Quality assessment of primary health care services provided for diabetes mellitus control in Alexandria.
Diabetes is a growing health problem worldwide. It is recognized as a particular threat to public health of the third world communities, particularly those living in rapidly developing countries. Therefore, the present study was conducted aiming at: assessment of the quality of primary health care (PHC) services provided for the control of diabetes mellitus (DM) in Alexandria; and opportunistic screening of high risk individuals attending PHC facilities for DM. Accordingly, the availability of human and nonhuman resources for DM control in two rural and two urban PHC centers in Alexandria (one of them was serving a desert area) was assessed by a pre-designed checklist 920 adult PHC attendants were screened for risk factors of DM. Individuals having more than one of the following risk factors: age above 50 years, overweight (body mass index > or =27 kg/m2), family history of DM in first degree relatives, history of hypertension, hypertension (systolic blood pressure > or =140 mm Hg and /or diastolic blood pressure > or =90 mm Hg), history of hyperlipidemia and history of gestational diabetes or birth of a large sized baby in females- were subjected to random capillary blood glucose (RCBG) testing. Cases were considered likely diabetic if RCBG was >200 mg/dl The performance of all PHC physicians examining and managing 560 diabetic patients was observed over a period of two months. One fourth of the diabetic cases were checked for the level of glycaemic control by fasting capillary blood glucose testing. The results revealed that 61.7% of the studied PHC attendants were at risk of developing DM and 14% were likely diabetic, with an urban: desert ratio of 2:1 The following factors were found to be independently associated with an increasing risk of DM occurrence among males: overweight (about 14 folds), family history of DM (9 folds), age above 50 years and history of hypertension (4 folds each). Whereas, among females the following risk factors were found: family history of DM (8 folds), history of gestational diabetes (6 folds) and overweight (4 folds). The majority of diabetic patients were poorly examined, investigated and managed; and an optimal level of glycaemic control was achieved in only 12.9% of the cases, as the PHC physicians didn't follow a model treatment plan for DM and due to unavailability of some equipment, laboratory facilities and essential drugs.
Koura
M R
MR
Primary Health Care Division, Alexandria University.
Khairy
A E
AE
Abdel-Aal
N M
NM
Mohamed
H F
HF
Amin
G A
GA
Sabra
A Y
AY
D000328:Adult; D003920:Diabetes Mellitus / Q000209:etiology / Q000628:therapy*; D004534:Egypt; D005260:Female; D006296:Health Services / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011634:Public Health; D011785:Quality Assurance, Health Care; D012307:Risk Factors