Quality of life among adult patients living with diabetes in Rwanda: a cross-sectional study in outpatient clinics

in BMJ Open (2021), 11

Objectives To report on the disease-related quality of life of patients living with diabetes mellitus in Rwanda and identify its predictors. Design Cross-sectional study, part of the baseline assessment ... [more ▼]

Objectives To report on the disease-related quality of life of patients living with diabetes mellitus in Rwanda and identify its predictors. Design Cross-sectional study, part of the baseline assessment of a cluster-randomised controlled trial. Setting Outpatient clinics for non-communicable diseases of nine hospitals across Rwanda. Participants Between January and August 2019, 206 patients were recruited as part of the clinical trial. Eligible participants were those aged 21–80 years and with a diagnosis of diabetes mellitus for at least 6 months. Illiterate patients, those with severe hearing or visual impairments, those with severe mental health conditions, terminally ill, and those pregnant or in the postpartum period were excluded Primary and secondary outcome measures Disease-specific quality of life was measured with the Kinyarwanda version of the Diabetes-39 (D-39) questionnaire. A glycated haemoglobin (HbA1c) test was performed on all patients. Sociodemographic and clinical data were collected, including medical history, disease-related complications and comorbidities. Results The worst affected dimensions of the D-39 were ‘anxiety and worry’ (mean=51.63, SD=25.51), ‘sexual functioning’ (mean=44.58, SD=37.02), and ‘energy and mobility’ (mean=42.71, SD=20.69). Duration of the disease and HbA1c values were not correlated with any of the D-39 dimensions. A moderating effect was identified between use of insulin and achieving a target HbA1c of 7% in the ‘diabetes control’ scale. The most frequent comorbidity was hypertension (49.0% of participants), which had a greater negative effect on the ‘diabetes control’ and ‘social burden’ scales in women. Higher education was a predictor of less impact on the ‘social burden’ and ‘energy and mobility’ scales. Conclusions Several variables were identified as predictors for the five dimensions of quality of life that were studied, providing opportunities for tailored preventive programmes. Further prospective studies are needed to determine causal relationships. [less ▲]

Combating non-communicable diseases: potentials and challenges for community health workers in a digital age, a narrative review of the literature

in Health Policy and Planning (2019)

The use of community health workers (CHWs) has been explored as a viable option to provide home health education, counselling and basic health care, notwithstanding their challenges in training and ... [more ▼]

The use of community health workers (CHWs) has been explored as a viable option to provide home health education, counselling and basic health care, notwithstanding their challenges in training and retention. In this manuscript, we review the evidence and discuss how the digitalization affects the CHWs programmes for tackling non-communicable diseases (NCDs) in low- and middle-income countries (LMICs). We conducted a review of literature covering two databases: PubMED and Embase. A total of 97 articles were abstracted for full text review of which 26 are included in the analysis. Existing theories were used to construct a conceptual framework for understanding how digitalization affects the prospects of CHW programmes for NCDs. The results are divided into two themes: (1) the benefits of digitalization and (2) the challenges to the prospects of digitalization. We also conducted supplemental search in non-peer reviewed literature to identify and map the digital platforms currently in use in CHW programmes. We identified three benefits and three challenges of digitalization. Firstly, it will help improve the access and quality of services, notwithstanding its higher establishment and maintenance costs. Secondly, it will add efficiency in training and personnel management. Thirdly, it will leverage the use of data generated across grass-roots platforms to further research and evaluation. The challenges posed are related to funding, health literacy of CHWs and systemic challenges related to motivating CHWs. Several dozens of digital platforms were mapped, including mobile-based networking devices (used for behavioural change communication), Web-applications (used for contact tracking, reminder system, adherence tracing, data collection and decision support), videoconference (used for decision support) and mobile applications (used for reminder system, supervision, patients’ management, hearing screening and tele-consultation). The digitalization efforts of CHW programmes are afflicted by many challenges, yet the rapid technological penetration and acceptability coupled with the gradual fall in costs constitute encouraging signals for the LMICs. Both CHWs interventions and digital technologies are not inexpensive, but they may provide better value for the money when applied at the right place and time. [less ▲]