Department of Medicine & Therapeutics, University of Ghana Medical School, College of Health Sciences, Accra, Ghana.
Department of Community Health, University of Ghana Medical School, College of Health Sciences, Accra, Ghana.
PLoS One. 2024 May 20;19(5):e0303624. doi: 10.1371/journal.pone.0303624. eCollection 2024.
The human and material resources as well as the systems for managing diabetes in Africa are inadequate. This study or needs assessment, aimed at updating the human and material resources, identifying the gaps and unmet needs for comprehensive diabetes care in Ghana.
We conducted a national audit of 122 facilities in all 16 administrative regions of Ghana. Information obtained covered areas on personnel and multidisciplinary teams, access to medications, access to laboratory services, financing, screening services, management of diabetes complications, and availability/use of diabetes guidelines or protocols. Data was analysed using STATA version 16.1. P-values <0.05 were set as significant.
Only 85(69.7%) out of the 122 surveyed facilities had a dedicated centre or service for diabetes care. Twenty-eight (23%) had trained diabetes doctors/specialists; and whilst most centres had ophthalmic nurses and dieticians, majority of them did not have trained diabetes educators (nurses), psychologists, ophthalmologists, podiatrists, and foot/vascular surgeons. Also, 13.9% had monofilaments, none could perform urine dipstick for microalbumin; 5 (4.1%) and just over 50% could perform laboratory microalbumin estimation and glycated haemoglobin, respectively. Access to and supply of human insulins was better than analogue insulin in most centres. Nearly 100% of the institutions surveyed had access to metformin and sulphonylurea with good to excellent supply in most cases, whilst access to Sodium Glucose Transporter-2 inhibitors and Glucagon-like peptide-1 analogues were low, and moderate for Dipeptidyl peptidase-4 inhibitors and thiazolidinediones. Majority of the health facilities (95.1%) offered NHIS as payment mechanism for clients, whilst 68.0% and 30.3% of the patients paid for services using out-of-pocket and private insurance respectively. Fifteen facilities (12.3%) had Diabetes Support Groups in their locality and catchment areas.
An urgent multisectoral collaboration, including prioritisation of resources at the facility level, to promote and achieve acceptable comprehensive diabetes care is required.
非洲的人力和物力资源以及糖尿病管理系统都不足。本研究旨在更新人力和物力资源，确定加纳全面糖尿病护理的差距和未满足的需求，进行了一次全国性审计，对加纳所有 16 个行政区的 122 个设施进行了调查。获得的信息涵盖了人员和多学科团队、药物获取、实验室服务获取、融资、筛查服务、糖尿病并发症管理以及糖尿病指南或方案的可用性/使用情况等方面。使用 STATA 版本 16.1 分析数据。设 P 值<0.05 为有统计学意义。
在所调查的 122 家医疗机构中，只有 85 家（69.7%）设有专门的糖尿病治疗中心或服务。28 家（23%）有经过培训的糖尿病医生/专家；虽然大多数中心都有眼科护士和营养师，但大多数中心都没有经过培训的糖尿病教育工作者（护士）、心理学家、眼科医生、足病医生和血管外科医生。此外，13.9%的中心配备了单丝，没有一个中心可以进行尿微量白蛋白的尿试纸检测；5 家（4.1%）和略多于 50%的中心可以分别进行实验室微量白蛋白估计和糖化血红蛋白检测。大多数中心的人胰岛素供应和供应都优于类似物胰岛素。几乎 100%的被调查机构都可以获得二甲双胍和磺脲类药物，且大多数情况下供应情况良好或优秀，而钠葡萄糖转运蛋白-2 抑制剂和胰高血糖素样肽-1 类似物的获得情况较低，二肽基肽酶-4 抑制剂和噻唑烷二酮类药物的获得情况为中等。大多数卫生机构（95.1%）为患者提供 NHIS 作为支付机制，而 68.0%和 30.3%的患者分别通过自费和私人保险支付服务费用。15 家设施（12.3%）在当地和服务范围内设有糖尿病支持小组。
需要进行多部门紧急合作，包括在设施层面上优先考虑资源，以促进和实现可接受的全面糖尿病护理。
