COMPLIANCE TO SCHEDULED CLINICAL VISITS AMONG ADULT PATIENTS WITH TYPE 1 AND TYPE II DIABETES MELLITUS AT THE MERU TEACHING AND REFFERAL HOSPITAL MERU COUNTY, KENYA

Abstract

Diabetes mellitus is a global health problem that affects individuals of all age groups. The disease is associated with complications that cause morbidity, mortality and huge economic burdens on the health care system. The burden of DM continues to rise in Sub-Saharan Africa (SSA) with the current statistics showing a prevalence of 7.1% while in Kenya there is an estimated prevalence of 3.3 %.( Lancet, 2016). Cure is not expected with follow up although symptoms can be alleviated by achieving glycemic controls when patient is compliant. The main problem in the management of diabetes mellitus has been the non-compliance of patients to the management plan. This problem has also been identified at the Meru Teaching and Referral Hospital with 229 patients having missed appointment in the last 3 years. The objective of this study was to assess compliance to scheduled clinical visits among patient with diabetes for management at Meru Teaching and Referral Hospital. Mixed method approach was adopted for the study. The sample size comprised of 74 diabetes mellitus patients who were selected by systematic random sampling and 9 health workers purposively selected working in the diabetic clinic. Structured questionnaire were used to collect data from the patients while interview guided focus group discussion were used to collect qualitative data from the health workers. Quantitative data was analyzed using SPSS version 25 at 95% confidence interval and a significance level p=>0.05. Frequencies, percentages, means and SD were used for descriptive statistics while Chi squares was used for inferential analysis. Qualitative data was analyzed thematically. From the study the level of compliance is at 71.6% with 53 participants who had never missed a scheduled clinical appointment for diabetic follow-up, while 28.4% (n=21) had missed at least one visit. Majority (66.2%) did not have any general knowledge of diabetes and 60.8% knew of diabetes mellitus complications. Majority of the respondents (59.5%) were females most of whom (28.4%) were aged between 40-50 years. Majority (66.2%) were married and 37.8% of them had secondary level of education. Male gender was 1.31 times more likely to comply with scheduled visits. Participants aged between 18-28 years had better compliance with scheduled visits compared those aged above 40 years while participants who were single had better compliance compared to their counterparts who were either married or divorced. Most respondents (33.8%) travelled for 6-10 Kilometers to the health facility, and 40.5% reported that the hospital location was somewhat convenient. The relationship with staff was rated good at 47% and 41.9% reported that the services were fairly affordable. Majority (52.7%) were generally satisfied with the services offered at the hospital. Strategies to enhance compliance fell under four thematic areas, i.e. human resource, service affordability, turn-around time and improvement of service quality. The study concluded that there was poor knowledge of diabetes and on the risks of missing scheduled clinic appointments, the overall compliance with scheduled visits was low and the main factor influencing compliance with scheduled visits was availability of financial assistance while seeking treatment. The study recommends the hospital management to ensure that human resource is optimized by adding more health workers especially, cashiers at pay points, nurses and doctors, members of staff to empathize with the patients and report on duty in good time and further research is needed with patients, especially those who have missed appointments, to get their lived experiences with diabetes mellitus