Economic burden on families of childhood type 1 diabetes in urban Sudan
Introduction
Estimates of the cost of diabetes care can provide information to help prioritise and guide the allocation of scarce resources, attract additional resources and manage available assets to control the health and socio-economic burden of diabetes. According to the prevailing cost-of-illness methodology [1], [2] the economic costs of diabetes are divided into two categories, i.e. direct and indirect costs [3], [4]. The direct costs relate to outpatient visits, hospitalization, medication, and other supplies as well as the cost of traveling to diabetes clinics. The most important supplies are insulin, tablets, syringes, blood and urine monitoring equipment.
There is paucity of information on the cost of type 1 diabetes in developing countries [5]. Most countries do not have proper costing data when compared with developed countries [6], [7]. Such data depend on information, which is available in the files of the patients, but in developing countries the filing systems are poor with most filings incomplete. Thus, one has to rely on the patient's memory.
Health care expenditures in low-income countries were analyzed for the years 1990 and 1995 [8]. The key finding included substantial reduction in public spending per capita with a significant shift towards private expenditures. This appears increasingly to be substituting rather than supplementing public expenditures. Rises in out-of-pocket costs for public and private health-care services are driving many families into poverty and are increasing the poverty of those who are already poor. The main effects are untreated morbidity, reduced access to care and long-term impoverishment.
Diabetes mellitus in the Sudan, as in many other developing countries, is a growing health problem in all socio-economic classes [9] and associated with a high prevalence of complications [10]. Patients have poor glycaemic control, and a low quality of life [11]. The incidence of type 1 diabetes in 7–14-year-old children increased over a 4-year period from 5.8 to 10.3 per 100 000 children with an average annual incidence of 7.9 per 100 000 children [12].
There is a consequent need to evaluate the burden of diabetes for the society and to develop affordable and cost-effective prevention strategies. The present investigation was performed with the aims of estimating the contribution of families to the cost of care and to determine the quality of care received by diabetic children in an urban area in Sudan. We considered direct costs, since they are well defined and their limits stated.
Section snippets
Sudanese health system
Sudan is the largest country by area in Africa. The national capital, Khartoum State, is divided by the Nile and its two main tributaries into three towns, Khartoum, Khartoum North and Omdurman, and their suburban areas. The capital has got 6 million inhabitants, i.e. 21% of the population of Sudan.
The introduction of federalism in Sudan in the last decade fostered a three-layered health system structure comprising Federal, State Ministries of Health and Local health systems. In addition to the
Patients and methods
This descriptive cross-sectional study was conducted in Khartoum State and consists of interviews with parents of 147 diabetic children who were attending three public and three private clinics. These were the pediatric out-patient clinics in two main hospitals in Khartoum State (Khartoum Teaching Hospital and Omdurman Teaching Hospital), a public diabetes center (Gabir Abu Eliz), a private diabetes center (Mulazmin Diabetes Center) and two private diabetes clinics. During a 10-month period
Patient characteristics and family income
The patient characteristics are shown in Table 1. Out of the 147 diabetic children, 6.7% were preschool age and the others were enrolled in school. The mean diabetes duration was short in comparison to the age of the patients and the age at diagnosis of diabetes. Patients with a long duration of the disease, and with chronic diabetic complications, did not appear in this cohort. As to the level of education of the parents of the diabetic children, 19% of the fathers and 30% of the mothers were
Discussion
The economic aspects presented in this study provide an estimate and analysis of the direct cost of diabetes during childhood. Unlike cost estimates derived from the data of diabetic individuals identified from the general population or diabetes registers, this study had the advantage of interviewing individuals, thus obtaining relatively precise estimates of the cost of diabetes. We directly observed costs and the utilization pattern of individuals, rather than estimating cost from aggregated
Acknowledgements
This study was supported by the National Diabetes Program and Mulazmin Diabetes Center, Sudan. Fellowship of the principal investigator (HE) was granted by the Swedish Institute, Sweden.
References (19)
- et al.
Pattern of long-term complication in Sudanese insulin-treated diabetic patients
Diabetes Res. Clin. Pract.
(1995) - et al.
Health-related quality of life in insulin-treated diabetic patients in Sudan
Diabetes Res. Clin. Pract.
(1999) - et al.
Glycaemic control of insulin-dependent diabetes mellitus in Sudan: influence of insulin shortage
Diabetes Res. Clin. Pract.
(1995) - et al.
Cost-of-illness methodology: a guide to assessment practices and procedures
Milbank Memorial Fund Quart./Health Soc.
(1982) Diabetes—the cost of illness and the cost of control
Acta Med. Scand. Suppl.
(1983)- B. Lee, The cost of diabetes and its complications: A review, Discussion Paper 94, Center for Health Economics,...
The economic cost of non-insulin dependent diabetes mellitus
J. Am. Med. Assoc.
(1989)- et al.
Must diabetes be a fatal disease in Africa? Study of costs of treatment
Br. Med. J.
(1992) - et al.
Diabetes mellitus and health service utilization: a case-control study of outpatient visits 8 years after diagnosis
Diabetic Med.
(1996)