Quality of diabetic care at muhimbili national hospital diabetic clinic Dar es Salaam, Tanzania

Abstract

Background: Diabetes is a disease of increasing magnitude worldwide. It leads to acute and chronic complications, which are preventable if there is good diabetic care. Good diabetes care encompasses all good practice patterns, on how diabetic patients should be handled by clinicians and nurses, and good treatment strategies in order to treat and prevent diabetes related acute and chronic complications. Diabetic care can be assessed by several international indicators which have been put forward and improved.

Study objective: To assess the quality of diabetic care at Muhimbili diabetic clinic.

Vlll 60% of patients had received education on diet, insulin, oral hypoglycemic drugs, foot care and physical exercises. Blood pressure was measured in 68.9% and 31.6% of patients on the current and previous one visit respectively. Blood glucose levels were found high ( fasting blood glucose ~ 6.1 mrnolll and random blood glucose ~ 11.1 mmol/l in 67.6% of patients during their current visit and especially in those who were aged more than 40 years 47.8% , who were females (59.4%) , were married (59.4%) , and employed 47% . None of the patients with records of HbA 1 c measurements had reached the target levels of:s 6.5% and none of the 52 patients who had their HbAlc measured had reached the target level. Eighty percent of patients with records of cholesterol measurements had target levels < 5.2 mrnol/l. On the current visit, 61.7% had diastolic blood pressure less than 80mrnHg and 58% had systolic blood pressure less than 130 mrnHg, on the previous one visit 37.2% had systolic blood pressure less than 130mmHg and 47.9% had diastolic blood pressure less than 80mrnHg. Feet examination was never done in 69.5%ofpatients. Seven percent of patients had kidney disease, 2.9% had stroke, and 1.8% had diabetic foot. Conclusion and recommendations The quality of diabetic care at the Muhimbili Diabetic Clinic was quite satisfactory in terms of blood glucose measurements, diabetic education on diet and foot care. However the quality of diabetes care was not adequate enough in terms of proportion of patients with good or satisfactory blood glucose control, cholesterol and HbAlc measurements, and feet examination .Quality of care assessed using proportion of patients with records of cholesterol measurements and good cholesterol levels was very low. International and national diabetes guidelines need to be made more accessible to the attending medical personnel to remind about attained quality of diabetes care in their clinic and areas which they need to put more efforts to improve. More interventions for those above forty years of age and married are warranted to improve their glycemic control.