Diabetic care in Nigeria: report of a self-audit E.O. Okoro a, *, A.O. Adejumo b , B.A. Oyejola b a Department of Medicine, University of Ilorin, PMB 1515, Ilorin, Nigeria b Department of Statistics, University of Ilorin, PMB 1515, Ilorin, Nigeria Received 18 August 2000; received in revised form 3 January 2001; accepted 17 January 2001 Abstract As part of a wider study aimed at establishing baseline data on standard of diabetic care to compare with subsequent reassessment after measures to improve outcomes have been introduced, the case notes of 118 Nigerians (42 males) with diabetes attending a teaching hospital-based diabetic clinic were reviewed to assess the quality of professional care in a year with reference to an international standard of diabetic care. Patient attendance at the clinic averaged about nine times annually and majority of them had been attending the facility for about 6 years. Fasting blood glucose (FBG) was tested four or more times in 92.4% of the patients. The corresponding figures for footcare were 1.7%; referrals for eye, dental, or cardiac examination were 12.7%, while lipid profile, serum creatinine, and urinary protein estimation were documented in 16.9% of the patients. In contrast, high-risk assessment or part of it was documented in all patients, and in 61.9%, high-risk intervention was recorded. The data suggest that the quality of diabetic care was less than optimal, and foot examination and referrals, etc. are specific areas for improvement. D 2002 Elsevier Science Inc. All rights reserved. Keywords: Diabetic care; Quality assurance; Nigeria 1. Introduction Population-based studies conducted in the late eighties in urban and rural areas using WHO diagnostic criteria indi- cate a prevalence rate of diabetes of between 1.7% and 1.4% in Nigeria (Erasmus, Ebomoyi, & Fakeye, 1988; McLarty, Pollit, & Swai, 1991). More recently, two studies reported prevalence rates of 1% and 2.6% in urban and rural communities, respectively (Akinkugbe, 1992; King & Rewers, 1991). These data and the social changes in the last three decades that have led to increased availability of health facilities, awareness, and coupled with some gain in life expectancy may have contributed to the increased burden of diabetes now being seen in public hospitals across the country. Unfortunately, despite advances (DCCT Research Group, 1993; Mecklenberg et al., 1982; The Hypertension Detec- tion and Follow-up Program Research Group, 1985) in antidiabetic therapy, there is widespread evidence (Akanji & Adetuyibi, 1990; Dagogo, 1991; Famiyuwa, Adenaike, Osotimilehin, & Adetuyibi, 1988; Osuafor, 1998; Osunto- kun et al., 1971; Oviasu, 1973) that Nigerians with diabetes mellitus (DM) are at substantial risk of premature death and complications related to diabetes even while in care. Part of this unfavourable outcome has been attributed largely to patient characteristics that include ignorance, poverty, and a high default rate (Akanji & Adetuyibi, 1990; Dagogo, 1991; Famiyuwa et al., 1988; Osuafor, 1998; Osuntokun et al., 1971; Oviasu, 1973). Another part of the problem, which is only just coming into view (Matowe, 2000; Nwosu, 2000; Steyn et al., 1999), may be the processes involved in the health care system of many sub-Saharan African countries including Nigeria. Specifically, studies (Hellman, Baker, Flores, Lehman, & Bacon, 1997; Piette et al., 2000; Public Health focus, 1993) in healthcare services conducted in Europe and America indicate that professional adherence to approved guidelines for diabetic care can reduce variability in patient care and affect outcome. In this regard, as part of a wider study aimed 1056-8727/02/$ – see front matter D 2002 Elsevier Science Inc. All rights reserved. PII:S1056-8727(01)00145-3 * Corresponding author. Tel.: +234-31-227153. E-mail address: eookoro@unilorn.ed.ng (E.O. Okoro). In tribute to the memory of Claude Ake, PhD. Journal of Diabetes and Its Complications 16 (2002) 159 – 164