Abstract
BackgroundDespite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda.MethodsThis was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data.ResultsThe mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication.ConclusionThe quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.
Highlights
Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas
Global estimates show that the greatest increase in the burden of T2DM will occur in low- and middle- income countries (LMICs) [7] and if not addressed, the adverse physical and socio-economic consequences of diabetes will constrain the health systems in these countries [3]
This study focused on the Health centre (HC) IVs and hospitals because more comprehensive diabetes services are provided at these levels
Summary
Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. Sub- Saharan Africa (SSA) is no exception, as reports show an increase in the prevalence of diabetes over the years [3]. Uganda’s reported overall prevalence of T2DM is relatively low at. Global estimates show that the greatest increase in the burden of T2DM will occur in low- and middle- income countries (LMICs) [7] and if not addressed, the adverse physical and socio-economic consequences of diabetes will constrain the health systems in these countries [3].
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