Health seeking and health related behaviour for type 2 diabetes mellitus among adults in an urban community in Tanzania

Early in the 20th century, diabetes mellitus was considered to be a rare medical condition in African countries, and mostly in sub-Saharan Africa. Over the past 30 or 40 years however, the situation has changed. Diabetes is now regarded as a major public health problem throughout Africa particularly among urban communities. The disease is little understood in the general population and is often poorly detected. Previous research, for example, shows about 50 percent of people with type 2 diabetes mellitus in Tanzania are unaware of their condition and more than 80 percent diabetes cases are undiagnosed. This thesis aims to explore factors influencing health-seeking and health related behaviour among adult patients with type 2 diabetes mellitus in an urban community in Tanzania. It seeks to answer the following key question: What are the key factors influencing health seeking and health related behaviour and care management for type 2 diabetes mellitus? Data collection was carried out from March to June 2007 in two diabetes clinics in Dar es Salaam, the commercial capital city of Tanzania. The main study population consisted of patients aged 35 years and above who had been diagnosed with the disease more than one year before the time of the current study. In-depth interviews were carried out with 20 frequent and 10 infrequent clinic attendees, their 14 caregivers, and seven health care workers; while key informant interviews were carried out with six key national health officials. Furthermore, eight focus group discussions were carried out with people with diabetes and selected community members. Multiple influences on health-seeking behaviour were identified, many of which affected clinic attendance, adherence to treatment programmes, and outcomes. These influences included poor accessibility to diabetes drugs and other services at the clinics, lack of financial resources for transport to the clinic and purchasing of drugs, overcrowded and inadequate public transport, lay beliefs and models of disease causation and treatment which accentuate the role of traditional healers, and poor organisation of the clinics leading to long queues and waiting times. The findings suggest that improving the delivery of care to people with diabetes will require action to address a range of structural, financial, cultural, and administrative issues. These might include improving the distribution and accessibility of essential diabetes drugs, as well as the accessibility and affordability of health care services, patient and public education, involvement of traditional healers, better provision of public transport and more patient-centred organisation of care in public health clinics. The findings have significant policy implications. First, the government needs to decentralise the current diabetes services from regional and district facilities to primary health care centres and existing dispensaries, along with procuring adequate drugs, equipment and health care providers to enhance access to services. Second, the government should develop mechanisms for working with traditional health practitioners as a strategy to enhance early referral of people with diabetes by these practitioners to biomedical care facilities to improve the rates of early diagnosis and management of this disease. Finally, the government needs to acknowledge the growing threat of NCDs such as diabetes and develop national prevention and control strategies including general public education about the disease