As other countries in Sub-Saharan Africa, Malawi is now faced with increasing incidences of diabetes and cardiovascular diseases.However, as one of the poorest nations in the world, resources are scarce, and since the country is also struggling with communicable diseases such as HIV/AIDS, TB and malaria, only a minor part of the already limited health expenditure is directed towards non-communicable diseases, incl. diabetes.As a result, diabetes care is far from adequate; there are not enough clinics dedicated to diabetes care at district hospital or health centre level, equipment and medication supplies are lacking and systematic screening is not available.The project seeks to improve diabetes care in Blantyre, Malawi.
This project is the first WDF-supported project in Malawi and it constitutes a pilot for testing a sustainable model for diabetes care potentially to be rolled out in the country. The project will be implemented by the College of Medicine in collaboration with Queen Elizabeth Central Hospital in Blantyre which hosts the diabetes clinic.Protocols for in-patient management of type 2 diabetes already exist. However, protocols for out-patient management will be developed based on the IDF Africa clinical practice guidelines, modified for locally available resources.As in many Sub-Saharan countries, not enough doctors are available to cater for the number of patients. Therefore, this project will pilot the concept of a nurse-led diabetes clinic to assess its feasibility in a Malawian context.In order to improve provision of diabetes care at the Queen Elizabeth Central Hospital, a nurse will be designated to work exclusively with diabetes patients. The nurse will initially undergo one month training at the hospital, getting familiar with the protocols and being taught the principles and practice of diabetes in a clinical setting. Moreover, the nurse will learn about diabetes complications, at-risk groups, the importance of diet, exercise and medication, and the proper referral pathways for patients with specific problems.Upon completion of the training, the nurse will ensure that the protocols are followed, take on some aspects of clinical management of diabetes, educate patients on self-management including injecting insulin and appropriate diet, and participate in the training of nurse students.It is expected that approximately 1,000 people with diabetes attending the Queen Elizabeth Central Hospital will benefit from the introduction of the protocols and the designated diabetes nurse.With a view to building capacity for future good clinical management of diabetes, nurse students, medical students and clinical officer students will receive training in diabetes management at the Queen Elizabeth Central Hospital as part of their formal training programmes. This will provide them with knowledge about the use of the protocols and first-hand practical experience of diabetes management for both in- and out-patients.Throughout the project, meetings with hospital managers will be held in order to sensitise them on the importance of caring for the increasing number of diabetes patients, including the need for regular supplies of equipment and medication. It is hoped that this might reduce some of the problems with scarcity of resources in the management of diabetes and facilitate the establishment of diabetes clinics at other hospitals and health centres in Malawi.
• A diabetes clinic has been established at the Queen Elizabeth Central Hospital in Blantyre city. An HbA1c-machine has been procured for the clinic.• Protocols for out-patient management have been developed for and adjusted to a Malawian setting, based on the recommendations set by IDF.• 2 diabetes nurses have been trained and are training others. • 1,800 diabetes patients have been registered at the clinic and are now benefitting from the improved diabetes services.• 450 health care professionals (medical students, nurses and clinical officers) have been trained.• A Global Diabetes Walk was conducted on World Diabetes Day. It was attended by diabetes patients, friends, relatives and staff and covered by the newspapers and TV.