3 research outputs found
Economic burden of diabetes on patients and their families in Sudan
Diabetes mellitus in Sudan is a growing health problem in all
socio-economic classes. The natural history of the disease is associated
with poor glycaemic control, a high prevalence of complications and a low
quality of life.
Objectives: The studies aimed to estimate the contribution of Sudanese
patients and their families to the cost of diabetes care, and to
determine the quality of this care. The direct costs and intermediate
benefits of attaining good glycaemic control were estimated, and
specifically the contribution by adult patients with type 2 diabetes, to
manage their disease without reported chronic complications.
Design and methods: Two cross-sectional descriptive studies were
conducted in Khartoum State. Parents of 147 children with type 1 diabetes
and 822 adult patients with type 2 diabetes attending a public diabetes
centre and private diabetes clinics were interviewed Data regarding
socio-demographic characteristics, family and patient incomes, costs of
diabetes care and metabolic control of the patients were obtained.
Glycosylated haemoglobin (HbA1c) as a measure of glycaemic control was
measured in a cohort of 123 randomly selected adult patients.
Results: The median annual expenditure of diabetes care during childhood
was USD 283 per diabetic child, of which 36% was spent on insulin. The
direct median cost of diabetes care of type 2 adult diabetes patients was
USD 175 per year, which included the cost of drugs and ambulatory care.
These costs represent 23% and 9% of incomes of the families of the
diabetic children and the adult patients, respectively. More than half of
the income of adult patients was contributed by the spouse or siblings.
For households of diabetic children 16% was received as financial help
from relatives and friends. Recall of levels of blood glucose monitoring
indicated poor glycaemic control in 86% of diabetic children. HbA1c was
at unsatisfactory levels in 77% of adult patients. Patients attending
private clinics had both higher income and higher costs than those
attending public clinics. However, both groups had poor glycaemic
control, which may reflect the low direct costs and the minimal care
given to all diabetic patients.
Conclusions and recommendations: These studies have emphasized the
intensity of the economic burden on Sudanese diabetic patients. This
economic burden has generally not been translated into optimum diabetes
care in either private or public practices and can be considered as a
depletion of family resources and the consequences of an inefficient
healthcare system. Diabetic patients and their families pay a
considerable part of their income to sponsor health, and in return they
receive insufficient care. Implications for health policy are that
primary care services should be imposed to attain better diabetes control
and that the economic burden on diabetic patients must be alleviated.
Future research is needed to gain more understanding of how families cope
and mechanisms to improve services in a costeffective way