The adequacy of diabetic care for children in a developing country.
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.


CONCLUSIONS
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.
Bassili
A
A
Department of Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt. amalot@yahoo.com
Omar
M
M
Tognoni
G
G
D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000453:epidemiology; D015190:Blood Glucose Self-Monitoring; D017028:Caregivers / Q000193:education*; D002648:Child; D002662:Child Health Services / Q000592:standards*; D002675:Child, Preschool; D003128:Coma / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D003710:Demography; D003906:Developing Countries; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000628:therapy*; D003926:Diabetic Coma / Q000453:epidemiology; D004534:Egypt; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public; D006785:Hospitals, University; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007223:Infant; D007348:Insurance, Health; D008297:Male; D010353:Patient Education as Topic; D010372:Pediatrics; D011795:Surveys and Questionnaires; D000078329:Workforce