P-455: Establishing a pediatric and adolescent type 1 diabetes clinic at a Kenyan sub-county hospital during COVID-19: a six-year experience from Mariakani, Kilifi county
R Michuki, P Kashero, J KimettoAbstract
Introduction
In Kilifi County, Kenya, children with type 1 diabetes (T1D) previously travelled long distances to Coast General Teaching & Referral Hospital (CGTRH) in Mombasa or to Kilifi Sub-County Hospital. The 2020 COVID-19 lockdown cut off this access, prompting establishment of a decentralized pediatric T1D clinic at Mariakani Sub-County Hospital (MSCH), serving Kaloleni, Rabai and surrounding areas.
Objectives
To describe the six-year growth, outcomes and psychosocial interventions of the T1D clinic in a resource-limited Kenyan sub-county hospital.
Methods
Retrospective review of MSCH clinic records from May 2020 to April 2026. The clinic was set up with mentorship from CGTRH and support from the Changing Diabetes in Children programme. Enrolment, retention, mortality with causes, and psychosocial interventions were reviewed.
Results
The clinic opened in May 2020 with 22 children and has cumulatively enrolled 69; 58 are currently active and mostly clinically stable aged between 2-19 years. Seven deaths were recorded (three during COVID-19); causes included diabetic ketoacidosis, end-stage renal disease on dialysis, malnutrition with wounds, and sepsis. Psychosocial interventions included placing a 16-year-old with T1D, Down syndrome and epilepsy who was rejected by mainstream schools for comorbidity in a special-needs boarding school. Escalating parental neglect of an adolescent to the sub-county children’s office and probation offices; advocating vocational training pathways for adolescents unable to attend mainstream school; and rehabilitating a malnourished 15-year-old (15 kg, low hemoglobin) who returned to school.
Conclusions
A mentor-supported, decentralized T1D clinic at a sub-county hospital can sustain pediatric T1D care in coastal Kenya, with outcomes extending beyond glycemic control to school re-entry, child protection and vocational advocacy. The model is scalable to other Kenyan sub-county hospitals to close the rural access gap.