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      Self-Care Practices among Diabetes Patients in Addis Ababa: A Qualitative Study

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          Abstract

          Background

          Self-care practices that include self-monitoring of blood sugar level, diet management, physical exercise, adherence to medications, and foot care are the cornerstones of diabetes management. However, very little is known about self-care in developing countries where the prevalence of diabetes is increasing.

          Objective

          The objective of this study was to describe self-care practices among individuals with type II diabetes in Addis Ababa, Ethiopia.

          Methods

          A qualitative method was used to gather data from type II diabetes patients. Patients were recruited from the outpatient diabetes clinics of two public hospitals in Addis Ababa. Data were collected using a semi structured interview guide. A thematic analysis approach was used to process the data.

          Results

          Overall self-care practices were not adequate. Most patients reported irregular self-monitoring of blood sugar. Dietary and physical exercise recommendations were inadequately practiced by most of the participants. Most patients better adhered to medication prescriptions. Patients generally lack proper information/knowledge regarding the importance of self-care and how it should be implemented. Based on reported behavior we identified three main categories of patients; which are those ‘endeavor to be compliant’, ‘confused’ and ‘negligent’.

          Conclusion

          Diabetes patients largely depend on prescribed medications to control their blood sugar level. The importance of proper self-care practices for effective management of diabetes is not adequately emphasized in diabetes care centers and patients lack sufficient knowledge for proper self-care.

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          Most cited references4

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          Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia

          Purpose Diabetes mellitus is a growing global health problem that affects patients of all ages. Even though diabetes mellitus is recognized as a major chronic illness, adherence to antidiabetic medicines has often been found to be unsatisfactory. This study was conducted to assess adherence to medications and to identify factors that are associated with nonadherence in type 2 diabetes mellitus (T2DM) patients at Primary Health Clinics of the Ministry of Health in Malaysia. Materials and methods The cross-sectional survey was carried out among T2DM patients to assess adherence to medication in primary health clinics. Adherence was measured by using the Medication Compliance Questionnaire that consists of a total of seven questions. Other data, such as patient demographics, treatment, outcome, and comorbidities were also collected from patient medical records. Results A total of 557 patients were recruited in the study. Approximately 53% of patients in the study population were nonadherent. Logistic regression analysis was performed to predict the factors associated with nonadherence. Variables associated with nonadherence were age, odds ratio 0.967 (95% confidence interval [CI]: 0.948–0.986); medication knowledge, odds ratio 0.965 (95% CI: 0.946–0.984); and comorbidities, odds ratio 1.781 (95% CI: 1.064–2.981). Conclusion Adherence to medication in T2DM patients in the primary health clinics was found to be poor. This is a cause of concern, because nonadherence could lead to a worsening of disease. Improving medication knowledge by paying particular attention to different age groups and patients with comorbidities could help improve adherence.
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            Hypertension, Diabetes Mellitus and Task Shifting in Their Management in Sub-Saharan Africa

            Chronic diseases are becoming increasingly important in sub-Saharan Africa (SSA). The current density and distribution of health workforce suggest that SSA cannot respond to the growing demand for chronic disease care, together with the frequent infectious diseases. Innovative approaches are therefore needed to rapidly expand the health workforce. In this article, we discuss the evidences in support of nurse-led strategies for chronic disease management in SSA, with a focus on hypertension and diabetes mellitus.
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              Prevalence of hypertension and diabetes among Ethiopian adults.

              To determine the prevalence of hypertension and diabetes among members of an Ethiopian occupational cohort; and to examine the proportion of adults who were aware of their conditions. A total of 2153 of subjects were included in this cross-sectional study. The World Health Organization STEPwise approach for non-communicable diseases was used to collect socio-demographic data, blood pressure measures and blood samples from participants. Prevalence estimates for hypertension and diabetes were determined separately. The 95% confidence intervals for prevalence estimates were also determined. The overall prevalence of hypertension was 19.1% (95%CI: 17.1-20.8) and 22% (95%CI: 20.2-23.8) and 14.9% (95%CI: 13.4-16.4) among men and women respectively. The overall prevalence of diabetes was 6.5% (95%CI: 5.4-7.6) and 6.4% (95%CI: 5.0-7.8) and 6.6% (95%CI: 4.8-8.4) among men and women correspondingly. Notably, 15% of hypertensives reported never having had their blood pressure checked prior to the present study examination. Approximately 45% of participants who had their blood pressure checked were never diagnosed with hypertension, but were found to be hypertensive in our study. Approximately 27% of newly diagnosed diabetics (during this study) reported never having a previous blood glucose test. Among those who had their blood glucose assessed prior to this study, 17.4% were found to have diabetes but were never diagnosed. The high prevalence of hypertension and diabetes reported in our study confirms findings from other Sub-Saharan Africa countries, and extends the literature to urban dwelling Ethiopians where non-communicable diseases are emerging as a major public health concern. Copyright © 2012 Diabetes India. Published by Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                3 January 2017
                2017
                : 12
                : 1
                : e0169062
                Affiliations
                [001]Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
                Weill Cornell Medical College Qatar, QATAR
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: DT.

                • Data curation: DT.

                • Formal analysis: DT.

                • Funding acquisition: DT.

                • Investigation: DT.

                • Methodology: DT YB.

                • Project administration: DT.

                • Resources: DT YB.

                • Software: DT.

                • Supervision: DT YB.

                • Validation: DT YB.

                • Visualization: DT.

                • Writing – original draft: DT.

                • Writing – review & editing: DT YB.

                Article
                PONE-D-15-31240
                10.1371/journal.pone.0169062
                5207399
                28045992
                308359cb-4877-4545-9768-07e543478ab3
                © 2017 Tewahido, Berhane

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 July 2015
                : 12 December 2016
                Page count
                Figures: 0, Tables: 1, Pages: 10
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Endocrinology
                Endocrine Disorders
                Diabetes Mellitus
                Medicine and Health Sciences
                Metabolic Disorders
                Diabetes Mellitus
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                Health Care
                Patients
                Biology and Life Sciences
                Anatomy
                Body Fluids
                Blood
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                Africa
                Ethiopia
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                Custom metadata
                Interview transcripts cannot be made public without participant consent due to ethical reasons due to confidentiality issues, as required by the Addis Continental Institute of Public health Institutional Review Board. Data will be made available upon request at the following contact: Dagmawit Tewahido, email: Dagmawit.tewahido@ 123456gmail.com , tel. 251 911 472 281, Po. box: 24123/1000, Addis Ababa, Ethiopia.

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