title: Content, participants and outcomes of three diabetes care programmes in three low and middle income countries.
abstract: OBJECTIVE
  To improve access and quality of diabetes care for people in low-income countries, it is important to understand which elements of diabetes care are effective. This paper analyses three diabetes care programmes in the DR Congo, Cambodia and the Philippines.
  
  
  METHODS
  Three programmes offering diabetes care and self-management were selected. Programme information was collected through document review and interviews. Data about participants' characteristics, health outcomes, care utilisation, expenditures, care perception and self-management were extracted from a study database. Comparative univariate analyses were performed.
  
  
  RESULTS
  Kin-réseau (DR Congo) is an urban primary care network with 8000 patients. MoPoTsyo (Cambodia) is a community-based peer educator network, covering 7000 patients. FiLDCare (Philippines) is a programme in which 1000 patients receive care in a health facility and self-management support from a community health worker. Content of care of the programmes is comparable, the focus on self-management largest in MoPoTsyo. On average, Kin-réseau patients have a higher age, longer diabetes history and more overweight. MoPoTsyo includes most female, most illiterate and most lean patients. Health outcomes (HbA1C level, systolic blood pressure, diabetes foot lesions) were most favourable for MoPoTsyo patients. Diabetes-related health care expenditure was highest for FiLDCare patients.
  
  
  CONCLUSIONS
  This study shows it possible to maintain a diabetes programme with minimal external resources, offering care and self-management support. It also illustrates that health outcomes of persons with diabetes are determined by their bio-psycho-social characteristics and behaviour, which are each subject to the content of care and the approach to chronic illness and self-management of the programme, in turn influenced by the larger context.
authors.affiliation: Institute of Tropical Medicine, Department of Public Health Antwerp, Belgium; Department of General Practice & Elderly Medicine, EMGO, Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: jvanolmen@itg.be.
authors.forename: Josefien
authors.initials: J
authors.lastname: Van Olmen
authors.affiliation: Institute of Tropical Medicine, Department of Public Health Antwerp, Belgium.
authors.forename: Ku Grace
authors.initials: KG
authors.lastname: Marie
authors.affiliation: Memisa, Brussel, Belgium.
authors.forename: Darras
authors.initials: D
authors.lastname: Christian
authors.affiliation: Memisa, Kinshasa, People's Republic of Congo.
authors.forename: Kalobu Jean
authors.initials: KJ
authors.lastname: Clovis
authors.affiliation: Memisa, Kinshasa, People's Republic of Congo.
authors.forename: Bewa
authors.initials: B
authors.lastname: Emery
authors.affiliation: MoPoTsyo, Phnom Penh, Cambodia.
authors.forename: Van Pelt
authors.initials: VP
authors.lastname: Maurits
authors.affiliation: MoPoTsyo, Phnom Penh, Cambodia.
authors.forename: Hen
authors.initials: H
authors.lastname: Heang
authors.affiliation: Algemeen Ziekenhuis Heilige Familie, Reet & Centre de Santé des Fagnes, Chimay, Belgium.
authors.forename: Van Acker
authors.initials: VA
authors.lastname: Kristien
authors.affiliation: Universitair Ziekenhuis, Vrije Universiteit Brussels. Belgium.
authors.forename: Eggermont
authors.initials: E
authors.lastname: Natalie
authors.affiliation: Department of General Practice & Elderly Medicine, EMGO, Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; NIVEL (Netherlands Institute for Health Services Research), The Netherlands.
authors.forename: Schellevis
authors.initials: S
authors.lastname: François
authors.affiliation: Institute of Tropical Medicine, Department of Public Health Antwerp, Belgium.
authors.forename: Kegels
authors.initials: K
authors.lastname: Guy
mesh_terms: D000368:Aged; D002160:Cambodia / Q000453:epidemiology; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries / Q000191:economics*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration; D010353:Patient Education as Topic; D010679:Philippines / Q000453:epidemiology; D011203:Poverty / Q000191:economics*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D017064:Process Assessment, Health Care / Q000191:economics / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D012648:Self Care; D016896:Treatment Outcome
keywords: Diabetes care; Low-income countries; Self-management education; Translational research