Quality of Life Among Type II Diabetes Mellitus Patients at Kamuzu Central Hospital in Lilongwe, Malawi: a Mixed-method Study

Abstract

Background: Type II diabetes mellitus (T2DM) significantly impacts the quality of life (QoL) yet data on quality of life among these patients in Malawi are lacking. This study was conducted to assess QoL among patients with T2DM. Methods: A mixed-method cross-section study was carried out at Kamuzu Central Hospital (KCH), Lilongwe, Malawi. A systematic sampling method was used for quantitative data and purposive sampling was used for qualitative data. A modified diabetes quality of life (MDQoL)-17 questionnaire was used for quantitative data while in-depth interviews and diary methods were used for qualitative data. Demographic data were summarized using descriptive statistics and inferential statistics using t-test and ANOVA. Thematic content analysis guided by Braun and Clark (2006) was utilized to analyze qualitative data. Ethical approval was obtained from the College of Medicine Research and Ethics Committee (CoMREC) reference number P.09.20.3122.Results: A sample of 339 participants with a mean age of 50.3±15.5 was recruited. Overall, the mean QoL score was moderate (63.91±19.54). Those with tertiary education and those on health insurance had better QoL (QoL 73.8, C.I. 68.56-79.04, p-value 0.005), (QoL 76.71, C.I. 69.22-84.19, p-value 0.005) respectively compared to those with lower education and those without health insurance. Furthermore, the absence of comorbidities was associated with having better QoL (QoL 71.18, C.I. 66.69-75.67, p-value < 0.0001). Qualitatively, the participants referred to QoL as an absence of disease and leading an independent life. T2DM was associated with patients’ health status, increased stress levels, loss of independence as well as lifestyle changes. There were QoL-promoting factors among T2DM patients such as diabetes health talks, having a supportive family, accepting one’s condition positively, and following hospital advice such as doing physical exercises and following a prescribed diet. Inhibiting factors include drug shortages, societal perceptions, sedentary lifestyle, stress, and despising hospital advice.Conclusion: Overall the QoL in patients with T2DM receiving treatment at KCH is moderate. The QoL of patients with T2DM is influenced by interrelated factors and this requires multidisciplinary team care to optimize the QoL among these patients. Health workers need to adopt a holistic approach when treating patients with T2DM, such as managing comorbidities and including assessment of QoL, behavioral change measures like physical exercises, and a healthy diet. The government and various stakeholders need to promote education and mandatory national health insurance which improve health status.