The visit of a delegation from the World Diabetes Foundation to the Republic of Sierra Leone ends today. A one week duty travel alongside CUAMM workers to see firsthand what has been achieved so far and what can still be done in diabetes care to respond to what WHO has labeled as pressing public health problem. Together with the delegation, other important stakeholders took part in the visit as the representatives from the Ministry of Health and Sanitation (MoHS), the Directorate of Non-Communicable Diseases (NCD), the health authorities from PCMH and Pujehun district and the COMAHS (College of Medicine and Allied Health Sciences).
On field meetings between the urban area of Freetown and the rural districts around were scheduled to see firsthand the results of a collaboration that WDF and CUAMM started in 2017 with a first pilot project on gestational diabetes mellitus (GDM). Main results were the integration of a dedicated area for Diabetes Screeing (IDS) within the PCMH in Freetown – the referral hospital and the creation of specific spaces in the PHUs (Peripheral Health Units) in the western area of the country. 14.231 women took part in screening at the IDS clinic in the PCMH, 4.296 at the PHUs thanks to the project. Among the results, the creation of a referral system to the IDS clinic at the PCMH for patients diagnosed in the PHU; the design of the first Protocol for Integrated Diabetes Screening for all patients and the development of the first operational research on diabetes during pregnancy “A simplified diagnostic procedure for the detection of gestational diabetes mellitus in resource-poor settings: results and challenges.”
“Considering that the management of Gestational Diabetes Mellitus/ Diabetes in Pregnancy is limited in services provided in the routine activities done to pregnant women attending ANC. In Sierra Leone, WDF project which support the screening, follow up and management of pregnant women positive with diabetes, had not only helped the good outcome of the mother pregnant but it had also contributed to strengthening Sierra Leone profile on Maternal and infant morbidity and mortality.” Said José Moniz Da Silva- CUAMM Project Manager during the meeting with WDF delegation.
A two-year new project followed the pilot one allowing to extend the GDM screening service to rural areas as Pujehun district, in the southern province of the country where around 234.000 people live. Over two years, GDM screening services were introduced not only in Pujehun hospital but also in 5 BeMONC (Basic Emergency Obstetric and Newborn Care). Among the results: training sessions on GDM and data collection addressed to MoHS health workers, activities on nutrition education; follow-up of cases at risk for hyperglycemia during pregnancy (HIP) and training on the job to improve the quality of health services with the support of a expert. 17.682 women received the GDM screening compared to the 10.933 estimated. Over the length of the project advocacy activities on prevention, screening and GDM addressed to MoHS were also introduced in government policies and strategies for noncommunicable diseases.
As stressed by the management team at the PCMH, the integration of such services within the facilities represents a strength since integrated care can increase the system-level efficiency of treatment.
Currently 24 million adults are living with diabetes in Africa and only 46% of them know their health status. Lack of testing facilities and equipment, inadequate number of trained health personnel, poor access to health facilities and services are some of the barriers to diabetes testing. According to WHO the figure is projected to rise by 129% to 55 million by 2045. Over 70 years of presence in Africa, Doctors with Africa has witnessed the rise of numerous non-communicable diseases such as diabetes, little-known and neglected conditions. The partnership with World Diabetes Foundation permitted to implement interventions to bring about a change in health systems, engaging communities, local activists, health authorities and Ministry of Health.
