1. Prospects of Diabetes in Sudan Mohamed Ali Eltom

2. Summarize the past Rescale the present Predict the future

3. Sudan after 9 July

4. Sudan before and after separation

5. National Diabetes Survey 1993 0.1 % Type 1 Diabetes 3.4 % Crude prevalence 2.1 % Unknown Diabetics 5.5 % in the Northern State 8.3 % in Dongla 14 % in Argo 6.0 % in Khartoum State 4.0 % in Gezeira State 1.0 % in North Kurdofan State Diabetes prevalence

6. DiseasesFrequencyValid Percent Valid Hypertension 429,65122.0 Diabetes 235,44612.0 Heart Disease 46,4432.4 Cancer 5,1150.3 Epilepsy 18,1370.9 Asthma 179,2879.2 Thyrotoxicosis 67,5093.4 Hypothyroidism 57,7363.0 Glaucoma 105,9285.4 Cataract 110,0605.6 Mental Health 59,2203.0 Others 585,69129.9 DK 23,1621.2 Missing 33,6631.7 Total 1,957,048100.0 MissingSystem 28,108,952 Total30,066,000 Sudan Household Health Survey 2006

8. 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 Natural History of Diabetes

9. Micro vascular complications Retinopathy 43 % Nephropathy 22 % Neuropathy 37 % Macrovascular complications Cardiovascular disease 28 % Peripheral vascular disease 10 % Cerebrovascular accidents 5.5 %

10. Deficient patients awareness and compliance Unaffordability and unavailability of drugs and monitoring equipment Reduced level of well organized diabetes care Poor health service organization Factors Related to Poor Metabolic Control

11. Challenges to diabetes care in Sudan Inadequate Financial Resources Insufficient Health care system Professionals Patients

12. 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

13. 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

14. 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 Education Facilities

15. Diabetes Control Among Low and High Income Parents

16. Ketone bodies in urine: 45.6% Hypoglycemia that needed special attention: 37% Acute Complications of Diabetes

17. 56.6 % admitted at least once to the hospital within a year Hospital Admission

18. Diabetic ketosis: 71.8% Hypoglycemia: 5.9% Malaria: 10.6% Other medical disorders or surgical intervention: 9.4% Main causes

19. 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

20. Prevalence 2025 Estimate 16% (more than 3 Million Diabetic )

21. Action Primary prevention programs Organized educational programs and proper medical services

22. 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 National Diabetes Policy

23. 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

24. 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

25. 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

26. Distribution of QCDF in the Country According to Prevalence Levels PrevalenceMDCUnit High6015 Moderate4010 Low205

27. International Relations Health Diplomacy IDF WDF World Summit

28. Regional Relations Arab African

29. Gulf States Egypt Jordan Syria Lebanon Libya Algeria Morocco Iraq Palestine Sudan Yemen Djibouti Somalia Mauritania Research Training Education Material Human Resources Philanthropies Civil Societies Middle income Low income High income

30. Cardiovascular risk factors (%) among adults in four Arab countries 2005 CountryDiabetesHypertensionHigh Cholesterol Egypt163324 Jordan162526 Kuwait162419 Sudan1223 19

31. Cardiovascular risk factors (%) among adults in four Arab countries CountrySmokingOverweigh & Obese Low physical activity Egypt227650 Jordan2967? Kuwait16?92 Sudan125487

32. موضة التدخين من الصعيد

33. إلى الســـــودان

34. Bilateral Relations Egypt Jordan Saudi Arabia Sweden

35. Diabetes Care in the Nile Valley

36. شكراً رمضان كريم