Establishment of diabetes association to enhance peer-education and self-management: perceptions of residents from Ogwashi-Uku and Ubulu-Unor communities in Delta state, Nigeria

Background: Diabetes epidemic is an evolving phenomenon in Nigeria and sub-Saharan Africa. Most African governments are showing strong desire to reversing the current trend. However, information on the perception and readiness of rural and suburban community dwellers towards managing this disease need to be gathered.Methods: This was mixed methods including descriptive observational study and survey regarding establishment of a diabetic network in the rural and suburban localities. Quantitative screening data were collected to assess prevalence of diabetes or prediabetes, as well as investigate the perceptions of diabetic and non-diabetic residents. Establishment of diabetes register was initiated. 180 complete questionnaires were included for analysis, though 199 consented to participate. In the qualitative phase of the research, a convenience sampling questionnaire and focus group discussion on their perception about diabetes association or network. Their perceived response and opinions were then documented.Results: Among the participants, approximately 12% prevalence of diabetes and 10% prediabetes were observed. 19/25 cases of diabetes were entered in the register. Over 43% of the population never heard about diabetes association/network, but 72% of the diabetes cohort are willing to join diabetes network. A greater fraction of the suburban patients seems more aware, but willingness to accept diabetes is higher in the rural community.Conclusions: Most of the persons living with diabetes, and their relatives, are willingly to join diabetes network as well as encourage such organisation in their communities. Given the level of unawareness, there is need to establish diabetic association and advance the benefits.

Diabetes registry initiative in Delta State Nigeria: narrative of the kick-off experience

Background: This is parallel with the piece of work on behavioral change wheel of healthcare professionals. The objective is to assess how much standard diabetes care service that is available in the community-based health facility and the barriers to patients’ participation.Methods: This was based on free diabetes clinics, which constituted the beginning of the development of diabetes register series. Observational study and surveys were conduct to determine scope service available in the hospital and factors that influence participation of patients.Results: It is observed that lack of hospital consultants is the greatest ‘health system’ barrier faced by the individuals living with diabetes.Conclusions: There is a need for individuals living with diabetes to be educated on the importance of adherence to medical check-up appointments. The healthcare professionals and providers also need professional development on the importance of diabetes register in the management of patients.

Development of diabetes register in low-mid income country VII: summary of series

Background: This is a summarizing discussion of the series. Six pieces of articles have been presented including two pilot studies and survey of the perception of healthcare professionals. The other four presented case observations from the different levels of health facilities.Methods: In this summary, a comparison between the four grades of facilities is presented with focus on completeness of patients’ contact details and clinical information regarding basic anthropometric data that can be easily collected anywhere.Results: It shows evidence that capacity and scope of diabetes services are in tandem i.e., least at the primary level and most at the tertiary facility. It also shows albeit anecdotal that the private general practices may be doing best in what they have capacity to do.Conclusions: The capacity for diabetes service in all tiers of the healthcare system. The need to advocate for diabetes register as a means to improve quality of service is highlighted.

Diabetes registry and service in Nigerian suburban-based tertiary healthcare facility

Background: Diabetes register is a clinical tool necessary for patient management including follow-up and referral procedures. In the Bringing Research in Diabetes to Global Environments and Systems that is in progress in Delta State, Nigeria; part of focus is establishment of diabetes register at a tertiary health facility. This phase of the project aimed to establish a diabetes register and to assess the baseline data.Methods: This was a clinical observational descriptive study at Eku Baptist Government Hospital. The diabetes register developed as in previous report was adopted as a scale-up study. After due clearance from the hospital, patients’ hospital record files were screened for cases of diabetes and 70 files were identified. Data were analyzed descriptively using Microsoft Excel Data Analysis ToolPak 2010.Results: There was a 2/1 female/male ratio, while 6% were below 40 years. 90% of patients had blood glucose levels results that indicated poor diabetes control. There is problem of incomplete data collection, for instance <25% BMI data was available. Capability and opportunity for standard service, e.g. diabetic foot examination, lipid profile, renal and retinal assessment was available at the tertiary health facility to allow management and referral from other hospitals.Conclusions: This report highlights poor adherence to diabetes care practices by stakeholders. It underscores the need for motivation to improve the quality of clinical data collection vis-à-vis documentation that enables assessment of diabetes epidemiology, especially in a facility that has the capacity.

Diabetes registry and service in Nigerian suburban areas: experience at a secondary healthcare facility

Background: Disease registries help to provide quality healthcare, including chronic care. As part of ongoing bringing research in diabetes to global environments and systems 2 project in Delta State, Nigeria; a preliminary concern is completeness of clinical assessments and data collection that would enable patients’ follow-up. The aim of this piece of work is to investigate if data collected for local diabetes registry is complete and sufficient to provide better understanding of the disease epidemiology and treatment follow-up.Methods: This was a purposive medical records audit at public secondary level hospital that followed initial development of diabetes register at the Catholic Hospital, Abbi with 44 pieces of clinical and demographic information. At the public hospitals, 93 patients’ medical records were audited and the data were entered into the register and evaluated, descriptively.Results: The results show that about 52% of the 44 itemized information were collected, of which completeness of data/documentation was as low as 3% in some items. Blood pressure assessment was done on 70% of patients and 16% of patients had diabetes complications. Lifestyle regimen monitoring was not documented. Neither incidence nor morbidity and mortality rate could be definitively ascertained.Conclusions: Quality of clinical data documentation was poor. This study contributes a measure of community needs assessment for professional development training on diabetes.

Prospects of diabetes registry and standard care at primary health facilities in Nigeria: experiential note

Background: As part of the series to advance diabetes register, the aim of this piece of the project was to evaluate the development of a diabetes register at primary healthcare (PHC) level in Delta State Nigeria. This is with a view to determine the PHC capacity for diabetes services.Methods: This clinical observational study was carried out in Novena University health centre in Ukwani Local Government Area and Ogume primary health centre in Ndokwa West Local Government Area, Delta State. A community-based screening was carried out in three communities of Amai, Ezionum and Ogume in July to September 2018, after which a diabetes registers were developed in Novena University health and Ogume primary health centres. Cases of probable diabetes were identified during screening and entered into the diabetes register being developed, which formed the sampled population (n=42). The data were analysed using Microsoft Excel Data Analysis ToolPak 2010.Results: Glucometer, stethoscope and sphygmomanometer were the most available equipment at the two facilities. Medical records of patients were incomplete with 81% missing home addresses and 62% did not have phone numbers. Others records such as date of entry, height, weight and type of diabetes were not recorded. The study also showed 35% prevalence of hypertension in diabetes cases.Conclusions: There is capacity to run diabetes screening and service clinic at the primary healthcare levels, but the limitation was incomplete patient information in the medical records. In development of a diabetes registry at the primary healthcare level, the study recommends comprehensive patients’ documentation during screening and routine medical check-up.

Prospects of diabetes registry in suburban community of Nigeria: experience at a private general practice

Background: As part of series of advocacy on development of diabetes register, one of the target health facilities is private general practices. In suburban Kwale community Delta State, Donak hospital was chosen to study the process of developing and implementing diabetes register program. Specific objectives include to evaluate the extent of completeness of data for patients follow-up, diabetes services within the private practice based on data collection, prevalence of high blood pressure, and patients’ compliance with medical appointments.Methods: The study followed a clinical observational method and after necessary ethical considerations, medical information was gotten from the record unit Donak Hospital, Kwale. The patients identified as potential diabetes or prediabetes were contacted for follow-up and 113 (65 females and 48 males) participants consented, all adults. Data collection were those required for a diabetes register proforma and were analyzed using Microsoft Excel Analysis Tool-pack. Results: There was no dedicated diabetes register per se except for usual medical records. The private practice has 100% record of contact details and blood pressure completeness for the participants. The scope of service offered to the patients was basically primary healthcare services. Over 50% of the participants have high blood pressure. On the patients’ compliance with medical check-up; only 23% of the participants complied with check-up appointments.Conclusions: The development of diabetes register in private practices can improve services. These services include documentation of appointments to enable follow-up strategies to encourage compliance to medical check-ups and a record diabetes education that may be provided.

Development of diabetes register in low-mid income country: survey of healthcare professionals’ behavioural change wheel

Background: There has been and ongoing research and development on diabetes care in Ndokwa community of Nigeria, and one of the items to be addressed is development of diabetes register in some of the health facilities. This study assesses the behavioural change wheel of the healthcare professionals to address the willingness of the primary healthcare providers willing to scale up and sustain the diabetes register; and how glycaemic control and metabolic syndrome factors in diabetes patients were assessed.Methods: The study adopted clinical observational approach and survey questionnaires. A descriptive cross sectional method evaluated how glycaemic control among diabetes patients (n=42) was assessed. Clinical observations were at Catholic Hospital Abbi, while the survey of healthcare professionals (n=71) included health facilities in other communities. Data from questionnaire and test results was analysed using Microsoft Excel Data Analysis Toolpak 2010.Results: It is observed that 62% wished they had a diabetes register. Over 50% of the patients showed presence of >2 metabolic syndrome indices. Further, ≈52% disagreed that diet, exercise, medication, quitting smoking and less stress contributed to effective control and management of diabetes.Conclusions: Most of the respondents thought that their practice did not have a special interest in diabetes. There is prevalence of metabolic syndrome, but the majority of healthcare professionals did not view lifestyle as effective to control diabetes. These observations highlight the need for diabetic education on healthcare professionals and patients.