الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
Appropriate treatment of common diseases and injuries is one of the essential elements of PHC aiming at prevention of death and disability so that all people have the possibility of healthy life .The PHC management of a ”case ” should not be interpreted as merely a classical curative care leading to prescription of drugs ; it should mean total and comprehensive management of the case . Diabetes is a growing health problem worldwide in both developed and developing countries and diabetes in adults is now recognized as a particular threat to public health of the third world communities, particularly those living in rapidly developing countries and to the disadvantaged minorities in industrialized nations . Primary Health Care is of first importance to diabetics and the health care of the diabetics forms an excellent example of a disease where PHC must play a key role . WHO had recommended that treatment and management of D.M. must be included in the framework of planning for the delivery of PHC in all countries . PHC is of great importance to diabetic patients and their families , since most care is obtained at this level. Basic care , screening for complications and patient education can be provided by a variety of health workers . The aim of the present study was to : 1-Assess the quality of the PHC activities provided for detection , management and follow up of diabetic patients attending some rural PHC and urban health facilities in Alexandria . 2-Recommend minimum requirements and standards for quality assurance of diabetic management through PHC . 3-Apply the recommended measures in one of the study units and its evaluation . To conduct the present study the following techniques were used : 1-A check list was designed according to WHO guidelines to assess the availability of resources for diabetic patients . 2-A clinical sheet was designed to screen for the presence of D.M. risk factors and to assess the number of missed suspicious cases by the PHC physicians . Persons having more than one risk factors were subjected to random capillary blood glucose measurement . 3-An observation sheet for the physician’s performance while dealing with diabetic patients was designed by the researcher according to guidelines obtained from modern textbooks and WHO guidelines . 4-A subsample of diabetic patients were subjected to FBG measurement to assess the level of D.M. control by the health facility physicians . 5-Two interview questionnaire were designed to measure the knowledge , attitude and practices concerning D.M. for the physicians and the paramedical team . 6-An interview questionnaire for the diabetic patients was designed to measure their knowledge , attitude and practice as regards D.M. and to assess their satisfaction with the services provided . 7-The recommended measures by the researcher were applied in one of the study facilities included : training course for the physicians , designing and supplying of diabetic files , provision of some equipment , laboratory facilities and medications . 8-Evaluation of the effectiveness of the intervention program was done 3 months later by assessing the availability of equipment and supplies , assessing the KAP of the physicians ( post-test ) , reviewing patients files , cards and checking the level of D.M. control . Data were subjected to statistical analysis and interpretation . The results obtained in this study could be summarized as follows : 1-The catchment areas were not identified in all the study facilities and the services provided for diabetes control were provided through a specific clinic 3 days / week in El-Mandara H.C. only and through the general outpatient clinics in the remaining 3 study facilities . 2-There were deficiencies in the percentage of physicians trained on D.M. or who had postgraduate studies in branches related to D.M. . 3-Blood glucose measurement , serum creatinine and serum cholesterol were done only in Borg El-Arab H.C. and Abis 2 H.C. , while glycosylated haemoglobin was not done in all the study facilities. 4-Intermediate acting Sulphonylureas were available in all the study facilities except Abis 8 H.C. , while Metformins were available in all the study facilities . The various forms of insulins were available in El-Mandara H.C. only . 5-Family files were not available in all the study facilities , while daily registration records for diabetic patients , specific record for each diabetic case , also monthly reports and follow up / appointment cards were available in El-Mandara H.C. only . 6-Referral sheets were only available at El-Mandara H.C. and Abis 2 H.C. , no feed back was received and none of the diabetic cases in all the study facilities was referred during the period of the study or the intervention program . Health education were not performed during the period of the study or the intervention program . . 7-D.M. is likely to occur in about 23 of the studied suspicious cases above the age of 20 years and in 14 of the total screened patients , this rate was lowest at the desert Borg El-Arab H.C. , only 12.5 in comparison to 25 in the rest of the studied facilities . 8-Age above 50 years, family history of D.M. in first degree relatives , history of hypertension , overweight , history of gestational D.M. and mothers who gave birth to large sized baby were independently associated with increased risk of D.M. . 9-The majority of diabetic patients 96.2 received poor level of care and only 3.8 received fair care and no one received good care . 10-The majority of diabetic patients ( 94 ) received poor history taking and all cases were poorly examined .