Abstract
Introductiondiabetes care in Guinea-Bissau (GB) is characterized by a lack of properly trained healthcare professionals (HCPs) and guidelines for diagnosis, treatment and follow up of patients. To address these issues, this project was launched with the objective to train HCPs in the management of diabetic patients and establish a specialized diabetes clinic in the Hospital Nacional Simão Mendes, a public tertiary care hospital in Bissau, capital of GB. This project is led by the Geneva University Hospitals (HUG) in collaboration with the Swiss Association for the Aid to Diabetic People in Guinea-Bissau, with the support of the International Solidairty Office (SSI) of the State of Geneva, and AIDA (Ayuda, Intercambio y Desarrollo).Methodsspecialists from the HUG in collaboration with local experts in GB developed and delivered a culturally and contextually adapted training course pertaining to diabetes care to HCPs in this hospital. Pre and post training tests were conducted to assess differences in knowledge and practices. Following the training program, a diabetes clinic was set up and an audit was conducted to assess its performance.Resultsa total of 24 HCP attended the training program and exhibited statistically significant improvements in their knowledge pertaining to diabetes care (mean difference between pre and post-test = 14.53, SD 11.60, t=-4.8, p < 0.001). The diabetes clinic was established and provided consultations 2 days per week. A total of 63 patients consulted at this clinic, of which 49 had type two diabetes treated with oral antidiabetic drugs and 14 were type 1 diabetics treated with insulin. Patients had blood glucose measurements and received therapeutic, dietary and physical activity counselling. Several barriers leading to occasional interruptions of service were encountered, including a political instability in the country and strikes of healthcare staff demanding better wages and working conditions.Conclusion:this study delineates the feasibility of setting up a diabetes consultation clinic in GB despite important barriers. To ensure successful running of such consultation clinics, continued buy-in and support from stakeholders should be ensured. Diabetes training should be incorporated in pre-and post-graduate training curriculums of all HCP to help shape a better workforce.
Highlights
Diabetes mellitus (DM) is a global challenge due to its growing incidence and associated long-term complications and poor quality of life
Thereafter, to improve the delivery of diabetes care in Hospital Nacional Simão Mendes (HNSM), specific action points were formulated which included the development of a specialized consultation for people with DM (PWD) in the HNSM with a mobile multi-professional team, that would support other HNSM units regarding care of PWD
This study delineates the feasibility of setting up a diabetes consultation clinic in GB despite important barriers
Summary
Diabetes mellitus (DM) is a global challenge due to its growing incidence and associated long-term complications and poor quality of life. In Sub-Saharan Africa (SSA), a recent dramatic change in age-related demographics as well as lifestyle changes is the leading factors of this rising prevalence [3-6]. This is evident in the republic of Guinea-Bissau (GB), a country lacking in health care infrastructure, resources, and a wellintegrated health system [7]. The current prevalence estimates are considered to represent only the tip of the iceberg, due to the important number of undiagnosed cases This was reflected in the survey conducted by Haraldsdottir et al where none of the diagnosed people with DM (PWD) were registered at the local diabetes clinic, and were unaware of their impaired glucose level status [8]. According to Byberg et al the prevalence of undiagnosed diabetes is estimated to be 9% [10]
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