Browsing by Author "Nkomani, Sanele"

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    Assessing the extent and effectiveness of diabetes self-management education in public health care institutions in Harare, Zimbabwe
    (Stellenbosch : Stellenbosch University, 2016-12) Nkomani, Sanele; Blaauw, Renee; Rusakaniko, Simba; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Introduction: Nutrition focused diabetes self-management education (DSME) provided by a dietitian or diabetes educator considerably improves glycaemic control, reduces the rate of complications, and reduces costs. Little is known about the effectiveness of DSME interventions, despite the rising prevalence of type 2 diabetes (T2DM) in Harare. This study therefore aimed to assess the extent to which existing DSME interventions improve nutrition focused knowledge, attitudes and practices (KAP). Secondly, health facility resoures to support effective DSME were assessed. Methods: A cross sectional survey design was used to determine nutrition focused diabetes KAP for 156 participants with T2DM attending eight public health facilities within the Harare metropole. The final sample size detected an effect size of 0.4 between two groups perceived to differ with regard to DSME received, i.e. central hospital outpatient clinic attendees and city health clinic attendess. Two (out of two) central hospital clinics in Harare were selected and six city health clinics (representing six of nine health districts in Harare) were selected using a multiple stage sampling strategy. Participants were divided equally between the two groups. Mean KAP scores from a reseacher designed questionnaire were compared between clinic groups, consultation with a dietitian and a diabetes educator. Nineteen health professionals involved in diabetes management at the sampled facilities also completed a self assessment on the primary care resources available to deliver quality DSME at their respective clinics. Results: The majority of participants (90.3%, n=139) reported recieving DSME, while fewer had consulted a dietitian (49.0%, n=76) or diabetes educator (52.0%, n=80). Dietitian (χ2=10.61,p=0.01) and diabetes educator (χ2=12.31,p=0.00) led interventions occurred more frequently at central hospitals. Participants showed better knowledge (p<0.01), and attitudes (p<0.00) for other self-care behaviours compared to nutrition knowledge (p<0.01). Significantly higher levels of knowledge were observed for central hospital clinic atendees (p=0.00), consultation with a dietitian (p<0.01) or diabetes educator (p=0.00). However, no differences were observed in attitudes for clinic group (p=0.10), consultation with a dietitian (p=0.30) or diabetes educator (p=0.19). Only those that had consulted a dietitian reported better adherence to dietary guidelines (p=0.00) and physical activity (p=0.02) self-care behaviours. Over half of the health professionals (57.9%, n=19) and (68.4%, n=19) scored resources for patient and organisational support respectively as inconsistent and limited. Health professionals from city health clinics rated their patient (p<0.01) and organisational (p<0.01) support capacity higher than health professionals from central hospital clinics. Conclusion: DSME intervention occurs more frequently at central hospitals, although no evidence of structured DSME programmes exists. Only dietitian led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in city health clinics were very little DSME occurs. Health professional perceived resources for DSME to be inadequate and inconsistent, revealing the need for improved training of health professonals involved in diabetes management.
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    The impact of existing diabetes self-management education interventions on knowledge, attitudes and practices in public health care institutions in Harare, Zimbabwe
    (MedPharm Publications, 2019-07-25) Nkomani, Sanele; Ruskaniko, Simbarashe; Blaauw, Renee
    Introduction: Diabetes self-management education (DSME) and medical nutrition therapy (MNT), provided by diabetes educators and registered dietitians respectively, considerably improve glycaemic control. However, it is unknown what interventions exist in many African countries and the impact thereof. Aim: To determine the impact of existing DSME interventions on knowledge, attitudes and practices (KAP) of adults with type 2 diabetes attending public health care facilities in Harare, Zimbabwe. Methods: A cross-sectional, researcher-administered survey was designed to assess DSME KAP at eight outpatient diabetes clinics that provide diabetes services. Participants were conveniently sampled. Associations between mean scores for knowledge, attitudes and practices were compared between characteristics of DSME interventions. Results: A total of 154 participants were recruited and divided evenly between two tertiary (n = 77) and six primary outpatient clinics (n = 77). The mean age was 61.8 years (SD ± 12.7), mean years since diagnosis with diabetes was 8.1 years (SD ± 8.3) and the majority were females (66.9%, n = 103). Most participants (90.3%, n = 139) reported receiving some DSME. Participants most frequently cited a tertiary clinic as the place where DSME was received. Fewer had consulted a dietitian (49.0%, n = 76) or diabetes educator (52.0%, n = 80). Higher levels of diabetes knowledge were observed for tertiary clinic attendees (p = 0.00), consultation with a dietitian (p < 0.01) and diabetes educator (p = 0.00). Only those who had consulted a dietitian reported better adherence to dietary guidelines (p = 0.00) and physical activity (p = 0.02) self-care behaviours. Conclusion: Dietitian-led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in primary clinics where limited interventions occur.