ESPE Abstracts

Introduction: Type 1 diabetes mellitus (T1DM) is a common endocrine disorder among children and adolescents worldwide. Reports indicate a rising trend of T1DM in the past decades. However, data on T1DM in Sub-Saharan Africa, particularly Kenya, is limited. It is estimated that 127,000 children live with T1DM in Kenya, but only 5,000 are on treatment. This project aims to improve early diagnosis and appropriate management of T1DM in children and adolescents through introduction of first-ever TIDM management Guidelines in Kenya.

Methods: Clinton Health Access Initiative (CHAI) partnered with the Ministry of Health in training two pediatric endocrinologists for the public sector, who supported the development of Kenya's first ever T1DM management guidelines for children and adolescents. From December 2023- June 2024, 704 healthcare workers (HCWs) from 262 facilities, across 32 counties received a three-day training on screening, diagnosis/differentiation of T1DM from the main childhood illnesses such as malnutrition, pneumonia, and management of T1DM. HCWs (nurses, clinical officers and doctors) from key entry points where sick children present-MCHs, paediatric wards and outpatient departments were trained and tasked with screening, identification as well management/referral of the T1DM patients. On the other hand, the endocrinologists worked to set up specialized clinics and provide mentorship to the entire multidisciplinary team.

Results: Results show improvements in screening, diagnostic accuracy, and patient outcomes, hence validating the effectiveness of a comprehensive and integrated approach in managing children and adolescents living with T1DM. In addition to enhancing quality of care for the paediatrics and adolescents with T1DM, the approach promotes a collaborative environment for progressive learning and quality improvement. Two pilot counties with 83 trained HCWs from 12 hospitals, had six months post-training experience. In these counties, 1,792 children were screened and 65 diagnosed with T1DM. Out of the 65, 18 children presented with diabetes ketoacidosis (DKA). All the 65 children were enrolled in care and treatment and are being followed up to ensure continued management. The trend is currently being replicated in the other counties and similar results are being seen.

Conclusion: In conclusion, the results indicate that integrating T1DM management into existing child health programs will raise the index of suspicion and improve screening, early diagnosis, and overall survival for the children and adolescents living with the condition. In addition, investment in specialty and sub-specialty pre-service and in-service training and developing relevant policies and clinical guidelines is essential in strengthening and sustaining T1DM management.