Abera Merhawit Atsbha, Alemu Haregeweyni Gebreselassie, Kahsay Hailemariam Berhe, Weldegerima Abraha Hailu, Mulugeta Afework, Tequare Mengistu Hagazi, Nigusse Afewerki Tesfahunegn, Weledegebriel Migbnesh Gebremedhin, Dawit Tsega Cherkos, Berhe Ephrem, Geberhiwot Tarekegn
College of Health Sciences and Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia.
Institute for Health Care Improvement, Mekelle, Ethiopia.
PLoS One. 2025 May 7;20(5):e0320296. doi: 10.1371/journal.pone.0320296. eCollection 2025.
The prevalence of diabetes mellitus has been increasing in the past few decades. Mortality and morbidity have increased faster in low- and middle-income countries than in high-income countries. In Ethiopia it has been a practice to handle most diabetes mellitus patients in general and referral hospitals which in turn caused over burden in these hospitals. Besides, the possibility of implementing diabetic care service in primary health care facilities is not assessed in Ethiopia. The aim of this study was to decentralize and implement diabetic service in primary health care facilities in Tigray.
The study was conducted in Tigray region, at Hagereselam primary hospital from September 2019 to September 2020. A pilot study which aimed to bring diabetes services to non-specialized health care facilities. Diabetic patients who were on follow up in tertiary hospital (Ayder Comprehensive Specialized Hospital) were moved to Hagereseam primary hospital voluntarily, which is the main study site. The data were collected by trained health professionals and the data collection tool was adapted and developed from national guideline and analysed through SPSS 21. Independent t-test and chi-square was applied to compare the outcomes among study participant groups.
The mean and median Fasting Blood Sugar (FBS) level was 171mg/dl and 151.5 (IQR = 109.5-180.7) respectively. and the mean difference of FBS with randomly selected patients in a referral hospital was 3.55 (p = 0.8) which shows no significant difference. Mean systolic BP and haemoglobin A1c were 114.2 mmHg and 8.34% respectively.
There is no significant difference in the diabetes service among the primary and tertiary hospital. Diabetes service can be decentralized to primary health care facilities without compromising the quality of diabetic care. Further large implementational study is necessary to overcome the problems in the decentralization of service delivery in diabetes service.
在过去几十年中，糖尿病的患病率一直在上升。低收入和中等收入国家的死亡率和发病率增长速度高于高收入国家。在埃塞俄比亚，大多数糖尿病患者通常在综合医院和转诊医院接受治疗，这反过来给这些医院带来了过重负担。此外，埃塞俄比亚尚未评估在初级卫生保健机构提供糖尿病护理服务的可能性。本研究的目的是在提格雷的初级卫生保健机构中分散并实施糖尿病服务。
该研究于2019年9月至2020年9月在提格雷地区的哈格雷斯拉姆初级医院进行。这是一项旨在将糖尿病服务引入非专科卫生保健机构的试点研究。在三级医院（阿伊德综合专科医院）接受随访的糖尿病患者自愿转至主要研究地点哈格雷斯拉姆初级医院。数据由经过培训的卫生专业人员收集，数据收集工具根据国家指南进行调整和开发，并通过SPSS 21进行分析。应用独立t检验和卡方检验比较研究参与者组之间的结果。
空腹血糖（FBS）水平的均值和中位数分别为171mg/dl和151.5（四分位间距=109.5-180.7）。与转诊医院中随机选择的患者相比，FBS的平均差异为3.55（p=0.8），表明无显著差异。平均收缩压和糖化血红蛋白A1c分别为114.2 mmHg和8.34%。
初级医院和三级医院在糖尿病服务方面无显著差异。糖尿病服务可以分散到初级卫生保健机构，而不会影响糖尿病护理的质量。有必要进行进一步的大型实施研究，以克服糖尿病服务分散化过程中存在的问题。
