Non-adherence to diabetes treatment at Mulago Hospital in Uganda: prevalence and associated factors

JN Kalyango, E Owino, AP Nambuya

Abstract
Background: Non-adherence to diabetes treatment leads to poor glucose control and increases the risk of disease complications. The prevalence and factors associated with non-adherence in resource limited settings should be determined so as to lower the impact of a disease that is on the increase, on the health systems which are already overburdened with communicable diseases.

Objectives: To determine the prevalence and factors associated with non-adherence to diabetes treatment. Methods: A cross sectional study was carried out from February to April 2004 in Mulago Hospital, Uganda. The participants were 402 type 1 and 2 diabetic patients selected from the outpatients’ diabetic clinic using systematic sampling. They were aged 18 years and above, had been taking diabetes treatment for at least one month and gave informed consent to participate. Non-adherence was assessed using patients’ self reports.

Results: The prevalence of non-adherence was 28.9% (n = 116, 95%CI = 24.5 – 33.3%). Factors that were independently associated with non-adherence were: female gender (OR = 2.9, 95%CI = 1.4 – 6.3), not understanding the drug regimen well (OR = 4.0, 95%CI = 1.0 – 16.3), affording only some or none of prescribed drugs (OR = 3.7, 95%CI = 1.8 – 7.6) and longer time since last since last visit to a health worker (OR = 7.3, 95%CI = 2.7 – 19.9).

Conclusions: Adherence to diabetic treatment was suboptimal. There is need to improve it through strategies helping patients understand their drug regimens, always availing drugs in the hospital so that they do not have to buy them and giving shorter time between visits to health worker. Further studies should be done to find out why females were not adhering to treatment so as to improve their adherence.