were more common in insured children.
- Premixed insulin via syringe was prevalent, limiting patient initiative. Uninsured children had higher rates of acute diabetic complications (hypoglycemia, hyperglycemia/ketoacidosis), with recurrence linked to lower parental education and rural residence.
Conclusions:
- Significant deficiencies exist in diabetes information provision to children and parents in Egypt.
- There is a critical need for public education strategies, standardized treatment recommendations, flexible insulin regimens, and accessible home monitoring devices.
Unlabelled:
A cross-sectional study was conducted over 4 months evaluating the quality of care provided to diabetic children in public children's hospitals in Alexandria, Egypt.
Results:
Adult diabetologists were the main healthcare providers (HCP) (60.4%) in the School Health Insurance Hospital followed by paediatric diabetologists in the University Hospital. Insured children had a significantly higher frequency of physical examination, investigations and diabetes education compared to uninsured children. One-quarter of insured and 22% of uninsured children were performing self monitoring of blood glucose, while 45.2% of insured children were checking glucosuria at home compared to 34.0% of uninsured children. Premixed suspensions of biosynthetic human insulin, administered mainly via a syringe, was the most commonly prescribed insulin type with little possibility for personal initiative. Acute diabetic complications were also higher in uninsured compared to insured children. The frequency of these life threatening acute diabetic complications in the school health insurance system is estimated to be approximately 12.7 severe hypoglycaemic and 57.2 hyperglycaemic/ketoacidotic episodes per 1000 diabetic children per year. Recurrence of diabetic emergencies was significantly higher among children of parents with lower educational levels and children living in semiurban and rural residence. Children with recurrent diabetic emergencies had lower educational achievement, and more grade repeating and school absence during the year.
Conclusion:
The results of this study appear to reflect marked deficiencies in the provision of information to children with diabetes and their parents in a developing country. A need for public-education strategies, consensus about treatment recommendations, use of more flexible insulin regimens, and devices for home monitoring is identified.