Socio-economic status and diabetes control in patients presenting to Princess Marina hospital (PMH), Gaborone, Botswana

Baruti, Violet (2015-12)

Thesis (MMED) -- Stellenbosch University, 2015

Thesis

Background Literature supports a relationship between low income status and poor diabetes control. However this relationship has not been assessed in Botswana. Aim To determine the relationship between socio-economic status and diabetes control in patients presenting to PMH. Objectives To measure the degree of glycaemic control; to determine the relationship between glycaemic control and monthly income as well as between glycaemic control and lifestyle modification factors;to describe the relationship between glycaemic control and core social welfare indicators. Methods A cross-sectional study, conducted over a 3 months in Gaborone, The questionnaire assessed self-care activities, monthly household earnings and core social welfare indicators among diabetes patients attending PMH. A total of 240 patients were randomly selected to complete the questionnaire. Routine HbA1c values were studied alongside questionnaire responses. Results A total of 58 (24%) participants with HbA1c between 4.0%-7.0% were well controlled, 96 (40%) of participants were poorly controlled (7.1%-9.0%) and 86 (36%) in the very poorly controlled category with HbA1c >9.0%. Of the well-controlled category, 59% lived on a monthly income between P0- P5000(the lowest income bracket). Only 3% participants in this category earned above P20000 monthly (the highest income bracket). Of the 40% poorly controlled participants, 69% fell in the lowest income bracket. No participants in this poorly controlled category earned above P20000 monthly. There were 40% participants in the very poorly controlled category. Of these, 63% earned between P0 - P5000. Only 2 participants with HbA1c values of 9.1 earned above P20000. Conclusion In this study high HbA1c percentages were associated with low monthly income levels and low scores in lifestyle modification factors. Participants with poor access to core welfare indicators also had poor glycaemic control. This study suggests that poor socio-economic status is directly related to poor glycaemic control in patients attending PMH diabetes clinic.

ENGLISH ABSTRACT Background Literature supports a relationship between low income status and poor diabetes control. However this relationship has not been assessed in Botswana. Aim To determine the relationship between socio-economic status and diabetes control in patients presenting to PMH. Objectives To measure the degree of glycaemic control; to determine the relationship between glycaemic control and monthly income as well as between glycaemic control and lifestyle modification factors;to describe the relationship between glycaemic control and core social welfare indicators. Methods A cross-sectional study, conducted over a 3 months in Gaborone, The questionnaire assessed self-care activities, monthly household earnings and core social welfare indicators among diabetes patients attending PMH. A total of 240 patients were randomly selected to complete the questionnaire. Routine HbA1c values were studied alongside questionnaire responses. Results A total of 58 (24%) participants with HbA1c between 4.0%-7.0% were well controlled, 96 (40%) of participants were poorly controlled (7.1%-9.0%) and 86 (36%) in the very poorly controlled category with HbA1c >9.0%. Of the well-controlled category, 59% lived on a monthly income between P0- P5000(the lowest income bracket). Only 3% participants in this category earned above P20000 monthly (the highest income bracket). Of the 40% poorly controlled participants, 69% fell in the lowest income bracket. No participants in this poorly controlled category earned above P20000 monthly. There were 40% participants in 4 the very poorly controlled category. Of these, 63% earned between P0 - P5000. Only 2 participants with HbA1c values of 9.1 earned above P20000. Conclusion In this study high HbA1c percentages were associated with low monthly income levels and low scores in lifestyle modification factors. Participants with poor access to core welfare indicators also had poor glycaemic control. This study suggests that poor socio-economic status is directly related to poor glycaemic control in patients attending PMH diabetes clinic.

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