Non-Adherence To Treatment Among Diabetic Patients Attending Outpatients Clinic At Mutare Provincial Hospital, Manicaland Province, Zimbabwe.

Introduction: World-wide, diabetes mellitus is increasing affecting millions of people and its related complications continue to be of great concern. Hence, the issue of non- adherence to treatment recommendations is featuring as the major problem to achieve optimal control and management of the disease. Non-adherence to diabetes treatment recommendations is usually associated with increases in HbA1c levels, hospitalization rates, disability and overall premature deaths. Background: Mutare Provincial Hospital is a referral and a teaching hospital in Manicaland Province of Zimbabwe. Study Purpose: This study was done to determine the factors associated with non-adherence to treatment recommendations among diabetic patients attending diabetic clinic Mutare Provincial Hospital, Zimbabwe from February-April 2012.Research Design: An unmatched 1:1 Case-Control study was conducted in order to collect data from 104 Cases and 104 Controls. A total of 208 participants and aged between 19 and 98 were recruited to participate in this study. The majority of the participants were females (58 males and 150 Females). Semi- structured questionnaire was employed to collect data from the study participants where face-to face interviews were administered to sixteen key informants. The majority of the participants, 78.3% (n=163) patients were on oral anti-diabetic regimens and 11.5 (n=24) were on insulin alone and10 (n=21) were on both insulin and oral antigens. Findings: The results from this study indicated that the prevalence of non-adherence to medication was 38.9%, diet43.3% and exercise 26%. Factors which were found to be significantly associated with non-adherence to treatment after multivariate analysis were: financial constraints (OR 7.4; 95% CI 3.20-16-93; p<0.001), travelling away from (OR 2.8;95% CI 1.70-24.71; p<0.001), when very ill (OR6.6; 95% CI 1.45-30.50; p=0.014), eating out (OR 4.4; 95% CI 1.81- 11.13; p=0.001, longer duration of diabetes treatment ( more than 10 years OR 3.1 CI 1.70-5.71; p< 0.001), lack of detailed information on how to exercise( OR 2.3; distance from health facility (OR 2.5; 95% CI 1.15-5.50; p =0.02) and affordability of drugs (OR 3.7;95% C.I 1.81-7.59; p=0.014). However, receiving support from family (financial, material, emotional or moral OR 0.41; 95% CI 0.20-0.8; p= 0.013), being a member of the Diabetic Association (OR 0.27; 95% CI0.15-0.53; p=0.001) and having attended more than two health education sessions in the past six months (OR 0.40; 95% CI0.17-0.93; p=0.003) appeared to be protective factors against non-adherence to treatment recommendations. Conclusion: Non-adherence to treatment recommendations among diabetic patients is a result of interplay of many, varied and multifaceted factors. Therefore, strategies to improve adherence among patients attending Mutare provincial hospital in Manicaland province requires the collaboration among important stakeholders such health care workers, the patients, care givers and the government. In addition, interventions are needed in order to enhance patient education, improve patients' self treatment behaviours and facilitate the identification and self- management skills on medication administration, dietary and exercise management. There is also need to widen the network of health care facilities through decentralizing the stocking and dispensing of diabetes drugs to peripheral sites.