Health system capacity to manage diabetic ketoacidosis in nine low-income and lower-middle income countries: A cross-sectional analysis of nationally representative survey data

Sarah Matthews, Matthew M. Coates, Alice Bukhman, Celina Trujillo, Gina Ferrari, Wubaye Walelgne Dagnaw, Darius Leopold Fénelon, Theodros Getachew, Biraj Karmacharya, Nancy Charles Larco, Aimée M. Lulebo, Mary Theodory Mayige, Maïmouna Ndour Mbaye, Getahun Tarekegn, Neil Gupta, Alma Adler, and Gene Bukhman

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There has been increasing awareness about the importance of type 1 diabetes (T1D) globally. Diabetic ketoacidosis (DKA) is a life-threatening complication of T1D in low-income settings. Little is known about health system capacity to manage DKA in low- and lower-middle income countries (LLMICs). As such, we describe health system capacity to diagnose and manage DKA across nine LLMICs using data from Service Provision Assessments.

We examined data from 2028 higher-level and 7534 lower-level facilities. Of these, 1874 higher-level and 6636 lower-level facilities’ data were eligible for analysis. Availability of all item sets were low at higher-level facilities, where less than 50% had the minimal set of supplies, less than 20% had the full minimal set, and less than 15% had the ideal set needed to diagnose and manage DKA. Across countries in lower-level facilities, less than 14% had the minimal set of supplies and less than 9% the full set of supplies for diagnosis and transfer of DKA patients. No country had more than 20% of facilities with the minimal set of items needed to assess or manage DKA.