Volume 9, Issue 5 (2021)                   Health Educ Health Promot 2021, 9(5): 469-474 | Back to browse issues page

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Alabedi R, Alsaffar H, Abdoun D. The Status of Health Services in Iraq; A Case Study of Pediatric Diabetes. Health Educ Health Promot 2021; 9 (5) :469-474
URL: http://hehp.modares.ac.ir/article-5-56125-en.html
1- Department of Pediatrics, Faculty of Medicine, University of Babylon, Iraq , faisalrehab@uobabylon.edu.iq
2- Pediatric Endocrine and Diabetics Uni, Sultan Qaboos University Hospital, Muscat, Oman
3- Department of Pediatrics, Central Child Teaching Hospital, Baghdad, Iraq
Abstract:   (1202 Views)
Aims: Diabetes mellitus type 1 as a chronic disease represents a heavy burden on its patients and families. In the absence of health insurance in Iraq, the public sector should provide these patients with standard care to not compel them to get it from the costly, private one. This study aimed to overview the provided public service for children and young people living with diabetes in Iraq and compare it with international standards.
Instrument & Methods: In this descriptive study in 2019, the opinions of physicians running public PDU in 18 provinces of Iraq were collected via an online questionnaire. The collected data were analyzed using the Survey Monkey built-in analyzing tools.
Findings: The number of patients in each center ranged between 98-3000. Before transferring patients to adult services, the mean age was 16 years, ranging between 14-19 years. 78% of health care providers had no transition policy in their centers. Team composition was variable; 44% of the units had no pediatric diabetologists or trained physicians in pediatric diabetes, half had no diabetes specialist nurses or diabetes educators, 78% had no dietitians, and 94% functioned without psychologists. Basic facilities and medical supplies were limited, and not all investigations were available. The annual screening was performed in 56% of centers. Educational activities were organized only in 39% of units.
Conclusion: There is a significant shortage of essential requirements for running a reasonable pediatric diabetes service with a wide variation in the provided services between the pediatric diabetes units.
Full-Text [PDF 389 kb]   (877 Downloads) |   |   Full-Text (HTML)  (309 Views)  
Article Type: Descriptive & Survey | Subject: Health Communication
Received: 2021/09/5 | Accepted: 2021/09/6 | Published: 2022/01/25
* Corresponding Author Address: Department of Pediatrics, Faculty of Medicine, University of Babylon, Iraq

References
1. Chiang JL, Maahs DM, Garvey KC, Hood KK, Laffel LM, Weinzimer SA, et al. Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care. 2018;41(9):2026-44. [Link] [DOI:10.2337/dci18-0023] [PMID] [PMCID]
2. American Diabetes Association. 13. Children and Adolescents: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S148-64. [Link] [DOI:10.2337/dc19-S013] [PMID]
3. DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. Lancet. 2018;391(10138):2449-62. [Link] [DOI:10.1016/S0140-6736(18)31320-5]
4. Acerini CL, Codner E, Craig ME, Hofer SE, Maahs DM, editors. ISPAD clinical practice consensus guidelines [Internet]. Berlin: ISPAD; 2018 [cited 21 Aug 2021]. Available from: https://www.ispad.org/general/custom.asp?page=ISPADGuidelines2018. [Link]
5. American Diabetes Association. 13. Children and adolescents: standared of medical care in diabetes 2021. Diabetes Care. 2021;44(Suppl 1): S180-99. [Link] [DOI:10.2337/dc21-S013] [PMID]
6. National Institute for Health and Care Excellence (NICE). Diabetes (type 1 and type 2) in children and young people: diagnosis and management [Internet]. London: NICE; 2015 [cited 21 Aug 2021]. Available from: https://www.nice.org.uk/guidance/ng18/chapter/1-Recommendations. [Link]
7. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2018;42(Suppl 1):S1-S325. [Link] [DOI:10.1016/S1499-2671(17)31026-2]
8. IDF/ISPAD. Global guideline for diabetesin childhood and adolescence [Internet]. Berlin: ISPAD; 2011 [cited 21 Aug 2021]. Available from: https://www.ispad.org/page/IDFISPAD2011. [Link]
9. Codner E, Acerini CL, Carig ME, Hofer SE, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Introduction to the Limited Care guidance appendix. Pediatri Diabetes. 2018;19(27):326-7. [Link] [DOI:10.1111/pedi.12765] [PMID]
10. Pettitt DJ, Talton J, Dabelea D, Divers J, Imperatore G, Lawrence J, et al. Prevalence of diabetes in US youth in 2009: the search for diabetes in youth study. Diabetes Care. 2014;37(2):402-8. [Link] [DOI:10.2337/dc13-1838] [PMID] [PMCID]
11. Patterson CC, Dahlquist GG, Gyurus E, Green A, Soltesz G. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet. 2009;373(9680):2027-33. [Link] [DOI:10.1016/S0140-6736(09)60568-7]
12. Vehik K, Hamman R, Lezotte D, Norris J, Klingensmith G, Bloch C, et al. Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth. Diabetes Care. 2007;30(3):503-9. [Link] [DOI:10.2337/dc06-1837] [PMID]
13. Dabelea D, Bell R, D'Agostino RB, Imperatore G, Johansen JM, Linder B, Liu LL, et al. incidence of diabetes in youth in the United States. JAMA. 2007;297(24):2716-24. [Link] [DOI:10.1001/jama.297.24.2716] [PMID]
14. Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffel L, et al. care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care. 2005;28(1):186-212. [Link] [DOI:10.2337/diacare.28.1.186] [PMID]
15. Wigert H, Wikström E. Organizing person-centred care in paediatric diabetes: multidisciplinary teams, long-term relationships and adequate documentation. BMC Res Notes. 2014;7:72. [Link] [DOI:10.1186/1756-0500-7-72] [PMID] [PMCID]
16. Cooke DW, Plotnick L, Dabelea D, Klingensmith GJ, Gallo L, Silverstein JH, Winter W. Diabetes mellitus. In: Kappy MS, Allen DB, Geffner ME, editors. Pediatric practice endocrinology. New York: McGraw-Hill; 2010. Pp: 343-92. [Link]
17. Sperling MA, Tamborlane WV, Battelino T, Weunzimer SA, Phillip M. Diabetes mellitus. In: Sperling MA, editor. Pediatric endocrinology. 4th Edition. Elsevier, Saunders; 2014. Pp: 846-900. [Link] [DOI:10.1016/B978-1-4557-4858-7.00028-7]
18. Butler G, Kirk J. Oxford specialist handbook in pediatrics; Pediatric endocrinology and diabetes. Oxford: Oxford University Press; 2011. Pp: 115-89. [Link]
19. The World Bank Group. Physicians (per 1,000 people) [Internet]. Washington: The World-Bank; 2018 [cited 21 Aug 2021]. Available from: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS. [Link]
20. Deeb A, Attia S, Yousef H, Abdelrahman L, Suliman S, Tomy M. Improving Glycemic Control in Children with Diabetes through Implementation of Multidisciplinary Team Approach. J Endocrinol Diabetes. 2016;3(2):1-4. [Link] [DOI:10.15226/2374-6890/3/2/00147]
21. Fortin K, Pries E & Kwon S. Missed Medical Appointments and Disease Control in Children with Type 1 Diabetes. J Pediatr Health Care. 2016;30(4):381-9. [Link] [DOI:10.1016/j.pedhc.2015.09.012] [PMID]
22. Styne DM. Pediatric endocrinology; A clinical handbook. Sacramento, CA: Springer; 2016. Pp: 263-304. [Link] [DOI:10.1007/978-3-319-18371-8_11]
23. DiMeglio LA, Acerini CA, Codner E, Carig ME, Hofer SE, Pillay K, Maahs DM. ISPAD clinical practice consensus guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and yong adults with diabetes. Pediatr Diabetes. 2018;19(27):105-14. [Link] [DOI:10.1111/pedi.12737] [PMID]
24. Mathieu C, Gillard P, Benhalima K. Insulin analogues in type 1 diabetes mellitus: getting better all the time. Nat Rev Endocrinol. 2017;13(7):385-99. [Link] [DOI:10.1038/nrendo.2017.39] [PMID]
25. Danne T, Phillip M, Buckingham B, Jarosz-Chobot P, Saboo B, Urakami T, et al. ISPAD clinical practice consensus guidelines 2018:Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes. 2018;19 (27):115-35. [Link] [DOI:10.1111/pedi.12718] [PMID]
26. Svoren BM, Jospe N. diabetes mellitus in children. In: Kleigman RM, editor. Nelson textbook of pediatrics. 20th Edition. Amsterdam: Elsevier; 2016. Pp: 2760-90. [Link]
27. Hanas R, Adolfsson P, Elfvin-Akesson K, Hammarén L, Ilvered R, Jansson I, et al. Indwelling catheters used from the onset of diabetes decrease injection pain and pre-injection anxiety. J Pediatr. 2002;140(3):315-20. [Link] [DOI:10.1067/mpd.2002.122470] [PMID]
28. Blun RW, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, Slap GB. Transition from child-centered to adult healthcare systems for adolescents with chronic conditions. A position paper of the Society for adolescent medicine. J Adolesc Health. 1993;14(7):570-6. [Link] [DOI:10.1016/1054-139X(93)90143-D]
29. Van Walleghem N, Macdonald CA, Dean HJ. Evaluation of a systems navigator model for transition from pediatric to adult care for young adults with type 1 diabetes. Diabetes Care. 2008;31(8):1529-30. [Link] [DOI:10.2337/dc07-2247] [PMID] [PMCID]
30. Holmes-Walker DJ, Llewellyn AC, Farrell K. A transition care programme which improves diabetes control and reduces hospital admission rates in young adults with Type 1 diabetes aged 15-25 years. Diabet Med. 2007;24(7):764-9. [Link] [DOI:10.1111/j.1464-5491.2007.02152.x] [PMID]
31. Nicolarsen J, Weissberg-Benchell J. Transition medicine-from pediatric to adult care: part 1. Pediatr Ann. 2017;46(5):e180-1. [Link] [DOI:10.3928/19382359-20170419-01]
32. Garvey KC, Wolpert HA, Rhodes ET, Laffel LM, Kleinman K, Beste MG, et al. Health care transition in patients with type 1 diabetes: young adult experiences and relationship to glycemic control. Diabetes Care. 2012;35(8):1716-22. [Link] [DOI:10.2337/dc11-2434] [PMID] [PMCID]
33. Nakhia M, Daneman D, To T, Paradis G, Guttmann A. Transition to adult care for youths with diabetes mellitus: findings from Universal Health Care System. Pediatrics. 2009;124(6):e1134-41. [Link] [DOI:10.1542/peds.2009-0041] [PMID]

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