Enhancing Diabetes Education and Care in Ogun State, Nigeria 

     Adesina OF, Talabi JE, Adediji D, Jaiyeola BJ, Solarin MT, Akinsanya AI, World Diabetes Foundation.

Background: Primary Health Care is the first level of contact of individuals, the family and community within the national health system, bringing health care as close as possible to where people live and work. In Nigeria, diabetes care is absent at the Primary care level.
Empowerment of workers within the primary care setting with knowledge and minimal equipment about diabetes will encourage and ensure earlier diagnosis and management of the disease and its complications. Also, screening (blood glucose testing) programmes should be set up in each Primary healthcare Centre to facilitate identification and earlier diagnosis of gestational diabetes. 
To achieve this, the Talabi Diabetes Centre, in conjunction with Ogun State Chapter of the Diabetes Association of Nigeria and the Ogun State Local Government Service Commission which oversees Primary Healthcare Centres in Ogun State of Nigeria applied for and obtained a grant from the World Diabetes Foundation (WDF15-1527) to train 1, 000 Primary healthcare workers in Ogun State and equip 100 Primary healthcare Centres with basic diabetes care equipment over a period of two years from October 2016 to September 2018.
Aim
The aim of the project was to improve knowledge and strengthen the skill of Primary Healthcare Workers in Ogun State to deliver basic diabetes care while the objectives were to:
i. Improve the knowledge base of 1000 primary healthcare workers on diabetes.
ii. Improve the ability of 1000 primary healthcare workers to deliver good diabetes education and care thereby improving the lives of people living with diabetes in their communities.
iii. Furnish the participating 100 Primary Healthcare Centres in Ogun state with Glucometres and strips and blood pressure monitors.
iv. Screen 25,000 individuals who present to the various primary healthcare centres for diabetes.
Method
•	3 day update courses on Diabetes- 2 cycles per zone will be organized in the 4 zones to which the 20 Local Government Areas in Ogun state are divided.
•	125 Primary Healthcare workers will attend the course per zone per cycle during which 20 lectures on the various aspects of diabetes will be delivered by various lecturers. 
•	All the lectures delivered will be compiled into a training manual for distribution to participants.
•	Monofilaments, Glucose monitors and strips will be distributed at the end of the 3 day program to the various Primary care centres represented at the course.
•	All the Health Centres will be encouraged to actively screen individuals who come to the Centres for routine care for diabetes. 
•	10 monofilaments will be distributed to each participating primary healthcare Centre to enhance foot screening.

 Results
505 Primary healthcare workers have been trained so far. Evaluation of the Pre- and Post- Test Questionnaire showed that their level of knowledge improved at the end of the lectures with only 1.1% left with a fair level of knowledge from the 40% with fair level of knowledge from the Pre Test. 
2, 000 copies of the Training manual were produced. Each participating Primary healthcare Centre had one copy for the generality of the staff while each of the participating 505 primary healthcare workers had a copy each. Each of the 100 participating Health Centres received the following:
-One (1) Blood Pressure Monitor
-Two (2) Blood Glucose Monitors
-250 Glucose Monitor strips
- 10 Monofilaments.
4, 996 individuals have been screened for diabetes in the 100 participating Primary Healthcare Centres. 265 (5.3%) had abnormal blood sugar levels. 229 of these are being treated at the Health Centres where the diagnosis was made. The treatment comprises counselling on diet and exercise and commencement of oral antidiabetic medications. The rest were referred to higher tier of care due to presence of complications.
Discussion
Primary healthcare Centres which did not previously have capacity to screen for diabetes are now able to screen for and manage uncomplicated diabetes through the educational intervention and service delivery capacity building engendered by the support received from the World Diabetes Foundation. Empowering Primary healthcare Centres in Nigeria with knowledge and basic diabetes equipment will lead to early diagnosis and therefore reduce the incidence of late presentation with complicated diabetes.

Enhancing diabetes education and care in Ogun State, Nigeria