Self-perceived health and metabolic control in Tanzanian diabetic patients

Objectives: To analyse self-perceived health and metabolic control over a two-year period in a group of urban adult diabetic patients in Dar es Salaam, Tanzania.Design: A longitudinal study with cross-sectional measurements of metabolic control and self-perceived health.Setting: The study was carried out at the diabetes out-patient clinic of Muhimbili Medical Centre and at three district hospitals in the Dar es Salaam area in Tanzania.Subjects: In 1995, one hundred and fifty consecutive diabetic patients (M/F:78/72) were seen. A re-organisation of the diabetes care was done in 1996. Due to difficulties in tracing the patients after the re-organisation, 50.4% of them were re-assessed in 1997.Main outcome measures: The Swahili version of SF-36 health questionnaire was used to assess health. HbA1c and fasting blood-glucose were used to evaluate metabolic control.Results: In patients assessed both in 1995 and 1997 significant improvements were found in the socialand emotional functioning health domains. The mean HbA1c valuewas significantly improved after the two years (9.3±3.2% in 1995 versus 7.5±2.8%). Significant negativecorrelations were found between metabolic control and the health domains bodily pain, general health and vitality.Conclusions: The study has highlighted the difficulties in performing follow up studies and it is most important to put lot of effort in informing patients prior to re-organisation of the care. Furthermore, our findings have shown that Tanzanian diabetic patients had improved their self-perceived health in social and emotional functioning and they had an improved metabolic control over the two-year period indicating an improved diabetes care

Family perceptions in caring for children and adolescents with mental disabilities: a qualitative study from Tanzania

Observations have shown that the provision of services to children and adolescents with mental disability (CAMDs) is not responding to the needs of this population. This community based study was carried out in Temeke Municipality in Tanzania and aimed to explore factors that influence family perspectives in the provision of care to CAMDs. This is a qualitative study of 52 respondents from 29 families involved in the daily care of CAMDs, chosen through convenient sampling. A semi-structured questionnaire was used in the interviews. The text was analysed using thematic content analysis. The results of the study revealed family characteristics; deficient knowledge about mental disability (MD); and lack of health care facilities and resources for caring for CAMDs. The community and families of CAMDs had poor knowledge on MD and appropriate care, and about availability of resources and quality care. Families were not supported in the care of their children. Some children in consequence did not receive adequate health care. Some suffered from physical problems due to inadequate care; others were being locked in their room during periods when no-one was able to look after them. These factors were related to socio-economic characteristics of the families as well as to lacking service facilities. "Patient"-oriented, community/family-based health services to support management of chronic or life-long conditions such as MD are needed. The support of caregivers to children with MDs has to be improved. A well worked-out strategy would improve health care of CAMDs through provision of guidance and supervision to the families. Community and family/home-based care in the study area would benefit families of CAMDs

Family perceptions in caring for children and adolescents with mental disabilities: a qualitative study from Tanzania

Observations have shown that the provision of services to children and adolescents with mental disability (CAMDs) is not responding to the needs of this population. This community based study was carried out in Temeke Municipality in Tanzania and aimed to explore factors that influence family perspectives in the provision of care to CAMDs. This is a qualitative study of 52 respondents from 29 families involved in the daily care of CAMDs, chosen through convenient sampling. A semi-structured questionnaire was used in the interviews. The text was analysed using thematic content analysis. The results of the study revealed family characteristics; deficient knowledge about mental disability (MD); and lack of health care facilities and resources for caring for CAMDs. The community and families of CAMDs had poor knowledge on MD and appropriate care, and about availability of resources and quality care. Families were not supported in the care of their children. Some children in consequence did not receive adequate health care. Some suffered from physical problems due to inadequate care; others were being locked in their room during periods when no-one was able to look after them. These factors were related to socio-economic characteristics of the families as well as to lacking service facilities. "Patient"-oriented, community/family-based health services to support management of chronic or life-long conditions such as MD are needed. The support of caregivers to children with MDs has to be improved. A well worked-out strategy would improve health care of CAMDs through provision of guidance and supervision to the families. Community and family/home-based care in the study area would benefit families of CAMDs

Family perceptions in caring for children and adolescents with mental disabilities: a qualitative study from Tanzania

Observations have shown that the provision of services to children and adolescents with mental disability (CAMDs) is not responding to the needs of this population. This community based study was carried out in Temeke Municipality in Tanzania and aimed to explore factors that influence family perspectives in the provision of care to CAMDs. This is a qualitative study of 52 respondents from 29 families involved in the daily care of CAMDs, chosen through convenient sampling. A semi-structured questionnaire was used in the interviews. The text was analysed using thematic content analysis. The results of the study revealed family characteristics; deficient knowledge about mental disability (MD); and lack of health care facilities and resources for caring for CAMDs. The community and families of CAMDs had poor knowledge on MD and appropriate care, and about availability of resources and quality care. Families were not supported in the care of their children. Some children in consequence did not receive adequate health care. Some suffered from physical problems due to inadequate care; others were being locked in their room during periods when no-one was able to look after them. These factors were related to socio-economic characteristics of the families as well as to lacking service facilities. "Patient"-oriented, community/family-based health services to support management of chronic or life-long conditions such as MD are needed. The support of caregivers to children with MDs has to be improved. A well worked-out strategy would improve health care of CAMDs through provision of guidance and supervision to the families. Community and family/home-based care in the study area would benefit families of CAMDs

Implementing empowerment group education in diabetes

The overall aim was to gain insight into and understand how physicians and nurses view the implementation of empowerment group education (EGE) in diabetes. Prior to the study the physicians and nurses attended a 2-day empowerment workshop. Further, they had implemented the empowerment approach in two groups of patients with type II diabetes. Three to 9 months later they (five physicians and 11 nurses from six family practices) participated in focus group interviews to evaluate the implementation of the EGE. The interviews were audio-taped, transcribed and analysed using the constant comparative method. The main result showed a conflict in roles. The physicians and nurses knew their role in the traditional approach but not with respect to the empowerment approach, which they needed to grow into. At the same time as they started a new way of working, their role had changed from being an expert to being a facilitator. As experts they felt secure, as facilitators they needed support in their educational process. To implement EGE they required support both from the family practice and from a supervisor in direct connection with the EGE. © 2004 Elsevier Ireland Ltd. All rights reserved.</p