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2381 741Km 2 85% Sahara 32. 400.000 population (2004)

ORGANIZATION OF CARE : SPECIFICITIES OF THE MEDITERREAN REGION. THE EXPERIENCE OF ALGERIA . A. BOUDIBA. HUC ALGIERS. 2381 741Km 2 85% Sahara 32. 400.000 population (2004) 52,7% < 25 years 5,1% > 65 years. GBR: Gross birth rate GDR: Gross death rate NGR: Natural growth rate.

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2381 741Km 2 85% Sahara 32. 400.000 population (2004)

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  1. ORGANIZATION OF CARE :SPECIFICITIES OF THE MEDITERREAN REGION.THE EXPERIENCE OF ALGERIA.A. BOUDIBA. HUC ALGIERS

  2. 2381 741Km2 • 85% Sahara • 32. 400.000 population (2004) • 52,7% < 25 years 5,1% > 65 years • GBR: Gross birth rate • GDR: Gross death rate • NGR: Natural growth rate

  3. 48 Wilayas / 548 Dairas / 1541 municipalities 185 Health districts (100 / 200.000 people) 13 HUC 1252 3964 Private sector SHC Health centers health care (privately owned rooms sector strong growth : specialists (58%)

  4. DIABETES CARE MANAGEMENT « Awareness » GOVERNMENT ENTITIES • Health Department/Prevention Direction/national diabetes committee • National program against non transmissible diseases • 8 risk factors (tobacco, alcohol drinking, obesity, sedentariness, • , high blood pressure, hypercholesterolemia, diet) Diabetes « Problem of networks » TREATMENT PRIMARY LEVELSECONDARY LEVELTERTIARY LEVEL Health Centers Diabetics Homes HUC General Physicians Polyclinics Regional Hospitals Private Sector Technical Equipments not sufficient Basic Specialists

  5. « Economic transition » SOCIAL • Social care security (Free medical care / Reimbursement…) • Associations / National Diabetes Federation • Social protection and Solidarity Department. « Diabetes and vascular Risk option » FORMATION - RESEARCH • Formation Centers : Endocrinology, Diabetology, Internal Medicine • Research : - Clinical Epidemiology :Many post graduate oriented towards • diabetes • - Fundamentals : University of Sciences and Technology (biology/ • animal physiology : Experimental model …Psammomys obesus ) • - Immunology… • Financing sources insufficient : SRNA (Scientific Researches National Agency), • Universities, Health Ministry).

  6. RISK FACTORS ASSOCIATED WITH TRANSMISSIBLE DISEASES * Mostaganem (M) (2140) 4136 Sétif (S) (1996) ** * Methodology « Step wise OMS ». 2004 - Known = 2.5% - Screened = 4.8 % ** - 5.5% (25 – 54 years) - 13.7% (55 – 60 years)  ID. R. MALEK, 2001

  7. DIETETICS • Dieteticians  very insufficient ? • National inquiry TAHINA (Transition Health Impact in North Africa)* • Feculents(3.84) •  Bread 2.14 •  Potatoes 0.91 •  Pasta 0.63 •  Couscous 0.3 • Dairy products 1.28 • Vegetables0.83 • Sugar products/Sodas 0.62 • Fruits0.53 • Meats products/proteins Eggs 0.43 • Meats 0.19 • Poultry 0.15 • Fish 0.14(< 0.06)Country side • Fats Olive oil 0.44 • Others 1.3 • * National Public Health Institute 2006

  8. HEALTH NETWORKS ORGANISATION 3 REGIONAL POLES WEST / 18 Wilayas (W) CENTRE / 12 W EAST / 18 W 1 NETWORK / HEALTH SECTOR* ~ 100.000/200.000/ • Screening (2006)/ AG** - BP Care offerEducation Formation • West (~ 190.000 ~ 10% - 18.3% Access / Availability Recommendations • Centre (~ 141.000 ~ 11% - 19.2% Easy pathway Uniformisation • East (~ 90.000 ~ 7.7% • COMPONENTS : - Health professionals / Doctors – Paramedics - Patients of the health district • STRUCTURES : - Referential ─ HUC / Internal Medicine - Diabetology - Reception sites ─ Diabetes home / Polyclinics…  OBJECTIVES :~ 3 years - Phase I ─ Implementation patient’s file sharing (minimal data) - Phase II ─ Evaluation of medical Audits practices and behaviors. - Phase III ─ Optimization Recommendations • * M. BROURI. Algiers Reevaluation • **AG : Abnormal Glycemia

  9. PRIMARY PREVENTION« Determination of a predictives score »*n = 1500Priliminary results (297)** * LINDRSTRÖM J. TUOMILEHTO J. The diabetes risk score. A practical tool to predict type 2 diabetes risk. D. care 2003, 26, 725-731. * Implementation of the national type 2 diabetes prevention TUOMILEHTO J. IDF 2006. ** M. AZZOUZ, A. BOUDIBA. Algiers.

  10. PREVENTION : RISK FACTORS OF THE GESTATORY DIABETESProfile of the Algerian Pregnant woman with GD risk* • Age > 30 / ATCD T2D / Insulinotherapy during pregnancy  Decisive factors of the persistance of post-partum diabetes. • Obesity / Age > 30 / Insulinotherapy during pregnancy showing GD  high risk factors of recurency** * S. MIMOUNI – A. BOUDIBA. ** M. BACHAOUI – M. BELHADJ.

  11. PREVENTION : DIABETIC FOOT • Problem : - 10% - 30% hospitalizations : 55% bed occupancy rate • - Amputations : 2001-2005 (decrease 31%) • - Podologists / Revascularition surgery : do not exist ? • Prevention recommendations – education : reinforcement at all levels • Projections I • PRELIMINARY RESULTS* • PODOSCOPY • Organ risk normal FHallowFlat • Anatomic condition 54% 38% 8% • RECOMMANDATIONS • GoodAverageBad • Footwear 30% 52% 18% • Hygiene 63% 32% 5% • Education Level 21% 46% 33% • Of the patient • Regular foot 39% • Check up • LÉSION STATUS • Clinic N = 48% Neurologic = 32% Ischemic = 6% Mixte = 14% • EchoDoppler N = 42% Pathologic = 58% - Atherosclerosis 44% - Mediacalcosis 39% - Atheromatosis + Stenosis 7% • Projections II  (Algerian Society of Vascular Medecine**) prevention / Preservation treatment / Decrease of amputations. * S. AOUICHE, A. BOUDIBA – Diabetology Algiers. ** M. BROURI – UHC Birtraria Internal Medecine Algiers. vulnerability score SAMEV creation

  12. MEDICAL CARE /SECONDARY LEVELExemple «Diabetic Home»~ 30 000 Check up/yearClinical practice evaluation 2005 • HbA1c > 1/an 30% • 1f/an 70% • Retinal screening 85% • ECG 70% • Lipids (TC – Trig.) 95% • HDL/LDL 20% • Micro albuminuria 21% • Vascular Doppler 22% • Foot care 30% • Educators/dieteticians : 8 (2 sessions/day) • Psychologists : 2

  13. TYPE 2 DIABETES MEDICAL CARE EVALUATION«Diabetics Home in Algeria» cms/Hg 28% 39% 27% 35% 11% 23% 42% 51% 11% 27%

  14. 25 mars 2007 5400 Health Associations To sum up, they consist, inter alia, into the creation of a «national fund» dedicated to ill People; to listen to and evaluate the waiting time to access medical care; to bring closer quality care services to citizens where they live, to repertoriate ; chronic ill people in order to be able to respond with quality medical care and allow for real treatment opportunities to happen. Dj. K

  15. BETWEEN RECOMMENDATIONS ..… AND MEDICAL PRACTICE DISEASE PATIENT PHYSICIAN HEALTH SYSTEM • Diet/ exercice • Métabolic Syndrom « anti hyperglycemic objectives drown • Multidisciplinairy • Relays with little • efficiency • Socio- • économic level • Cost • Complexity • Priorities • Motivation • Rémuneration • work place • Education • Attitudes • Organisation • Transition • Public/Private • Ressources • - Spécialized staff • - Equipments • Therapeutic alliance= Bypass / supress hurdles* • Care offers / Easy way • Realistic messages / simple / rehabilitation of mediterranean diet • General physician rehabilitation. • Appropriate recommendations / act on modifiable constraints** • * Euro-Obstacles • * VENKAT NARRAYAN KM et Al. Translation research for chronic disease. The case of diabetes. Diabetes care • 23, 12, 1794-98, 2000. • ** H. ALBERTI, N. BOUDRISSA. Primary care of patients with diabetes mellitus in Tunisia qualitative study of barriers and facilitators to care (IDF 2006).

  16. « Death is anavoidable, but a lasting bad health is not» FID 2006.

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