Epidemiological factors affecting outpatient department service utilization and hospitalization in patients with diabetes: A time-series analysis from an Ethiopian hospital between 2018 and 2021

Barriers and facilitators to accessing Non-Communicable Disease services among children, adolescents and young people with Type 1 Diabetes in Mozambique: a quantitative content analysis using the COM-B framework

BACKGROUND

Non-communicable diseases (NCDs), and diabetes in particular, are on the rise even in sub-Saharan African countries. Despite this, access to care is still poor. This study aimed to assess barriers/facilitators to access NCDs services for children, adolescents and young people with Type 1 Diabetes (T1DM) in Mozambique.

METHODS

A qualitative cross-sectional study using focus groups (FG) and key-informant interviews was conducted between September and October 2023, involving patients (16-30 years), caregivers of child and adolescent patients and health care staff of 5 health facilities. A deductive approach was adopted using the Capability-Opportunity-Motivation-Behaviour (COM-B) framework to classify themes referring to barriers/facilitators to access. Two researchers carried out quantitative content analysis independently, assessing the inter-rater agreement through Cohen's K.

RESULTS

Four FGs were conducted with 26 patients (61.5% female, 16-24 years), three with 18 caregivers (83.3% female) and 16 interviews with healthcare workers. A total of 455 themes were identified, with a predominance of barriers (67.3%) compared to facilitators (32.7%) in accessing T1DM services. The area ''Capability'' was labelled significantly more often as a barrier (89.5%) than ''Motivation'' and ''Opportunities'' (60.2% and 62.6%, p < 0.001). The most frequent barriers were related to the psychological ability to accept and manage the disease in the absence of professional psychological support, inadequate interactions with healthcare personnel, long waits in the outpatient clinic and stigma towards diabetes in the community. Social support from family and friends appears to be an important facilitator. Social opportunities emerge more often as facilitators (76/105, 72.4%) than physical opportunities, which were 79.0% (n = 139/176) of the barriers in the 'Opportunities' area (p < 0.001).

CONCLUSIONS

The study highlights the difficulties of patients suffering from T1DM, in particular due to the lack of psychological support and inadequacies of the health services. It also points out the need to improve the training of healthcare personnel and to strengthen the health literacy of patients to improve recognition and management of the disease, respectively. Increased awareness by the community, supported by structured interventions, could also contribute to reducing stigma towards patients and improving the quality of care.

Evaluation of diabetes care services, data quality, and availability of resources in Ethiopia: Difference-in-differences analysis of the NORAD-WHO NCDs' midterm project evaluation

BACKGROUND

The Ethiopian government, supported by NORAD, the WHO, and other partners, is decentralizing diabetes care to primary health units via a task-shifting approach. Despite substantial investment, there is still a lack of up-to-date information on diabetes screening, diagnosis, treatment, and medication availability in the country.

OBJECTIVE

This study assessed the effects of the NORAD-WHO intervention on diabetes care services, data quality, and the availability of infrastructure and medical supplies in Ethiopia.

METHODS

A quasiexperimental study was conducted across 31 NORAD-WHO project facilities and 62 control facilities in six regions of Ethiopia and Addis Ababa. We used descriptive statistics to assess diabetes screening, diagnosis, treatment services, medication availability, and data quality over 54 months from January 2019 to June 2023. Additionally, we performed a difference-in-differences (DID) regression analysis comparing data from two periods: before the intervention (January to December 2019) and after the intervention (July 2022 to June 2023).

RESULTS

This study revealed a notable increase in diabetes services, with over 82% of facilities offering screening, early diagnosis, and treatment. Written treatment guidelines are present in three quarters of the facilities. The proportion of trained staff increased from 58% in 2019 to 100% in 2023 across all the evaluated facilities. Intervention facilities had significantly more functional glucometers than did control facilities, averaging four (95% CI: 3.4, 4.6) per month in 2023 compared with 2.5 (95% CI: 2.1, 2.9) in 2019. However, hemoglobin A1C testing remains uncommon. Despite improvements in diabetes service data, issues with missing records, overreporting, and timeliness persist, with an average reporting rate of 99.2% and on-time reporting rate of 51.5%. The NORAD-WHO intervention notably increased the average number of fasting blood sugar tests by 17 per month (95% CI: 12.2-21.8, p = 0.014).

CONCLUSIONS

This midterm evaluation revealed a significant increase in the availability of fasting blood sugar tests in the intervention facilities. Additionally, the availability of medical equipment, laboratory services, and medications has improved over the years. Intervention facilities, with more trained healthcare professionals and better resources, outperform control facilities in screening, diagnosing, treating, and managing high blood sugar levels. Notably, intervention facilities screened more clients for diabetes and showed that patients receiving follow-up care achieved better glycemic control than did those at control facilities. While there has been progress in diabetes service data availability, addressing issues such as missing data, overreporting, and reporting timeliness is essential for further improving the quality of diabetes services.

CLINICAL TRIAL NUMBER

Not applicable.

Effectiveness of the Hypertension Screening Corner in Enhancing the Cascade of Care at Primary Healthcare Center Level: Evidence from Zambezia, Mozambique

Background

Hypertension is the leading cause of cardiovascular disease, whose death burden is dramatically increasing in sub-Saharan Africa. To curb its effects, early diagnosis and effective follow-up are essential. Therefore, this study aims to evaluate the impact of a hypertension screening corner on the hypertension care cascade at the primary healthcare level.

Methods

A prospective cohort study was conducted between October 2022 and March 2023 in two PHCCs in Zambezia (Mozambique). The study involved a demographic and socioeconomic status (SES) questionnaire for those screened. Patients with blood pressure (BP) > 140/90 mmHg were given a follow-up questionnaire regarding the care cascade. The four cascade steps were: medical visit, diagnosis confirmation, follow-up visit, and recalling the follow-up appointment. The odds ratio (OR) of reaching each step of the cascade was assessed by binomial logistic regression.

Results

Patients with BP > 140/90 mmHg were 454, and 370 (86.0%) completed both study phases. Individuals attending the medical visit were 225 (60.8%). Those with low SES had a higher probability of visit attendance than those with middle (OR = 0.46, 0.95CI[0.23-0.88] p = 0.020) and high (OR = 0.21 0.95CI[0.10-0.42], p < 0.001). Hypertension diagnosis was confirmed in 181 (80.4%), with higher probability in the low SES group compared to the middle (OR = 0.24 IC95[0.08-0.66], p = 0.007) and high (OR = 0.23, IC95[0.07-0.74], p = 0.016) groups. The OR to complete step 1 and step 2 were higher for older age groups. A follow-up appointment was received and recalled by 166 (91.7%) and 162 (97.6%) patients, respectively.

Conclusions

The hypertension corner proved to be a useful tool for effective screening of hypertension with satisfactory retention in care, especially for people with lower socio-economic status.

Non-Genetic-Induced Zebrafish Model for Type 2 Diabetes with Emphasis on Tools in Model Validation

The unrelenting increase in the incidence of type 2 diabetes (T2D) necessitates the urgent need for effective animal models to mimic its pathophysiology. Zebrafish possess human-like metabolic traits and share significant genetic similarities, making them valuable candidates for studying metabolic disorders, including T2D. This review emphasizes the critical role of animal models in diabetes research, especially focusing on zebrafish as an alternative model organism. Different approaches to a non-genetic model of T2D in zebrafish, such as the glucose solution, diet-induced, chemical-induced, and combined diet-induced and glucose solution methods, with an emphasis on model validation using indicators of T2D, were highlighted. However, a significant drawback lies in the validation of these models. Some of these models have not extensively demonstrated persistent hyperglycemia or response to insulin resistance and glucose tolerance tests, depicted the morphology of the pancreatic β-cell, or showed their response to antidiabetic drugs. These tools are crucial in T2D pathology. Future research on non-genetic models of T2D in zebrafish must extensively focus on validating the metabolic deficits existing in the model with the same metabolic defects in humans and improve on the existing models for a better understanding of the molecular mechanisms underlying T2D and exploring potential therapeutic interventions.

Relationship Building between International Healthcare Volunteers and Local Healthcare Providers in Ethiopia: Real-Life Experiences in Low-Income Country

BACKGROUND

The number of international healthcare volunteers in low-income countries that need trained human resources has been increasing. However, migrating to a foreign country requires adapting to its environment and culture. The purpose of this study was to explore the international healthcare volunteers' experiences in Ethiopia in building relationships with local healthcare providers.

METHODS

Six participants were enrolled in the study, and data were collected through individual in-depth interviews conducted between September and October 2018. The collected data were analyzed using Colaizzi's phenomenological method.

RESULTS

Ten subthemes emerged from five themes: "facing new situations", "accepting myself as an outsider in Ethiopia", "impact on the wall of prejudice", "adapting to a new culture", and "positive outlook".

CONCLUSIONS

This study shows that international healthcare volunteers in Ethiopia experienced challenges in building relationships with local healthcare providers due to linguistic and cultural gaps. Nevertheless, they strived to accept the culture and play their part as helpers in providing healthcare services.

Influences of Spatial Accessibility and Service Capacity on the Utilization of Elderly-Care Facilities: A Case Study of the Main Urban Area of Chongqing

With the unprecedented growth of the elderly population in China, elderly-care facilities (ECFs) are in a fast expansion process. However, limited attention has been paid to the imbalance at the actual utilization level of ECFs. This research aims to reveal the spatial inequity of ECFs and to quantitatively examine the effect of accessibility and institutional service capacity on utilization. Taking Chongqing, China, as the study area, we measured the spatial accessibility of different travel modes by the Gaussian Two-Step Floating Catchment Area (G2SFCA) method and investigated distribution differences in spatial accessibility, service capacity, and utilization of ECFs by the Dagum Gini Coefficient and its decomposition. Then, the impact of spatial accessibility and service capacity on the utilization of regional ECFs was quantified by multiscale geographically weighted regression (MGWR). The study findings can be summarized as follows. (1) Walking accessibility has the most significant impact on the utilization of ECFs and shows geographic heterogeneity. Developing a pedestrian-oriented network of pathways is essential to enhance the utilization of ECFs. (2) Accessibility by driving and bus-riding does not correlate with regional ECFs utilization, and relevant studies cannot rely on them alone for assessing the equity of ECFs. (3) In the utilization of ECFs, since the inter-regional difference is more significant than the intra-regional difference, efforts to reduce the overall imbalance should be oriented toward inter-regional variation. The study's findings will assist national policymakers in developing EFCs to enhance health indicators and quality of life for older adults by prioritizing financing for shortage areas, coordinating ECFs services, and optimizing road systems.

Prediction of women and Children's hospital outpatient numbers based on the autoregressive integrated moving average model

Objective

To evaluate the predictive value of the autoregressive integrated moving average (ARIMA) product seasonal model for the daily outpatient volume of paediatric internal medicine departments in hospitals.

Methods

The daily outpatient volume of paediatric internal medicine recorded by the hospital information system of the Chengdu Women's and Children's Central Hospital from 1 January 2011 to 31 December 2020 was collected. Using the data from 1 January 2011 to 31 December 2019, the seasonal summation ARIMA model of the time product was established by fitting the tseries program in the R-3.6.3 software. The monthly outpatient volume from January to December 2020 was predicted, and the prediction effect was evaluated according to the mean absolute percentage error (MAPE) between the predicted value and the actual value.

Results

The outpatient volume of paediatric internal medicine in the hospital from 2011 to 2019 showed an upward trend, with obvious seasonal fluctuations. The optimal model was the ARIMA model ([3,4], 1,2) × (1,1,0) 12, with an Akaike information criterion of 3116.656 and a Bayesian information criterion of 3217.412. The model's residual was a white noise sequence (x² = 7.56, P = 0.819), and the MAPE between the predicted value and the actual value of the model was 9.56%. Within a 95% confidence interval of the predicted value, the prediction accuracy of the model was high.

Conclusion

The ARIMA multiplicative seasonal model established in this study is suitable for the short-term prediction of the outpatient volume.

The Health-Seeking Behavior of the Elderly with Non-Communicable Diseases in Coastal Areas of Vietnam

This study aimed to analyze the utilization of health care facilities and the health-seeking behavior of elderly people with non-communicable diseases and find the factors that affect them. A cross-sectional study was conducted in seven coastal areas of the Thua Thien Hue province, Vietnam, using a sample of 370 elderly people aged over 60 years. Chi-square and multiple logistic regression analyses were used to examine the factors associated with the utilization of health care services. The participants' average age was 69.70 (SD), and 18% of them reported having ≥ two non-communicable diseases (NCDs). The results of the study showed that 69.8% of the total participants exhibited health-seeking behaviors. The findings also revealed that elderly people living alone, and those with an average or above-average income, had higher utilization of health care services. Participants with multiple NCDs exhibited more health-seeking behaviors than those with only one (OR: 9.24, 95% CI: 2.66-32.15, p = <0.001). The presence of health insurance and the need for health care counseling were also relevant ([OR: 4.16, 95% CI: 1.30-13.31, p = 0.016], [OR: 3.91, 95% CI: 2.04-7.49, p < 0.001], respectively). Health-seeking behavior is one of the most important positive implications for the aged population, as it encompasses one's physical, mental, and psychological wellbeing. Future studies can aim at gaining an in-depth understanding of the same results, helping improve the health-seeking behavior of elderly people, and enhancing their quality of life.