Prospects of Diabetes
in Sudan
Mohamed Ali Eltom

Summarize the past
 Rescale the present
 Predict the future
Sudan after 9 July
Diabetes prevalence
National Diabetes Survey 1993
0.1%
3.4%
2.1%
5.5%
8.3%
14 %
6.0 %
4.0 %
1.0 %
Type 1 Diabetes
Crude prevalence
Unknown Diabetics
in the Northern State
in Dongla
in Argo
in Khartoum State
in Gezeira State
in North Kurdofan State
Sudan Household Health Survey 2006
Diseases
Valid
Missing
Frequency
Valid Percent
Hypertension
429,651
22.0
Diabetes
235,446
12.0
Heart Disease
46,443
2.4
Cancer
5,115
0.3
Epilepsy
18,137
0.9
Asthma
179,287
9.2
Thyrotoxicosis
67,509
3.4
Hypothyroidism
57,736
3.0
Glaucoma
105,928
5.4
Cataract
110,060
5.6
Mental Health
59,220
3.0
Others
585,691
29.9
DK
23,162
1.2
Missing
33,663
1.7
Total
1,957,048
System
28,108,952
Total
30,066,000
100.0
Percentage of Raised blood glucose (≥7mmol/l)
19.20%
Raised BG
non raised BG
80.80%
Natural History of Diabetes

Poor glycaemic control, adequate control
only in 12%

Low quality of life

Acute and long-term complications are
common (67%)

High mortality rates among children
Micro vascular complications
 Retinopathy 43%
 Nephropathy 22%
 Neuropathy 37%
Macrovascular complications
 Cardiovascular disease 28%
 Peripheral vascular disease 10%
 Cerebrovascular accidents 5.5%
Factors Related to Poor Metabolic
Control
 Deficient patients awareness and
compliance
 Unaffordability and unavailability of drugs
and monitoring equipment
 Reduced level of well organized diabetes
care
 Poor health service organization
Challenges to diabetes care in
Sudan
 Inadequate Financial Resources
 Insufficient Health care system
 Professionals
 Patients
Difficulties experienced in diabetes
care
Patients
 Limited access to care : less than 20% of
patients have access to minimum standards of
care + urban/rural differences
 Insulin, other medications and supplies for
testing metabolic control
 Involvement of patients and families
Difficulties experienced in
Diabetes Care
Patients, cont.
 Lack of awareness and the challenge of
 self- management
 Reluctance to become empowered and
 self- managing
 Standards and materials for education
Diabetes Education Facilities

Education is offered by doctors in a busy
clinic atmosphere

Diabetes educator has not been integrated in
diabetes management

No national diabetes patient education programs
to define patient goals, monitor progress and
evaluate achievement

Lack of educational materials and equipment
Diabetes Control Among Low and
High Income Parents
80
70
60
50
40
30
20
Diabetes control
10
Poor
0
Good
low income
high income
Income Group
Acute Complications of Diabetes
 Ketone bodies in urine: 45.6%
 Hypoglycemia that needed special
attention: 37%
Hospital Admission
 56.6 % admitted at least once to
the hospital within a year
Main causes
 Diabetic ketosis: 71.8%
 Hypoglycemia:
5.9%
 Malaria:
10.6%
 Other medical disorders
or surgical intervention:
9.4%
 Families pay a considerable part of their income and receive
insignificant support other than that from relatives and friends
 The direct cost of diabetes care requires 23% of the available
economic resources of the parents
 The low costs reflect the minimal care given to the diabetic
patients
 The present organization of diabetes care does not provide the
patient with empowerment, knowledge and self-care ability
 Well-trained diabetic teams and education programs may
improve this situation
Prevalence 2025

Estimate 16%
(more than 3 Million Diabetic)
Action
 Primary prevention programs
 Organized educational programs and
proper medical services
National Diabetes Policy
Federal and state governments have identified
priorities and agreed on an approach to:
 Diabetes prevention, early detection,
management and treatment
 In partnership with key organizations and
service providers
www.diabetesinsudan.org
Areas of Development
 Primary prevention strategies
 Approved guidelines
 Optimum practice models for service delivery
 Partnerships between the different
stakeholders in the diabetes sector
 Alternative methods of funding for diabetes
prevention and management
Integrated Approach to Prevention
and Care
1. Promotion of Healthy Life-Styles
2. Raising Community Awareness
3. Primary Prevention at onset
4. Screening for Type II DM
5. Development of National Strategy
Optimum Practice Models
for Service Delivery
Quality Care Diabetes Facilities (QCDF)
 MDC in 25% of Primary Health Care Centers
(1 MDC for a catchment area of 4000 diabetic)
 1 Diabetes Referral Unit for every 4 MDC
Distribution of QCDF in the Country
According to Prevalence Levels
Prevalence
MDC
Unit
High
60
15
Moderate
40
10
Low
20
5
International Relations
 Health Diplomacy
 IDF
 WDF
 World Summit
Regional Relations
 Arab
 African
Arab World
High income
Gulf States
Middle income
• Egypt
•Jordan Syria
•Lebanon
•Libya
•Algeria
•Morocco
•Iraq
• Palestine
Low income
Research
Training
Education Material
Human Resources
Philanthropies
Civil Societies
• Sudan
• Yemen
• Djibouti
• Somalia
• Mauritania
Cardiovascular risk factors (%) among
adults in four Arab countries 2005
Country
Diabetes
Hypertension
High
Cholesterol
Egypt
16
33
24
Jordan
16
25
26
Kuwait
16
24
19
Sudan
12
23
19
Cardiovascular risk factors (%) among
adults in four Arab countries
Country
Smoking
Overweigh
& Obese
Low
physical
activity
Egypt
22
76
50
Jordan
29
67
?
Kuwait
16
?
92
Sudan
12
54
87
‫موضة التدخين من الصعيد‬
‫إلى الســـــودان‬
Bilateral Relations
 Egypt
 Jordan
 Saudi Arabia
 Sweden
Diabetes Care in the Nile Valley
‫شكرا‬
‫رمضان كريم‬