Elrayah Hind, Eltom Mohamed, Bedri Ashraf, Belal Abdelrahim, Rosling Hans, Ostenson Claes-Göran
Division of International Health Care Research, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
Diabetes Res Clin Pract. 2005 Nov;70(2):159-65. doi: 10.1016/j.diabres.2005.03.034.
The aims of this study were to estimate the direct costs of childhood diabetes in a low income country, Sudan, and to assess the effectiveness of care paid for by the families. For this purpose, socio-economic and demographic data on families were obtained from the parents of 147 children with type 1 diabetes, attending public or private clinics in Khartoum State, Sudan. The median annual income of the families of diabetic children was US dollars (US$) 1222 (range 0-14,338) of which 16% was received as financial help from relatives and friends. The median annual expenditure of diabetes care was US$ 283 per diabetic child of which 36% was spent on insulin. Of the family expenditure on health, 65% was used for the diabetic child. Families of diabetic children who were attending private clinics had a significantly higher total expenditure on health and home blood glucose monitoring than those who were attending the public clinics. However, there was no difference in total income between the two groups and glycaemic control was poor in 86% of the patients, regardless of whether care was being given by private or public clinics. The occurrence of the disease and its poor control appeared to exert a negative impact on the school performance of the diabetic child. In conclusion, the low direct costs reflect the minimal care given to the diabetic patients. Under the present economic conditions, families pay a considerable part of their income to sponsor the health of their diabetic children and receive little support other than that from relatives and friends. 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.
本研究的目的是估算低收入国家苏丹儿童糖尿病的直接成本，并评估家庭支付的护理效果。为此，从苏丹喀土穆州公立或私立诊所就诊的147名1型糖尿病儿童的父母那里获取了家庭的社会经济和人口数据。糖尿病儿童家庭的年中位数收入为1222美元（范围0 - 14338美元），其中16%来自亲戚和朋友的经济帮助。糖尿病护理的年中位数支出为每名糖尿病儿童283美元，其中36%用于胰岛素。在家庭健康支出中，65%用于糖尿病儿童。在私立诊所就诊的糖尿病儿童家庭在健康和家庭血糖监测方面的总支出明显高于在公立诊所就诊的家庭。然而，两组的总收入没有差异，86%的患者血糖控制不佳，无论护理是由私立诊所还是公立诊所提供。疾病的发生及其控制不佳似乎对糖尿病儿童的学业成绩产生了负面影响。总之，低直接成本反映了对糖尿病患者的护理极少。在当前经济条件下，家庭将相当一部分收入用于资助糖尿病子女的健康，除了亲戚和朋友的支持外，几乎没有得到其他支持。目前的糖尿病护理组织没有赋予患者权力、知识和自我护理能力。训练有素的糖尿病团队和教育项目可能会改善这种情况。
