P-419: Delayed recognition and specialist enrolment among children and adolescents with diabetes in South-west Nigeria: a mixed-methods study of clinic records and caregiver narratives
O Ashubu, A Orimadegun, A OduwoleAbstract
Introduction
Children with diabetes may reach specialist care late when classical symptoms are misread or biochemical confirmation is delayed.
Objectives
To describe presentation, diagnostic delay, care-seeking pathways and barriers to specialist enrolment among children and adolescents with diabetes.
Methods
This clinic-based mixed-methods study analysed records and caregiver interviews for 30 children and adolescents attending a tertiary paediatric diabetes clinic in South-West Nigeria. Variables were summarised with frequencies, percentages, medians and interquartile ranges. Diagnostic delay was days from symptom onset to diagnosis; specialist enrolment delay was days from symptom onset to first specialist clinic attendance. Responses were analysed thematically.
Results
Median age was 14.5 years; 17 (56.7%) were female and 28 (93.3%) had type 1 diabetes. Polyuria and polydipsia occurred in 28 (93.3%), weight loss in 25 (83.3%) and fatigue in 26 (86.7%). Twenty-three (76.7%) had diabetic ketoacidosis and 28 (93.3%) were admitted at diagnosis. Median delay from symptom onset to diagnosis was 14.0 days, and median delay to specialist clinic attendance was 21.5 days. Insulin was unavailable at first facility in 21 (70.0%), 29 (96.7%) lacked health insurance and 23 (76.7%) described initial treatment cost as very difficult. Dominant themes were poor awareness that diabetes occurs in children, misdiagnosis, cost, alternative care and delayed referral.
Conclusions
Late enrolment reflected preventable clinical, biochemical and financial delays. Early capillary blood glucose testing should be routine for children with polyuria, polydipsia, weight loss, new bedwetting, unexplained weakness or acute deterioration.