Abstract
BackgroundIn Cambodia, the age-standardized prevalence of diabetes mellitus has increased in both men and women. The main objective of this study was to identify factors associated with diabetes medication adherence among people with diabetes mellitus in poor urban areas of Phnom Penh, Cambodia.MethodsA cross-sectional study was conducted in 2017 using a structured questionnaire for face-to-face interviews by trained interviewers. The participants were people with diabetes mellitus who were the active members of a peer educator network, lived in poor urban areas of Phnom Penh, and attended weekly educational sessions during the survey period. Diabetes medication adherence was measured using four items of modified Morisky Medication Adherence Scale. Participants were classified into two groups based on their adherence score: 0 (high adherence) and from 1 to 4 (medium or low adherence). Sociodemographic characteristics; medical history; accessibility to health services; and knowledge, attitude, and practices related to diabetes mellitus were examined. A multiple logistic regression analysis was conducted adjusting for sex, age, marital status, and education levels.ResultsData from 773 people with diabetes were included in the analyses. Of the total, 49.3% had a high level of diabetes medication adherence. A high level of adherence was associated with higher family income (≥50 USD per month) (adjusted odds ratio [AOR] = 5.00, 95% confidence interval [CI] = 2.25–11.08), absence of diabetes mellitus-related complications (AOR = 1.66, 95% CI = 1.19–2.32), use of health services more than once per month (AOR = 2.87, 95% CI = 1.64–5.04), following special diet for diabetes mellitus (AOR = 1.81, 95% CI = 1.17–2.81), and absence of alcohol consumption (AOR = 13.67, 95% CI = 2.86–65.34).ConclusionsHigh diabetes medication adherence was associated with better family economic conditions, absence of diabetes mellitus-related complications, and healthy behaviors. It would be crucial to improve affordable access to regular follow-ups including promotion of healthy behaviors through health education and control of diabetes mellitus-related complications.
Highlights
In recent years, non-communicable diseases (NCDs) have been the cause of majority of deaths in the developing countries, where the burden of NCDs is greater than that of communicable diseases [1]
High diabetes medication adherence was associated with better family economic conditions, absence of diabetes mellitus-related complications, and healthy behaviors
A recent literature review has concluded that health system response to NCDs in the AsiaPacific region is weak [3]
Summary
Non-communicable diseases (NCDs) have been the cause of majority of deaths in the developing countries, where the burden of NCDs is greater than that of communicable diseases [1]. In Cambodia, according to Institute for Health Metrics and Evaluation, the estimated number of deaths caused by diabetes mellitus in 2017 was reported to be 2,756, which was 1.4 times of the number in 1990 [4]. The International Diabetes Federation predicted that the number of adults aged from 20 to 79 years with diabetes mellitus in Cambodia was 246,200 in 2017 [5]. The World Health Organization (WHO) estimated that the number of people with diabetes mellitus in Cambodia would reach approximately 317,000 in 2030, which is about three times of the number in 2000 (n = 110,000) [6]. It is predicted that about half of the people with diabetes mellitus would remain undiagnosed and untreated [7]. The main objective of this study was to identify factors associated with diabetes medication adherence among people with diabetes mellitus in poor urban areas of Phnom Penh, Cambodia
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