IDF21-0542 Sharing “a.ma.dia” Experiences of how the Institution Have Faced COVID-19 Issues

Background: As part of low-income countries, Madagascar is actually at the 186th place as poorest country around the world. Regarding the diabetes context, the specialists are not sufficient. Then, it becomes mandatory for the diabetic person to go to the sanitarian structure which is the most accessible. These structures don’t have the adequate skills for a better follow-up and care of diabetes. A.MA.DIA is the Madagascar diabetes association composed by 47 000 diabetic members for a total of fourteen centers in twelve regions of the island. As a reference, the main activities of A.MA.DIA are: diabetes care and consultation especially for different complications (teeth and mouth, eyes, foot care), hospitalization, therapeutic education, sensitization, diabetes screening and his related complications. The main issues of diabetes in Madagascar during the covid period are the increased number of diabetes complications. A.MA.DIA was forced to receive complicated cases of diabetes and covid despite the few places we had at our Diabetes Clinic in Antananarivo: 21 beds of hospitalization. A.MA.DIA also faced many issues: lack of oxygen, lack of medicines, lack of individual protection equipment. Aim: This study aims to share A.MA.DIA experiences of how our institution have faced covid-19. The goal is to show the importance of having a Diabetes Clinic for a Diabetes association in case of extreme situation. Method: First, we have chosen to study the impacts of covid-19 in medical, social and economical aspects from 2020 to 2021. Second, we have realized some activities as solutions of the burdens Finally, we have observed the results for each aspect. Results: IMPACTS: The number of diabetes complications has increased: • 55% of the total consultation get imbalance to their diabetes. • 36% of the hospitalization represents chest diseases by virus; • 18% of the hospitalized diabetics died of covid-19 syndrom. Due the high cost of medicines and the lack of money: • 55% of diabetics coming for consultation missed their treatment; • 53% of the hospitalized diabetics could not afford the cost of oxygen. The bottle of 10m3 costs 70$. Due to the lack of individual protection equipment: • The price of the equipment increased at about 800%. Due to the restriction for moving from a region to another: • Diabetic people do not have access to specialized care and medicines. SOLUTIONS: • 90% of public centers for primary care in Antananarivo have received glucometers under help of A.MA.DIA and the world diabetes Foundation project. • Oxygen project was conducted by buying new machines (extractor); • Individual protection was reinforced; • The access to diabetes and hypertension medicines was facilitated; • 10% of diabetics were vaccinated. RESULTS: • The number of diagnosed persons has increased at about 10%; • The number of consulted persons has increased at about 30%; • After the vaccine period, the chest diseases by virus have decreased at about 50%. Discussion: The impacts of covid-19 on diabetics have made diabetes as a priority for Malagasy leaders. The commitment of Diabetic association in the integrated management of diabetes is a major key for the development of the association as well as for the protection of diabetic people.