Economic burden of diabetes on patients and their families in Sudan

Abstract: 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.