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Abstract
Purpose
The purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda.
Research design and methods
A facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs) at the 95% confidence interval (CI) were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0.
Results
The overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78), being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71), being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14) and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27), taking three or less tests of blood glucose per day (APRR: 0.63; 95% CI: 0.42, 0.95), and having a caretaker with poor knowledge about diabetes (APRR: 0.49; 95% CI: 0.43, 0.57) and who is inactive in supervision of insulin injections (APRR: 0.58; 95% CI: 0.56, 0.60) were associated with adherence to type 1 diabetes care recommendations.
Conclusion
Adherence to type 1 diabetes care recommendations is still low among this population. The results suggest that reinforcing caretaker involvement could be vital in improving adherence to diabetes care recommendations in this population.
Acknowledgments
We thank the staff at Mulago Hospital and St Francis Nsambya Hospital diabetes clinics for the support during the study. The participants who took part in the study are also appreciated.
Author contributions
CK helped to conceptualize the design of the project, supervised the data collection, and helped to prepare and revise the final manuscript. NM assisted in conceptualizing the design of the study, carried out the data analysis, interpreted the data, prepared the first draft of the manuscript, and revised the final document. Both authors are responsible for the accuracy and integrity of the presented findings in this study.
Disclosure
The authors report no conflicts of interest in this work.