The Quality of Care of Diabetic Patients in Rural Malawi: A Case of Mangochi District

Abstract

Background: Diabetes mellitus is a global public health problem. In Malawi, the prevalence of diabetes is 5.6% but the quality of care has not been well studied. 

Objective: The aim of this study was to assess the quality of care offered to diabetic patients in Mangochi district. 

Methods: This was a cross-sectional descriptive study. Quantitative data were collected using a questionnaire from a sample of 75 diabetic patients (children and adults) who attended the Diabetes Clinic at Mangochi District Hospital between 2012 and 2013. Qualitative data were also collected using semi-structured interviews with eight key informants from among the District Health Management Team. Frequencies and cross-tabulation were obtained from the quantitative data. Patients’ master cards were checked to validate results. Clinical knowledge about diabetes, care practices and resources were the themes analysed from the qualitative data. 

Results: Among the 75 participants interviewed, 46 were females and 29 males. The overall mean age was 48.3 years (45.6 for females and 53.3 for males). More than half of patients had little or no information about diabetes - 40% (n=30) and 22.7 (n=17), respectively. The majority of patients were taking their medicines regularly, 98.7% (n=74). Only 17.3% (n=13) reported having their feet inspected regularly. Fifty-six percent of patients were satisfied about services provision. Some nurses and clinicians were trained on diabetes care but most of them already left the hospital. Guidelines on diabetes management were not accessible. There were shortages in medicines (e.g. soluble insulin) and reagents. Information Education and Communication messages were offered through discussions, experiences sharing and posters. 

Conclusion: Quality of diabetes care provided to diabetic patients attending Mangochi hospital in rural Malawi was sub-optimal due to lack of knowledge among patients and clinicians and resources. More efforts are needed towards retention of trained staff, provision of pharmaceutical and laboratory resources and health education.