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IJSTR >> Volume 3- Issue 9, September 2014 Edition



International Journal of Scientific & Technology Research  
International Journal of Scientific & Technology Research

Website: http://www.ijstr.org

ISSN 2277-8616



Non-Adherence To Treatment Among Diabetic Patients Attending Outpatients Clinic At Mutare Provincial Hospital, Manicaland Province, Zimbabwe.

[Full Text]

 

AUTHOR(S)

Winnie Mandewo, Edward, E Dodge, Auxilia Chideme-Munodawafa, George Mandewo

 

KEYWORDS

Key words: Diabetes mellitus, adherence, non-adherence, glycaemic control, facilitators, barriers.

 

ABSTRACT

Abstract: Introduction: World-wide, diabetes mellitus is increasing affecting millions of people and its related complications continue to be of great concern. Hence, the issue of non- adherence to treatment recommendations is featuring as the major problem to achieve optimal control and management of the disease. Non-adherence to diabetes treatment recommendations is usually associated with increases in HbA1c levels, hospitalization rates, disability and overall premature deaths. Background: Mutare Provincial Hospital is a referral and a teaching hospital in Manicaland Province of Zimbabwe. Study Purpose: This study was done to determine the factors associated with non-adherence to treatment recommendations among diabetic patients attending diabetic clinic Mutare Provincial Hospital, Zimbabwe from February-April 2012.Research Design: An unmatched 1:1 Case-Control study was conducted in order to collect data from 104 Cases and 104 Controls. A total of 208 participants and aged between 19 and 98 were recruited to participate in this study. The majority of the participants were females (58 males and 150 Females). Semi-structured questionnaire was employed to collect data from the study participants where face-to face interviews were administered to sixteen key informants. The majority of the participants, 78.3% (n=163) patients were on oral anti-diabetic regimens and 11.5 (n=24) were on insulin alone and10 (n=21) were on both insulin and oral antigens. Findings: The results from this study indicated that the prevalence of non-adherence to medication was 38.9%, diet43.3% and exercise 26%. Factors which were found to be significantly associated with non-adherence to treatment after multivariate analysis were: financial constraints (OR 7.4; 95% CI 3.20-16-93; p<0.001), travelling away from (OR 2.8;95% CI 1.70-24.71; p<0.001), when very ill (OR6.6; 95% CI 1.45-30.50; p=0.014), eating out (OR 4.4; 95% CI 1.81- 11.13; p=0.001, longer duration of diabetes treatment ( more than 10 years OR 3.1 CI 1.70-5.71; p< 0.001), lack of detailed information on how to exercise( OR 2.3; distance from health facility (OR 2.5; 95% CI 1.15-5.50; p =0.02) and affordability of drugs (OR 3.7;95% C.I 1.81-7.59; p=0.014). However, receiving support from family (financial, material, emotional or moral OR 0.41; 95% CI 0.20-0.8; p= 0.013), being a member of the Diabetic Association (OR 0.27; 95% CI0.15-0.53; p=0.001) and having attended more than two health education sessions in the past six months (OR 0.40; 95% CI0.17-0.93; p=0.003) appeared to be protective factors against non-adherence to treatment recommendations. Conclusion: Non-adherence to treatment recommendations among diabetic patients is a result of interplay of many, varied and multifaceted factors. Therefore, strategies to improve adherence among patients attending Mutare provincial hospital in Manicaland province requires the collaboration among important stakeholders such health care workers, the patients, care givers and the government. In addition, interventions are needed in order to enhance patient education, improve patients’ self treatment behaviours and facilitate the identification and self-management skills on medication administration, dietary and exercise management. There is also need to widen the network of health care facilities through decentralizing the stocking and dispensing of diabetes drugs to peripheral sites.

 

REFERENCES

[1] Ali, S.M (2009) Barriers to Optimal Control of type 2 diabetes in Malaysian Malay patients, Global Journal of Health science, Vol1, No.2, http://www.ccsenet.org/gjhs accessed on 12/12/2011

[2] Aljasem, L. (2001) The impact of barriers and self efficacy on self-care behaviours in type 2 diabetes: http://www.ncbi.nlm.nih.gov/pubmed/11912800 accessed on 16/02/2012.

[3] Azevedo, M. and Alla, S (2008) Diabetes in Sub-Saharan Africa: Kenya, Mali, Mozambique, Nigeria, South Africa and Zambia; International Journal of diabetes in Developing countries, 2008; 28: 101-108.

[4] Bisiriyu, A.G (2007) Non-adherence to lifestyle modifications (Diet and exercise) amongst type 2 diabetes mellitus patients attending extension II Clinics in Gaborone, Botswana http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584325/accessedon 07/11/2011.

[5] Broadbent, E (2011) Illness and treatment perceptions associated with adherence to medications, diet and exercise: Journal for Diabetic care February 2011, Vol34, No.2, 338-340 http://care.diabetesjournals.org/content/34/2/338.full,accessedon 08/02/2012.

[6] Caballero, A.E (2004) Psychosocial factors associated with diabetes self-care, Available at: http://www.elsevier.com

[7] Chua, S.S and Chan, S.P (2011) Medication adherence and achievement of glycaemic targets in ambulatory type 2 diabetic patients; Journal of Applied pharmaceutical science 01 (04): 2011:55-59 Available on line at: www.japsonline.com Accessed on 31/01/2011.

[8] Ciechanowski, PS, et al (2001) The patient-provider relationship: Attachment theory and adherence to treatment in diabetes: Available at: 16. http://www.ncbi.nlm.nih.gov/pubmed/11136630 accessed on 20/01/12

[9] Ciherman, A (2011) How adherent people more likely to think? A meta-analysis of health beliefs and diabetes self-care, Available at: http://www.ncbi.nlm.nih.gov/pubmed/21478378 accessed on 16/02/2012.

[10] Cramer, J.A (2007) A systematic review of adherence with medications for diabetes http://www.ncbi.nlm.nih.gov/pubmed/15111553 accessed on 16/03/2012.

[11] Daly, J.M et al (2009) An Assessment of attitudes, behaviours and outcomes of patients with type 2 diabetes, Available at: http://www.ncbi.nlm.nih.gov/pubmed/19429734 accessed on 16/02/2012.

[12] Dev, J et al (2001) Factors influencing patient acceptability of diabetes treatment regimens http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584325/ accessed on 12/01 2012.

[13] Dezii, C.M et al (2002) Effects of once-daily and twice-daily dosing on adherence with prescribed Glipizide oral Therapy for type 2 diabetes: http://www.medscape.com/viewarticle/426957_1accessed on 21/02/2012.

[14] Farmer, A. (2005) Measuring beliefs about taking hypoglycaemic medication among people with type 2 diabetes, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584325/ accessed on 07/11/2011.

[15] Glasgow, R.E et al (1997) Personal-model beliefs and social-environmental barriers related to diabetes self-management, Available at: http://www.ncbi.nlm.nih.gov/pubmed/9096980 accessed on 16/02/2012.

[16] Gonzalez, J.S et al (2008) Depression and diabetes treatment non-adherence: A meta- analysis http://www.ncbi.nlm.nih.gov/pubmed/19033420 accessed on 18/02/2012.

[17] Golin, C.E et al (1996) The role of participation in the doctor visit: Implications for adherence to diabetes care, Diabetes care, Volume19, No.10 October 1996,Available at: http://care.diabetsjournals.org/content/19/10/1153.full.pdf+html accessed on 18/02/2012.

[18] Grant, R et al (2007) Relationship between patient medication adherence and subsequent clinical inertia in type 2 diabetes glycaemic management, Journal for Diabetes care http://www.ncbi.nlm.nih.gov/pubmed/17259469 accessed 16/03/2012.

[19] Guthrie, D.A and Guthrie, R. A (1991) Nursing management of diabetes mellitus, Springer Publishing Company, New York.

[20] Heisler, M et al (2010) Study Protocol: The adherence and intensification of medications (AIM) study-A cluster randomized controlled effective study: Available on line at: http://www.trialsjournal.com/content accessed on 12/12/2011.

[21] Hjelm, K and Mufunda, E (2010) Zimbabwean diabetics’ beliefs about health and illness: An Interview Study http://www.biomedcentral.com/1472-698X/10/7 accessed on 16/12/2012.

[22] Jackson, C.A (2010) Factors associated with non-adherence to Oral medication for inflammatory bowel disease: Available at: http://www.ncbi.nlm.nih.gov/pubmed/19997092 accessed on 20/3/2012.

[23] Kalyango, J.N, Owino, E. and Nambuya, A.P (2008) Non-adherence to diabetes treatment at Mulago hospital in Uganda: Prevalence and associated factors: Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584325/ accessed on 19/12/2011.

[24] Khattab, M, Khader, Y.S Ai-Khawaldeh, A and Ajlouni, K (2008) Factors associated with poor glycaemic control among patients with type 2 diabetes, Journal of diabetes and its complications : Available at: http://www.ncbi.nlm.nih.gov/pubmed/15707440 accessed on 16/02/2012.

[25] Kenreighn, C.A (2005) Medication adherence: A literature Review: Type 2 diabetes http://www.medscape.com/viewarticle/514163 accessed on 22/02/2012.

[26] Kirigia, J.M et al (2009) Economic burden of diabetes mellitus in WHO African region, http://www.biochemical.com1472-698X/9/6 accessed on 16/01/2012.

[27] Lam, P.W et al (2007) Drug non-adherence and associated risk factors among Chinese geriatric patients in Hong Kong, Hong Kong Med Journal, Volume 13, No.4, August 2007, http://www.hkmj.org accessed on 13/02/2012.

[28] Littlefield et al (1991) Relationship of self-efficacy and binging to adherence to diabetes regimen among adolescents; Available at: http://care.diabetesjournals/content/15/1/90.short accessed on 02/03/2012.

[29] Maphosa, D. Mudimu, E. Sigauke, C. Mlilo, P.Nyamugure, P. and Dube S. (2011) Relating Glycaemia levels in Zimbabwean population to some established type 2 diabetes risk factors using multiple linear regression: http://scholarsresearchlibrary.com/archive.html Accessed on 16/12/2012.

[30] Miccoli, R (2011) Multidrug treatment of type 2 diabetes: A challenge of compliance : Available at: http://www.ncbi.nlm.nih.gov/pubmed/21525461accessedon 28/02/2012.

[31] Morisky, D (2005) Methods to improve medication adherence in patients with hypertension: Current status and future directions: http://journals.www.com/cocardiology/Abstract/2005/07000/methods_to_improve_medication_adherence.aspx accessed on 10/02/2012.

[32] Mufunda, J et al (2006) Prevalence of Non-communicable diseases in Zimbabwe: Results from analysis of data from the National Central Registry and urban survey, http://www.ncbi.nlm.nih.gov/pubmed/16937610 accessed on 11/01/2012.

[33] Murray, M.D et a l (2004) A conceptual framework to study medication adherence in older adults: http://www.humanfactors.illinois.edu/ReportsandPapersPDFs/murmorweiciatudeebrawei04.pdf The American Journal of Geriatric pharmacotherapy, March 2004, Volume 2, No.1.

[34] Nyambura, A. (2009) Factors that influence non-adherence to antiretroviral therapy among HIV and AIDS patients in Central Kenya Province http://www2.aau.org/aur-hiv-aids/docs/students/nyambura_anthony.pdf accessed on 28/01/2012.

[35] Osterberg, L and Blaschke, T. (2005) Adherence to medication: Journal of medicine NEngl J Med 2005; 353:487-497.

[36] Phillips, K.A (1998) Understanding the context of health care utilization: Assessing environmental and provider –related variables in the behavioural model of utilization: http://www.ncbi.nlm.nih.gov/pubmed/9685123 accessed on 17/12/2011.

[37] Polly, R.K (1992) Diabetes health beliefs, self-care behaviours and glycaemic control among older adults with non-insulin dependent diabetes mellitus http://www.ncbi.nlm.nih.gov/pubmed/1628534 accessed on 16/02/2012,

[38] Rowley, C (1999) Factors influencing treatment adherence in diabetes, http://www.who.int/features/facilities/diabetes/01en.htmlaccessedon 15/12/2011.

[39] Sanal, T.S et al (2008) Factors associated with poor control of type 2 diabetes mellitus: A systematic review and Meta-analysis: Journal of Diabetology in Asia study group: Available at: http://scholarsresearchlibrary.com/archive.html Accessed on 16/12/2012.

[40] Schimttdel, J.A et al (2008) Why don’t diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification; Journal for General International medicine.

[41] Shaw, J.E et al (2010) Global estimates for the prevalence of diabetes for 2010 and 2030. Diabetes, Res Clinical Practice 2010; 87: 4-14, Available at: http://www.journalofdiabetology.org/Pages/Releases/FullTexts/SixthIssue/RA- 1-JOD-11-007.aspx Accessed on 01/02/2012.

[42] Siqurdardo’ttir, A.K (2005) Self-care in diabetes: Model of factors affecting self-care: http://www.ncbi.nlm.nih.gov/pubmed/15707440 accessed on 16/02/2012.

[43] Sobngwi, E. et al (2007) Diabetes in Africa: http://www.uchsc.edu/misc/diabetes/IDEG/IDEG_DOCS/Sobngwi.pdf accessed on 28/11/2011.

[44] Tang, S.T et al (2008) Social support, quality of life and self-care behaviours among African Americans with type 2 diabetes; Available at: http://tde.sagepub.com/content/34/2/266.short accessed on 28/02/2012.

[45] Tiv, M et al (2007) Medication adherence in type 2 diabetes: The Entered Study, A French Population Based: http://www.ncbi.nlm.nih.gov/pubmed/22403654 accessed on 20/03/2012.

[46] Travaline, J.M et al (2005) Patient-physician communication: Why and How? http://www.jaoa.org/content/105/1/13.full.pdf+html accessed 23/02/2012.

[47] Turchin, A. (2008) Poor outcomes in diabetes care: Is medication non-adherence or lack of treatment intensification to blame? http://www.nature.com/nrendo/journal/v4/n10/full/ncpendmet0926.html accessed on 14/12/2011.

[48] Uchenna, O et al (2010) Contributory factors to diabetes dietary regimen non-adherence in adults with diabetes, Available at: http:www.waset.org/journals/waste/v69/v69-136.pdf accessed on 01/02/2012.

[49] Vincze, G et al (2004) Factors associated with adherence to self-monitoring of blood glucose among persons with diabetes, Available at: http://www.ncbi.nlm.nih.gov/pubmed/14999899 accessed 20/01/2012

[50] Wabe, T.N (2011)Medication adherence in diabetes mellitus and self-management practices among type 2 diabetics in Ethiopia; Journal for Medical Sciences 2011 September, Volume 3. No.9 http://www.najms.org/old/resources/pdf. Accessed on 01/02/2012.

[51] WHO (2003) Adherence to long-term therapies: Evidence for action, http://apps.who.int/medicinedocs/en/d/Js4883e/8.4.5.htmLaccessed on22/01/2011

[52] Wong, M.C et al (2010) Adherence to oral hypoglycaemic agents in 26.782 Chinese patients: Available at: http://www.ncbi.nlm.nih.gov/pubmed/21098691 accessed on 17/02/2012.

[53] Ziemer, D.C et al (2006) Clinical inertia contributes to poor diabetes control in primary care setting http://tde.sagepub.com/content/31/4/564.abstract accessed on 18/02/2012.