Factors associated with noncompliance to diabetes medication in a rapidly urbanizing region in Ghana: a mixed-methods study.

Failure to achieve adequate glycemic control can lead to debilitating complications for diabetics. Strict compliance to prescribed diet, lifestyle, and medication can prevent complications. Methods: In order to examine factors accompanying noncompliance behavior to diabetes medication in a rapidly urbanizing region of Ghana, a mixed approach was adopted. Study subjects (N: 160, mean age: 58.3) were interviewed at the diabetic clinic of the Brong-Ahafo Regional Hospital, Sunyani. Compliance to diabetes treatment was evaluated with an adapted Morisky Medication Adherence Scale (MMAS). Face-to-face interviews of 20 subjects allowed for more personalized exploration of psychosocial aspects of noncompliance. The interviews were audio recorded, transcribed verbatim, and coded using the Nvivo software. Qualitative data was processed and subjected to inductive thematic analysis. Results: Majority of study participants reported an optimum (n = 121, 75.6%) level of compliance to diabetes medication, although some also reported poor compliance (n = 39, 24.4%). Qualitative responses received during interviews suggest that poor compliance may be attributable to misconceptions about religious beliefs and practices. Psychosocial factors relating to felt stress, the inevitability of fate, and compliance fatigue were also discovered to undermine compliance. Noncompliance behavior was also explained by socioeconomic status and barriers to health-seeking behavior. Conclusion: Reported medication compliance was among the highest in out-patient settings in Ghana. However, contextual determinants of noncompliance have to be addressed. Efforts to improve compliance to diabetic medication could benefit from interventions that address superstition, target psychological aspects of chronic disease management, and remove operational barriers to healthcare delivery such as transportation costs and long waiting times.

The Search for an Efficient Black Fly Trap for Xenomonitoring of Onchocerciasis.

Onchocerciasis is a neglected tropical disease that has plagued mankind for decades with pathologies that involve the eyes and the skin. The WHO and the global health community have earmarked the disease for global elimination by 2045. However, as control programmes shift focus from reduction of the burden of the disease to elimination, new tools and strategies may be needed to meet targets. Monitoring Onchocerca volvulus larvae in the black fly vectors is an important tool needed to monitor disease dynamics and certify elimination. For decades, human landing collections have been the sole means of acquiring vectors for monitoring of the disease. This procedure has been plagued with ethical concerns and sometimes the inability to harvest enough black flies needed to carry out effective monitoring. Since the 1960s, the WHO recognized the need to replace human landing collections but relatively few field studies have designed and tested alternative traps. This review article systematically discusses some of the key traps tested, their successes, and their challenges. It is the aim of the review to direct research and development focus to the most successful and promising vector traps which could potentially replace the human landing collections.