Diabetes care in Kilimanjaro region: clinical presentation and problems of patients of the diabetes clinic at the regional referral hospital-an inventory before structured intervention.

BACKGROUND: In order to improve care for diabetic patients in a developing country at the regional referral hospital for the Northern zone of Tanzania, a specialized clinic was established in November 1996. AIM: The aim of this study was to provide a situational analysis about the problems of the diabetic patient population treated at the hospital. For all patients who registered at the clinic a questionnaire was completed about personal data, diabetes history, symptoms, treatment, eating habits and psycho-social aspects of the disease. Results from patients who registered between November 1996 and December 1998 were analysed. RESULTS: Data from 474 diabetic patients (46% female) were obtained. Mean age was 53.75 (+/- 16; range 4-88 years), 15% were classified Type 1, 75% Type 2 and 10% remained unclassified. A body mass index of < 25 was recorded in > 80% of the Type 1 and approx. 50% of the Type 2 patients. Among complications, numbness of the legs was mentioned by 44%, hypertension was diagnosed in about 25%, retinopathy in 14%, foot ulcers in 10% and nephropathy in 7.5% of the patients. About 50% of the patients saw their disease as a big physical and psychological problem. Monthly cost for an average insulin-treated patient equalled around 25% of the minimal wage. CONCLUSION: Diabetes care in a developing country needs to address the specific background of the patient population, their needs, the medical problems and the social constraints. Active participation of the patients can help to overcome some of the difficulties.