ABSTRACT
Abstract: 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-compliance to diabetes treatment recommendations is usually associated with increases in HbA1c levels, hospitalization rates, disability and overall premature deaths. This study was done at Onicha Igboeze General Hospital to determine the factors associated with compliance to treatment recommendations among diabetic patients attending diabetic clinic from February-April 2017. 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.  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), 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. Factors influencing compliance of treatment among diabetic patients is a result of interplay of many, varied and multifaceted factors. Therefore, strategies to improve adherence among patients attending Onicha Igboeze General Hospital in Onicha Local Government Area of Ebonyi 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.
CHAPTER ONE
INTRODUCTION
Diabetes is the leading cause of complications including blindness from diabetic retinopathy, kidney failure and resulting dialysis and non-traumatic limb amputation. Persistent elevations of blood glucose may also lead to long term complications that include macro-vascular damage, for example, ischemic heart disease, stroke, and amputation and micro-vascular damage. Nerve damage occurs in 60-70% of the diabetes population (Muteiwa 2011). However, short-term complications include Hyperosmolar, hyperglycemia, super-added infection and diabetic Ketoacidosis and yperosmolar (coma resulting from biochemical imbalances). The rate of developing heart disease and stroke in people diagnosed with diabetes is 2 to 4 times higher that of general population probably due to unstable atherosclerosis (Bisiriyu 2007, Muteiwa 2011). Several studies on this subject have indicated that non-adherence to treatment recommendations is a major challenge the world over whereby adherence to medications was about 50% whilst for lifestyle behaviour modifications was shown to be very low( Kalyango et al 2008). Diabetes is regarded as the most demanding condition psychologically and behaviourally as it generally requires frequent self-monitoring of blood glucose, dietary modifications, exercise and proper administration of the prescribed medication. It is imperative for diabetic patients to achieve optimal glucose control by strictly adhering to medication recommendations, diet and exercise in order to reduce long term complications associated with non-adherence to treatment recommendations. Various studies on patient adherence to diabetic treatment recommendations have also indicated that factors such as disease related, health service, and socio-economic, sociodemographic variables such as age, race, gender and social support may have an influence on the patient’s adherence to treatment. However, most of the studies were carried out in developed countries and other African countries and a few were done in Ebonyi leaving a knowledge gap on the prevalence and factors associated with non-adherence to diabetes treatment recommendations at Onicha Igboeze General Hospital and in Ebonyi as a whole.
