Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

Abstract

PurposeThe purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda.Research design and methodsA facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs) at the 95% confidence interval (CI) were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0.ResultsThe overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78), being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71), being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14) and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27), taking three or less tests of blood glucose per day (APRR: 0.63; 95% CI: 0.42, 0.95), and having a caretaker with poor knowledge about diabetes (APRR: 0.49; 95% CI: 0.43, 0.57) and who is inactive in supervision of insulin injections (APRR: 0.58; 95% CI: 0.56, 0.60) were associated with adherence to type 1 diabetes care recommendations.ConclusionAdherence to type 1 diabetes care recommendations is still low among this population. The results suggest that reinforcing caretaker involvement could be vital in improving adherence to diabetes care recommendations in this population.

Factors Associated with Parents’ Adherence to Different Types of Exercises in Home Programs for Children with Disabilities

“…The rates of parents’ adherence to the NDT and BMPS exercises were similar, although the adherence rates for flexibility exercises was lower. This variability among the types of exercises is consistent with the variability reported among therapeutic modalities of medical treatments for children with chronic illnesses [8,21].…”

Caregivers’ Nutrition Knowledge and Dietary Intake of Type 1 Diabetic Children Aged 3–14 Years in Uganda

“…5 A facility-based study conducted in Uganda found that caregivers with low knowledge about diabetes did not adhere to diabetes care and management recommendations; however, this study did not consider dietary practices. 9 Another study conducted in Tanzanian caregivers reported a significant association between diabetes knowledge and glycated hemoglobin (HbA1c) levels. 10 In Kenya, another study established that the nutritional knowledge level among caregivers was significantly associated with the dietary practices of their children.…”

Effectiveness of a Structured Nutrition Education Course for Caregivers of Children and Adolescents with Type 1 Diabetes in Improving Glycemic and Dietary Outcomes: A Cluster-Randomized Controlled Trial Protocol

“…However, it was suggested that reinforcing caregiver involvement in the children's diet could help improve adherence to dietary recommendations. 14,15 In Tanzania, a study reported a significant association between caregivers' knowledge of diabetes and HbA1c levels. 16 A parentbased nutrition educational intervention targeting mealtime behaviors reported a decrease in mean daily blood glucose levels among children with type 1 diabetes.…”