An assessment of quality of care among diabetic adult patients as a guide towards optimum care requirements, a cross sectional study among five health facilities in Kenya
Abstract
Author(s): Dorcas Nyamai*

Background: Diabetes is a major public health problem with an estimated global prevalence of 9.3% (463 million people) by 2019 and a projection of 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045 (WHO 2013). Majority of diabetes mortality occurs in low and middle income countries where approximately 80% of people with diabetes live. Diabetes care is expensive and exerts a big economic burden on patients, their families, health systems and the society as a whole. Hence great need to evaluate indicators for a successful service delivery system. The objective of this study was to assess the diabetic care indicators and the associated factors among diabetic patients as a guide towards optimum care requirements. Methods: A cross sectional survey was conducted among diabetic patients receiving care from five health centres in Makandara sub-county between August and November 2019. Pre-tested questionnaires were used to collect the socio-demographic and quality of care data. The recruitment of the participants was done using the consecutive systematic sampling plan among the patients seeking care in the diabetic clinics and statistical analysis of data performed using excel and STATA. Results: A total of 201 diabetic patients (Male-57, Female-144) aged 18 years-93 years were interviewed. Study findings indicated that all (100%) of the facilities had clinical officers and nurses to offer quality care services but 40% of them lacked trained pharmaceutical technicians and 20% of them lacked trained laboratory technologists. Four out of five facilities had the clinical officers trained on diabetes care standards. On process of care indicators study results indicated that blood pressure and urinalysis were performed in 100% and 96.5% respectively of the patients while serum creatinine, serum lipid profiles and dilated eye examination were reported at a prevalence of 7.5%, 4.5% and 0.5% respectively. Health education was also a common practice in all the facilities which involved nutritional advice, diabetes education and exercise counselling. On diabetes management pharmacologic approach using oral hypoglycaemias was the most used method at 87%, followed by insulin at 13% and oral Insulin at 1% prevalence. On outcome of care indicators 58% of the patients had their systolic pressure below 140 mm/Hg with the overall mean of systolic blood pressure in the five facilities being 135.8 while 89% of the patients had their diastolic blood pressure below 90 mm/Hg with the overall mean in the five facilities being 78.2 mm/Hg. Conclusion: Majority of the health facilities had trained clinical officers and nurses with considerable training on diabetes management.However, lack of trained pharmaceutical technicians and laboratory technologists was hampering the quality of care given. Conclusion: Majority of the health facilities had trained clinical officers and nurses with considerable training on diabetes management. However, lack of trained pharmaceutical technicians and laboratory technologists was hampering the quality of care given.

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