Quality and barriers of outpatient diabetes care in rural health facilities in Uganda – a mixed methods study

Birabwa, Catherine; Bwambale, Mulekya Francis; Waiswa, Peter; Mayega, Roy William

doi:10.1186/s12913-019-4535-x

Cited by 36 publications

(48 citation statements)

References 28 publications

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“…Increasing screening will inevitably place a greater burden on the health system to provide medications and clinic visits to more individuals. This will put additional stress on an already under-performing system [ 8 , 9 ]. However, leveraging pre-existing HIV infrastructure as was done in this study already has been shown to be feasible and cost-effective when tailored to the appropriate population [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Only 80% of Ugandan health facilities offered blood glucose testing and 34% offered diabetes management in 2013 [ 8 ]. Rural clinics in Uganda continue to face challenges in training health workers and providing continuous support for diabetes care [ 9 ]. Additionally, the Ugandan essential medicines list includes medications for hypertension and diabetes management [ 10 , 11 ], but there is limited availability of essential medicines throughout Uganda and there are disparities related to less access at public hospitals compared to private for-profit hospitals [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and risk factors for hypertension and diabetes among those screened in a refugee settlement in Uganda

et al. 2021

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Background Diabetes and hypertension are increasingly prevalent in low and middle income countries, but they are not well documented in refugee settlements in these settings. We sought to estimate the prevalence and associated characteristics of diabetes and hypertension among adults presenting for clinic-based HIV testing in Nakivale Refugee Settlement in Uganda. Methods HIV-negative adults presenting to outpatient clinics for HIV testing at three health centers in Nakivale Refugee Settlement were enrolled from January 2019 through January 2020. Multi-lingual research assistants administered questionnaires aloud to ascertain medical history and sociodemographic information. The research assistants used standardized procedures to measure participants’ blood pressure to detect hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg), and conduct a point-of-care blood glucose test for diabetes (random blood glucose ≥11.1 mmol/L with self-reported frequent urination or thirst, or fasting blood glucose ≥7.0 mmol/L regardless of symptoms), as per Uganda Ministry of Health guidelines. We used χ-square or Fisher’s exact test to test for differences in disease prevalence by refugee status and log-binomial or Poisson regression models to estimate associations of immigration status and country of origin, respectively, with hypertension and diabetes while controlling for age, sex, education level, and body mass index. Results Among 2127 participants, 1379 (65%) were refugees or asylum seekers and 748 (35%) were Ugandan nationals. Overall, 32 participants met criteria for diabetes (1.5%, 95% CI 1.1–2.1%) and the period prevalence was 2.3% (95% CI 1.7–3.0). There were 1067 (50%, 95% CI 48.0–52.2%) who met the criteria for pre-hypertension and 189 (9%, 95% CI 7.7–10.1%) for hypertension. These proportions did not vary by immigration status or country of origin in univariate tests or multivariable regression models. Conclusions Hypertension was common and diabetes was uncommon among those screened in a Ugandan refugee settlement. Routine blood pressure screening should be considered in this setting. Additional research could develop diabetes screening criteria to help identify at risk individuals in this limited resource setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for hypertension and diabetes among those screened in a refugee settlement in Uganda

et al. 2021

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“… 16 Lack of HbA1c tests in health care facilities is one of the hindrances for clinicians to make long-term management decisions about DM patients. 17 Reports also showed that the absence of HbA1c measurement was an important indicator of frequent hospital readmission in T2 DM patients. 18 , 19 Moreover, it has been reported that limited access to the HbA1c test appeared to be a key predictor of poor glycemic control and is a significant obstacle to improving glycemic control in T2 DM patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Red Blood Cell Parameters as a Biomarker for Long-Term Glycemic Control Monitoring Among Type 2 Diabetic Patients in Southwest Ethiopia: A Cross-Sectional Study

Mengstie¹,

Sime²,

Kene³

et al. 2021

DMSO

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Objective The main aim of this study was to assess red blood cell parameters as a biomarker for long-term glycemic monitoring among T2 DM patients. Methods Facility-based cross-sectional study through a consecutive sampling technique was conducted among 124 T2 DM patients at the chronic illness follow-up clinic of Jimma Medical Center (JMC) from July 27 to August 31, 2020. A structured questionnaire was used to collect socio-demographic and clinical-related data. Five milliliters of the blood specimen were collected from each eligible T2 DM patient. Glycated hemoglobin (HbA1c) and red blood cell parameters were determined by Cobas 6000 and DxH 800 fully automated analyzers, respectively. Data were entered into EpiData software version 3.1 and exported to SPSS 25 version for analysis. Independent t -test and Pearson’s correlation coefficient were used to address the research questions. A P-value <0.05 was considered statistically significant. Results The mean age of study participants was 51.84± 11.6 years. Moreover, 60.5% of T2 DM patients were in poor glycemic control. There was a significant mean difference between good and poor glycemic controlled T2 DM patients in red blood cell count (4.79±0.5 vs 4.38±0.8), hemoglobin (14.13±1.4 vs 13.60±1.6), mean corpuscular volume (89.52±4.7 vs 92.62±7.5), mean corpuscular hemoglobin (29.63±1.6 vs 30.77±2.9), and red cell distribution width (13.68±1.1 vs 14.63±1.2) respectively. Red blood cell count was inversely correlated ( r =−0.280, p=0.002) with HbA1c while mean corpuscular volume ( r =0.267, p=0.003), mean corpuscular hemoglobin ( r =0.231, p=0.010), and red cell distribution width ( r = 0.496, p=0.000) were positively correlated with level of HbA1c. Conclusion Red cell count, mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width could be useful indicators to monitor the glycemic status of T2 DM patients instead of HbA1c, though large prospective studies should be considered.

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“…In Uganda, about half of all individuals with diabetes and 9 in 10 of those with impaired fasting glucose are unaware of their status [10]. Diagnostic services are heavily constrained as critical diagnostic equipment are lacking, reagents are in short supply, and healthcare workers' training on diabetic care is limited [11][12][13]. The pathways to diabetes diagnosis has not been well elaborated in Uganda, which undermines efforts to improve diagnostic processes.…”

Section: Introductionmentioning

confidence: 99%

Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study

et al. 2021

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Background Type 2 diabetes is rapidly becoming a significant challenge in Uganda and other low and middle-income countries. A large proportion of the population remains undiagnosed. To understand diagnostic delay, we explored the diagnostic pathways for diabetes among patients receiving care at a semi-urban district hospital in eastern Uganda. Methods Eligible participants were patients aged 35–70 years receiving care at the diabetes clinic of Iganga district hospital between April and May 2019 and their healthcare providers. Patients were interviewed using an interview guide to collect information on patients’ symptoms and their diagnostic experience. A separate interview guide was used to understand the organisation of the diabetes services and the diabetes diagnostic process at the hospital. Using maximum variation purposive sampling, we selected 17 diabetes patients aged 35–68 years, diagnosed within the previous three years, and the three health workers managing the diabetes clinic at Iganga hospital. The data was analysed using ATLAS.ti version 8 to code, organise and track the data segments. We conducted template analysis using a priori themes derived from the intervals of Walter’s model of Pathways to Treatment to identify the factors influencing diagnostic delay. Results We identified four typologies: a short diagnostic pathway, protracted appraisal pathway, protracted appraisal and diagnostic interval pathway, and delayed treatment pathway. The pathways of patients with protracted appraisal or diagnostic intervals demonstrated strong socio-cultural influences. There was a firm reliance on traditional healers both before and after diagnosis which deferred enrolment into care. Other health system barriers implicated in delayed diagnosis included stock-out of diagnostic supplies, misdiagnosis, and missed diagnosis. Denial of diagnosis was also found to lead to delayed initiation of care. Conclusion Reducing diagnostic delay requires addressing both negative socio-cultural influences and the adoption of system-wide interventions to address barriers to timely diagnosis.

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Quality and barriers of outpatient diabetes care in rural health facilities in Uganda – a mixed methods study

Cited by 36 publications

References 28 publications

Prevalence and risk factors for hypertension and diabetes among those screened in a refugee settlement in Uganda

Prevalence and risk factors for hypertension and diabetes among those screened in a refugee settlement in Uganda

Evaluation of Red Blood Cell Parameters as a Biomarker for Long-Term Glycemic Control Monitoring Among Type 2 Diabetic Patients in Southwest Ethiopia: A Cross-Sectional Study

Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study

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