Systematic review: a review of adolescent behavior change interventions [BCI] and their effectiveness in HIV and AIDS prevention in sub-Saharan Africa.

BACKGROUND: Despite sub-Saharan Africa [SSA] constituting just 12% of the world's population, the region has the highest burden of HIV with 70% of HIV infection in general and 80% of new infections among young people occuring in the region. Diverse intervention programmes have been implemented among young people but with minimal translation to behavior change. A systematic review of Behavior Change Interventions [BCI] targeting adolescents in SSA was therefore conducted with the objective of delineating this intervention vis-a-vis efficacy gap. METHODS: From April to July 2015 searches were made from different journals online. Databases searched included MEDLINE, EBSCOhost, PsychINFO, Cochrane, and Google Scholar; Cambridge and Oxford journal websites, UNAIDS and WHO for studies published between 2000 and 2015. After excluding other studies by review of titles and then abstracts, the studies were reduced to 17. Three of these were randomized trials and five quasi-experimental. Overall interventions included those prescribing life skills, peer education [n = 6] and community collaborative programmes. The main study protocol was approved by the University of Malawi College of Medicine Ethics Committee on 30th June 2016 [ref #: P.01/16/1847. The review was registered with PROSPERO [NIH] in 2015. RESULTS: The review yielded some 200 titles and abstracts, 20 full text articles were critically analysed and 17 articles reviewed reflecting a dearth in published studies in the area of psychosocial BCI interventions targeting adolescents in SSA. Results show that a number of reviewed interventions [n = 8] registered positive outcomes in both knowledge and sexual practices. CONCLUSIONS: The review demonstrates a paucity of psychosocial BCI studies targeting adolescents in SSA. There are however mixed findings about the effectiveness of psychosocial BCI targeting adolescents in SSA. Other studies portray intervention effectiveness and others limited efficacy. Peer education as an intervention stands out as being more effective than other psychosocial regimens, like life skills, in facilitating HIV risk reduction. There is therefore need for further research on interventions employing peer education to substantiate their potential efficacy in HIV risk reduction among adolescents. PROSPERO REGISTRATION NUMBER: CRD42015019244, available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015019244 .

Exposure to occupational health hazards among Zambian workers.

BACKGROUND: Data on occupational safety and health in Southern Africa are scant. Hence the negative impact of poor working conditions is unknown and the scientific basis for interventions and policy formulation is lacking. AIMS: To determine the prevalence of, and factors associated with, exposure to occupational health hazards in Zambia. METHODS: We used data collected in the 2009 National Labour Force Survey. Unadjusted and adjusted odds ratios and their 95% confidence intervals were used to measure magnitudes of associations. RESULTS: Exposure to occupational hazards among the 64 119 respondents (response rate = 78%) included vibration from hand tools or machinery (3%), temperatures that make one perspire even when not working (4%), low temperatures whether indoors or outdoors (4%), smoke, fume, powder or dust inhalation (13%), pesticides (3%), noise so loud that voice had to be raised to talk to people (4%), chemical handling or skin contact (3%) and exposure to heavy object lifting, frequent bending of the back or rapid movement of limbs causing body pain (30%). In multivariate analysis, exposure to occupational health hazards was associated with older age, male sex, low educational level, being married/cohabiting and not being self-employed. CONCLUSIONS: Results from this study indicate that Zambian workers are exposed to a broad range of occupational health hazards. This could be useful for the formulation of a multi-sector approach aimed at the prevention and control of hazard exposure.

District specific correlates for hypertension in Kaoma and Kasama rural districts of Zambia.

INTRODUCTION: Hypertension a major risk factor for cardiovascular disease and is the most widely recognized modifiable risk factor for this disease. There is little information on the prevalence and risk factors for hypertension in Zambia, and in particular in rural areas of the country. In order to contribute to the existing global literature on hypertension, particularly in rural Zambia, this study was conducted to determine the prevalence of hypertension and its correlates in two rural districts of Zambia, namely Kaoma and Kasama. METHODS: A cross-sectional study using a modified World Health Organization (WHO) global non communicable diseases (NCD) surveillance initiative NCD-STEPwise approach was used. Proportions were compared using the Yates' corrected χ2 test, and a result yielding a p-value of less than 5% was considered significant. Bivariate and multivariate logistic regression analyses were conducted. Factors that were significantly associated with the outcome in bivariate analyses were considered in a multivariate logistic regression analysis using a backward variable selection method. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were reported. RESULTS: In total, 895 participants from Kaoma and 1198 participants from Kasama took part in the surveys. Overall, 25.8% participants (27.5% male, 24.6% female; p=0.373) in Kaoma and 30.3% (31.3% male, 29.5% female; p=0.531) in Kasama were hypertensive. In Kaoma, age and BMI were independently associated with hypertension. Compared with participants aged 45 years or older, participants aged 25-34 years were 60% (AOR=0.40, 95% CI [0.21, 0.56]) less likely to be hypertensive. Participants with BMI <18.5 and 18.5-24.9 were 54% (AOR=0.46, 95% CI [0.30, 0.69]) and 31% (AOR=0.69, 95% CI [0.49, 0.98]) less likely to be hypertensive compared with participants with BMI ≥30. In Kasama, age, smoking and heart rate were significantly associated with hypertension in multivariate analysis. Participants 25-34 years were 49% (AOR=0.51, 95% CI [0.41, 0.65]) less likely to be hypertensive compared with participants 45 years or older. Compared with participants who were non-smokers, smokers were 21% (AOR=1.21, 95% CI [1.02, 1.45]) more likely to be hypertensive. Participants who had heart rate >90 beats/min were 59% (AOR=1.59, 95% CI [1.17, 2.16]) more likely to be hypertensive compared with participants who had heart rate 60-90 beats/min. CONCLUSIONS: The findings reveal that hypertension is prevalent among rural residents in Kaoma and Kasama, Zambia. The disease is highly associated with age, BMI, smoking and heart rate. Efficient preventive strategies are needed to halt the growing trend of non-communicable diseases through the control of risk factors highlighted in this study.

Prevalence and correlates of current cigarette smoking among adolescents in East Timor-Leste.

OBJECTIVES: To determine the prevalence and correlates for current cigarette smoking. DESIGN: Secondary analysis of the East Timor-Leste Global Youth Tobacco Survey conducted in 2006. SETTING: Public and private schools registered with the Ministry of Education. PARTICIPANTS: A two-stage cluster sample of 1790 students in Grades 7 to 9. Schools were selected with probability proportional to enrolment size, and classes were randomly selected in each school. All students in selected classes were eligible to participate in the survey. The school and student response rates were 96.0% and 84.5%, respectively. MAIN OUTCOME MEASURE: Prevalence of current cigarette smoking. RESULTS: Out of 1790 adolescents, 52.1% were of ages less than 15 years, 51.8% were males, 42.8% reported having some pocket money in a month, and 72.7% had at least a parent who was a smoker. Prevalence of current cigarette smoking was 40.3%. Current smokers also reported having bought cigarettes from peddlers (32.4%), someone bought for them (16.7%), got from someone older (13.7%), borrowed (13.3%), and stole (3.4%). Males were more likely to be smokers than females (59.0% versus 19.3%). Factors positively associated with current smoking were: parental smoking; closest friend smoking; amount of pocket money; and exposure to anti-tobacco messages. CONCLUSIONS: East Timor has one of the highest prevalence of cigarette smoking among adolescents. The fact that exposure to anti-tobacco messages was associated with being a smoker may be evidence suggesting that anti-tobacco messages, especially from tobacco-related industry, may have unintended consequences.

Effects of adolescent exposure to behaviour change interventions on their HIV risk reduction in Northern Malawi: a situation analysis.

Understanding adolescents' translation of HIV and AIDS-related behaviour change interventions (BCI) knowledge and skills into expected behavioural outcomes helps us appreciate behaviour change dynamics among young people and informs evidence-based programming. We explored the effects of adolescents' exposure to BCI on their HIV risk reduction in selected schools in Nkhatabay and Mzimba districts and Mzuzu city in Northern Malawi. The study used questionnaires as instruments. Data were collected between January and April 2017. Adolescent boys and girls [n = 552], ages 11-19 were randomly sampled to participate. Data analysis was through multiple regression and content analysis. Respondents included 324 female [58.7%] and 228 male [41.3%]. Multiple regression analysis indicated that exposure to BCI did not affect risk reduction in the study area. The best stepwise model isolated sexual experience ([Beta = .727, p = .0001, p < .05]) as having the strongest correlation with the dependent variable - risk reduction. BCI exposure was stepwise excluded ([Beta = -.082, p = .053, p > .05]). There was therefore no evidence against the null hypothesis of no relationship between adolescent exposure to BCI and their HIV risk reduction. Overall there was limited BCI knowledge and skills translation to behavioural risk reduction. The study points to the need to evaluate and redesign adolescent BCI in line with current behavioural dynamics among young people in Malawi. The findings have been used to inform the design and programming of a model to be tested for feasibility through a quasi-experiment in the second phase of our project.

HIV prevalence among prison inmates in a central prison in southern Malawi, 2005.

A cross-sectional study of 164 prison inmates (142 men [86.6%] and 22 women [13.4%]) in Malawi estimated a HIV prevalence rate of 36.6%; 29.9% among men and 50% among women. Three (2.1%) men reported having sex with men, and none reported intravenous drug use.

Potential benefits and harm of biotechnology in developing countries: the ethics and social dimensions.

The world has experienced phenomenal growth in science and knowledge since the second-world war. Infectious disease conditions that were almost always fatal in the early 1900s are now being effectively treated with antibiotics and other modalities emanating from science and prevented through the general improvements in vaccination, nutrition, sanitation and availability of safe water to many more people. Biotechnology as one aspect of this growth in knowledge and practice has particular potential to enable the development and increased accessibility of rapid and efficient diagnostic, preventive and health promotion tools, restoration of water quality, soil and other natural resources. This has the potential to make our environment much safer and also agriculturally more productive. Development of new biotechnology, especially in medicine, is essentially the domain of developed nations, and in Africa, a few countries like South Africa, Kenya and Egypt are leading the way. In this paper, we discuss the risks and benefits of biotechnology especially regarding human health in developing countries. We have drawn significantly from the ethical tenets of beneficence, autonomy of individuals, fairness or justice and informed consent.

Predictors of cigarette smoking among adolescents in rural Zambia: results from a cross sectional study from Chongwe [corrected] district.

INTRODUCTION: Cigarette smoking is a leading cause of morbidity and mortality globally. There are limited data on the prevalence of and factors associated with smoking among in-school adolescents in developing countries. OBJECTIVES: To estimate prevalence of those who have smoked cigarettes and to identify associated socio-demographic factors among adolescents in Chongwe district, Chongwe [corrected] Province, Zambia. METHODS: Data used was from the Zambia Global Youth Tobacco Survey, which was conducted using standardized methodology among in-school adolescents in 2002. Data were analyzed to assess if selected socio-demographic variables were associated with having smoked cigarettes. Bivariate and multivariate logistic regression analysis was used to assess the associations. RESULTS: A history of having smoked cigarettes ranged from 20.5% among 15 year olds to 37.2% among males younger than 12 years old. In females, 20.7% of 13 year olds and 37.7% of those less than 12 years old had smoked. Parental smoking, friends smoking, a lack of perception that smoking was harmful, and exposure to pro-tobacco advertisements were associated with having smoked cigarettes. Adolescents who had smoked cigarettes were more likely to allow others smoke in their presence. CONCLUSIONS: Many adolescents in rural Chongwe[corrected], Zambia had tried cigarette smoking. The identification of predictors for smoking should guide the design and implementation of programs aimed to prevent initiation and maintenance of tobacco use among adolescents.

Prevalence and determinants of cigarette smoking among adolescents in Blantyre City, Malawi.

Tobacco smoking is a major risk factor for non-communicable diseases such as ischaemic heart disease, stroke, chronic obstructive airways disease and several cancers. There is little data about the prevalence and determinants of smoking among adolescents in southern Africa. This study aimed to determine the prevalence and determinants of cigarette smoking among adolescents in Blantyre City, Malawi. Cross-sectional data were obtained from school-going adolescents in Blantyre in 2001 using the Global Youth Tobacco Survey data collection instrument. Data were analysed to determine prevalence of current and ever cigarette smoking, and predictors of smoking. The prevalence of current smoking and ever smoking were 3.0% and 15.6%, respectively. Predictors of current tobacco smoking included male gender, having friends or parents who smoked, having been exposed to advertisements about tobacco brands on television and having seen a lot of advertisements in newspapers and magazines. School programmes that included being taught about smoking in class and a class discussion on the dangers of tobacco were not associated with reduced current smoking. Intervention programmes aiming to curb tobacco smoking among adolescents should focus on dealing also with parental smoking, peer influence and pay special attention toward male gender. School-based programmes to prevent smoking should be evaluated as some may have little impact in influencing current smoking status.

Lost investment returns from the migration of medical doctors from Malawi.

Migration of medical doctors from African countries to developed nations compromises the delivery of health care on the continent. The full cost of producing a medical doctor was estimated in Malawi by adding the costs of education from primary school through undergraduate medical education. The cost in fees for one medical doctor produced was US$ 56,946.79. The amount of lost investment returns for a doctor who migrated out and served for 30 years in the receiving country ranged from about US$ 433,493 to US$46 million at interest rates 7% and 25%, respectively. Quantitative assessments of the estimated loss in investment allows for informed policy discussions and decisions.

The vulnerability of orphans in Thyolo District, southern Malawi.

It is estimated that Malawi has about 900,000 orphans, the majority of whom are orphaned as a result of AIDS. Orphans in rural areas are mostly neglected by economic and social empowerment initiatives. This study was conducted to explore the living situation of orphans in rural Thyolo District, southern Malawi. Qualitative methodology was used in data collection and analysis to explore orphan children's living situation and specifically with regard to access to health care, education, food and basic needs. In addition, issues of love and companionship, discrimination and the future. Twenty-three orphan children and four adults were interviewed. The children reported experience with lack of food, school drop out and truancy, lack of social support to obtain present needs and prepare for the future. Public health programs aimed to prevent and mitigate the effects of AIDS in Malawi should be tailored to provide support to orphan children.

Prevalence of sexual intercourse among school-going adolescents in Coast Province, Kenya.

A study was carried out to estimate the prevalence and associated factors of sexual intercourse among school adolescents in Coast Province, Kenya. Data were obtained through the Kenya Global School-Based Health Survey. Overall the prevalence of sexual intercourse within the last 12 months was 14.9% (22.2% in males and 5.0% in females). Among males, the protective factors against having sex were being of age < 15 years (OR = 0.60, 95% CI 0.58, 0.62) and ever been drunk (OR = 0.63, 95% CI 0.59, 0.67). The risk factors for having sex among males were ever smoked (OR = 2.05, 95% CI 1.92, 2.19), having close friends (OR = 1.68, 95% CI 1.56, 1.81), currently drinking alcohol (OR = 1.13, 95% CI 1.06, 1.20), ever used drugs (OR = 2.36, 95% CI 2.24, 2.49) and parental supervision (OR = 1.30, 95% CI 1.25, 1.34). Meanwhile among female respondents, parental supervision was protective (OR = 0.88, 95% CI 0.81, 0.94) and the only risk factor was ever used drugs (OR = 2.85, 95% CI 2.57, 3.15). It is suggested that public health interventions aimed to promote adolescent sexual health should be designed with the appreciation of the factors associated with sexual activity in due consideration.

Suicidal ideation and associated factors among in-school adolescents in Zambia.

A cross sectional study was conducted to estimate the prevalence and correlates of suicidal ideation among in-school adolescents in Zambia. Backward logistic regression analysis was conducted to assess the association between relevant predictor variables and suicidal ideation within the last 12 months. A total of 1970 in-school adolescents who participated in the Zambia Global School-Based Health Survey in 2004 responded to the question on suicidal ideation. Overall, 54.0% were males, 40.8% were current drinkers, and 35.9% ever smoked marijuana (cannabis). Altogether 31.3% reported suicidal ideation in the past 12 months (males = 31.1%; females = 31.4%). Being male (OR = 1.05; 95%CI 1.03, 1.05): being <14 years old (OR = 1.21; 95%CI 1.19, 1.23), having been drunk (OR = 1.28; 95%CI 1.27, 1.29). worried (OR= 1.05; 95%CI 1.04, 1.06), sad or hopeless in the past 12 months (OR = 1.02; 95%CI 1.01, 1.03) and ever used marijuana (OR = 1.18; 95%CI 1.17, 1.19) were positively associated with suicidal ideation. Loneliness appeared to be protective (OR = 0.92; 95%CI 0.91, 0.92). All the results, except for ever smoked marijuana and ever been drunk, may have been biased due to non-response to the question on suicidal ideation. A series of cross sectional studies should be conducted to monitor changes in behavioural factors among others ever smoked marijuana and ever been drunk in order to broaden our understanding of factors that may be causing adolescents to seriously consider committing suicide.

Sex differences in prevalence rates and predictors of cigarette smoking among in-school adolescents in Kilimanjaro, Tanzania.

An analysis of the Global Youth Tobacco Survey for Kilimanjaro, Tanzania was carried out to assess sex differences in the prevalence rates and predictors of current cigarette smoking among in-school adolescents. A total of 2323 adolescents participated in the study of whom 53% were females and 47% males. The prevalence of current cigarette smoking was 3.0% and 1.4% among males and females, respectively. The common factors that were significantly positively associated with cigarette smoking between sexes were: having more pocket money, closest friend smoked cigarettes, seeing actors smoke on TV, videos or movies, and seeing advertisements for cigarettes at social gatherings. Seeing anti-smoking messages at social gatherings were negatively associated with smoking among both sexes. While having had something such as a t-shirt or pen with a cigarette brand logo on it was positively associated with cigarette smoking among males, it was negatively associated with cigarette smoking among females. Male adolescents older than 15 years, those in their 9th year of schooling, and those who had seen cigarette brand names on TV were more likely to smoke. Meanwhile, male respondents who were in their 8th year of schooling, had seen anti-smoking media messages, and advertisements for cigarettes in newspapers or magazines were less likely to smoke. Among female adolescents, those who had parents who smoked, and surprisingly those who perceived that cigarette smoking as harmful were more likely to smoke. Interestingly, seeing advertisement for cigarettes on billboards was negatively associated with smoking among female adolescents. Interventions aimed to reduce adolescent smoking need to be designed and implemented with due consideration of sex differences in these associated factors.

Knowledge, attitudes and public health response towards plague in Petauke, Zambia.

In 2001, two plague outbreaks were reported in Zambia, one of which occurred in Petauke, Eastern Province, resulting in high morbidity and mortality. Of the community respondents, 43.4% did not know the aetiology of plague. Although rats and fleas were frequently mentioned, many respondents did not know how these were related to plague. Local belief that the plague outbreak was the result of witchcraft was prevalent. Use of rodenticides was not preferred as these were reports of they being used for poisoning people. The public health response was initially slow by both the community and also the formal health sector. Once the diagnosis of plague was made, fears of witchcraft dispelled and collaboration not only between the formal health sector and the community, but also between Zambian health workers and their Mozambican counterparts developed, and it was possible to control the outbreak.

The importance of Leadership towards universal health coverage in Low Income Countries.

Universal health coverage--defined as access to the full range of the most appropriate health care and technology for all people at the lowest possible price or with social health protection--was the goal of the 1978 Alma-Ata Conference on Primary Health Care in Kazakhstan. Many low-income (developing) countries are currently unable to reach this goal despite having articulated the same in their health-related documents. In this paper we argue that, over 30 years on, inadequate political and technical leadership has prevented the realization of universal health coverage in low-income countries.

Knowledge and perceptions of antenatal women towards prevention of mother to child transmission of HIV/AIDS in Blantyre, Malawi.

OBJECTIVES: To determine antenatal attendees' knowledge and perceptions towards selected aspects of prevention of mother to child transmission of HIV. SETTING: Five rural and six urban public health centers in Blantyre District, Malawi. SUBJECTS: 126 consecutive pregnant women attending antenatal clinics. DESIGN: Cross sectional qualitative study utilizing focus group discussions (FGDs). Analysis was based on content analysis. RESULTS: Knowledge about HIV/AIDS especially regarding causative agents of AIDS, transmission and prevention was generally high in all FGDs. One individual though, suggested that HIV was transmitted by mosquito bites and another that HIV was transmitted by being exposed to persistent coughing. The majority of 126 women identified HIV testing of pregnant women as of potential benefit and necessary for the prevention and control of HIV/AIDS. In most cases, the benefit mentioned for HIV testing was that it was good to know about one's HIV status rather than being ignorant. Other suggested benefits of HIV testing of pregnant women were: future family planning, as an incentive to reduce the number of sexual partners and to know the cause of the problem in case a child is failing to thrive rather than blame witchcraft. Male spouses were identified as both potential supporters and limiting agents towards pregnant women's acceptability of HIV testing. CONCLUSION: HIV testing among pregnant women to ensure prevention of mother to child transmission of HIV is a complex issue. Women consider various factors before making decisions. Programme planners and implementing agencies need to be aware of these issues and work together with women and other stakeholders in order to overcome such limitations.

Specialisation patterns of medical graduates, University of Malawi College of Medicine, Blantyre.

OBJECTIVE: To describe specialization patterns of medical graduates of the University of Malawi College of Medicine. DESIGN: Cross sectional study. SUBJECTS: Medical graduates of the University of Malawi College of Medicine. SETTING: University of Malawi College of Medicine. MAIN OUTCOME MEASURES: Speciality choices, sources of funding for training, employer at time of graduate studies and country where specialist training obtained. RESULTS: Between 1991 and 2000, 60 (35.5%) of the 169 graduates of the College of Medicine of the University of Malawi have obtained or are in specialist training, 38/60 (63.3%) with training institutions either in the United States or the United Kingdom, 10 (16.7%) had gone to South Africa, 8% Kenya, 5% to the Republic of China (Taiwan) and 3.3% to Uganda. Other countries are; Uganda, Australia and Finland. The preferred specialties were; Public Health 17 (28.8%), Internal Medicine 12 (20%) and Paediatrics 10 (16.7%). Most of the funding was provided by agencies/institutions in the USA and UK. At the time of their training fellowship, 33 (55%) of the candidates were employed by the College of Medicine, 24 (40%) by the public service and the rest, three (5%) by other institutions. CONCLUSIONS: Most Malawian medical graduates are obtaining their specialty training overseas funded mostly by institutions/agencies in the UK and USA. There is need to explore ways on how training could be provided regionally. Malawi and her neighbours must develop post graduate speciality training locally and regionally.

Test offering, not additional information, may increase HIV testing uptake in a knowledgeable population.

OBJECTIVES: To evaluate patient HIV knowledge and testing experience and assess the effect of an HIV informational handout on HIV testing propensity. DESIGN: Cross sectional, descriptive techniques were employed to assess demographics, HIV knowledge and HIV testing experience. A randomized controlled trial was performed to determine if an HIV/AIDS information sheet influenced testing propensity. SETTING: Blantyre Adventist Hospital Outpatient Clinic. SUBJECTS: Non-emergency patients over 18 years old attending during consulting hours. INTERVENTIONS: All subjects answered a questionnaire. For the randomized controlled trial component, half received an HIV information handout. MAIN OUTCOME MEASURES: Proportions were calculated to evaluate testing experience. Logistic regression was used to assess impact of written information and demographics on HIV testing propensity. RESULTS: 490 participants were recruited, of whom 57% had never been tested for HIV. Of the untested, 88% had never been offered an HIV test. Of those that had never been offered a test, 46% desired one. The sample was highly knowledgeable about HIV. Reading an information sheet had no impact on HIV knowledge (p=0.736 to 0.788) or desire for testing (p=0.387). However, age (OR=0.97, 95%CI (0.95,0.99)) and gender (OR=1.85, 95%CI (1.06, 3.23)) significantly correlated with testing propensity. CONCLUSIONS: A large percentage of patients who have never been offered HIV testing desire testing. More frequent HIV test offering by clinicians could improve testing rates. Clinician education programmes should be developed to increase test offering. Furthermore, written health information in a setting of high HIV/AIDS knowledge may not change behaviour. Alternative methods should be employed to encourage HIV testing uptake.

The quality of care of diabetic patients in rural Malawi: A case of Mangochi district.

BACKGROUND: Diabetes mellitus is a global public health problem. In Malawi, the prevalence of diabetes is 5.6% but the quality of care has not been well studied. OBJECTIVE: The aim of this study was to assess the quality of care offered to diabetic patients in Mangochi district. METHODS: This was a cross sectional descriptive study. Quantitative data were collected using a questionnaire from a sample of 75 diabetic patients (children and adults) who attended the Diabetes Clinic at Mangochi District Hospital between 20012 and 2013. Qualitative data were also collected using semi-structured interviews with eight Key Informants from among the District Health Management Team. Frequencies and cross-tabulation were obtained from the quantitative data. Patients' master cards were checked to validate results. Clinical knowledge about diabetes, care practices and resources were the themes analysed from the qualitative data. RESULTS: Among the 75 participants interviewed, 46 were females and 29 males. The overall mean age was 48.3 years (45.6 for females and 53.3 for males). More than half of patients had little or no information about diabetes (40.0 % (n=30) and 22.7 (n=17) respectively. The majority of patients were taking their medicines regularly 98.7% (n=74). Only 17.3% (n=13) reported having their feet inspected regularly. Fifty-six percent of patients were satisfied about services provision. Some nurses and clinicians were trained on diabetes care but most of them left. Guidelines on diabetes management were not accessible. There were shortages in medicines (e.g. soluble insulin) and reagents. Information Education and Communication messages were offered through discussions, experiences sharing and posters. CONCLUSION: Quality of diabetes care provided to diabetic patients attended to Mangochi hospital was sub-optimal due to lack of knowledge among patients and clinicians and resources. More efforts are needed towards retention of trained staff, provision of pharmaceutical and laboratory resources and health education.