Background: Out-of-pocket expenditure in health has substantial negative side effects. They may lead to impoverishment. The knowledge of pattern of health care utilization and out of pocket expenditure is imperative for policy making in health care. Objectives of this study were to study utilization pattern of health care services of the population in a rural area of Thrissur district and study of the self-reported chronic morbidity profile and out of pocket expenditure for chronic diseases among the population.Methods: A community based cross sectional study was conducted in Tholur panchayath area of Thrissur district of Kerala. The calculated sample size was 552 households. House hold was considered as primary sampling units. All family members of the house hold were included in the study. Cluster sampling method was adopted. Data was collected using a pre tested semi-structured questionnaire.Results: A total of 809 individuals from 583 households were found to have chronic diseases. Among them, 54.8% were utilizing private health facility for their treatment. Majority (86%) were following modern medicine system for treatment. Health insurance was availed by 26.6 % of the study participants. Most common reported morbidity was combination of hypertension, diabetes mellitus, and hypercholesterolemia. The total median out of pocket expenditure for chronic diseases was found to be 5000 Indian Rupees. It was found that 41.6% of the total income of study participants was spent for health care of chronic diseases which indicate catastrophic health expenditure.Conclusions: The burden of chronic disease is high and the private hospitals are approached more by the study population for treatment rather than government hospitals. Health insurance coverage is low, and social assistance availed for treatment is marginal. These factors lead to high out of pocket expenditure amounting to catastrophic health expenditure.

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BACKGROUND The prevalence of type 2 diabetes mellitus (T2DM) is increasing quickly all over the world. In spite of effective treatment guidelines for type 2 diabetes, in majority of the people, the disease is poorly controlled with existing therapies. Glycaemic control is considered as the most important step for prevention of organ damage and other complications of diabetes. A study on the prevalence and determinants of poor glycaemic control can assist in understanding the expanse of this problems and the ways to address it. We wanted to study the prevalence and determinants of poor glycaemic control among adult patients with type II diabetes mellitus attending a primary health care setting. METHODS The cross-sectional study was conducted in the outpatient department of NCD clinic in a Primary health centre of Kerala for a period of six months. Two hundred and fifty individuals diagnosed with Type II DM for a year were recruited as study participants. The study participants were interviewed using a semi-structured questionnaire. Adherence to medication was assessed using The Morisky Medication Adherence Scale. Anthropometric measurements and blood pressures were recorded. HbA1c and RBS was measured using semi quantitative technique. Any patient with an HbA1c of more than 7 was defined as having poor glycaemic control. RESULTS 64.4 % of the participants had poor glycaemic control. Poor adherence to medication, fewer visits to doctor, lack of diet modification, frequent junk food consumption, higher body mass index and lack of exercise were found to be significantly associated with poor glycaemic control. CONCLUSIONS A focused approach targeting these modifiable risk factors, especially in primary care setting, has the potential to bring about better glycaemic control which can prevent and minimize the occurrence of diabetes complications. KEYWORDS Poor Glycaemic Control, Uncontrolled Diabetes, Diabetes Mellitus, HbA1c, Diabetes Complications

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