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 Ale xandria, Egypt. Results: Adult diabetologists were the main healthcare prov iders (HCP) (60.4%) in the School Health Insurance Hospital followed by pae diatric diabetologists in the University Hospital. Insured children had a s ignificantly higher frequency of physical examination, investigations and d iabetes education compared to uninsured children. One-quarter of insured an d 22% of uninsured children were performing self monitoring of blood glucos e, while 45.2% of insured children were checking glucosuria at home compare d to 34.0% of uninsured children. Premixed suspensions of biosynthetic huma n insulin, administered mainly via a syringe, was the most commonly prescri bed insulin type with little possibility for personal initiative. Acute dia betic complications were also higher in uninsured compared to insured child ren. The frequency of these life threatening acute diabetic complications i n 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 signifi cantly higher among children of parents with lower educational levels and c hildren living in semiurban and rural residence. Children with recurrent di abetic emergencies had lower educational achievement, and more grade repeat ing and school absence during the year. Conclusion: The results of this stu dy appear to reflect marked deficiencies in the provision of information to children with diabetes and their parents in a developing country. A need f or public-education strategies, consensus about treatment recommendations, use of more flexible insulin regimens, and devices for home monitoring is i dentified. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.