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Understanding the diagnostic delays and pathways for diabetes in eastern Uganda: A qualitative study.
Kasujja, Francis Xavier; Nuwaha, Fred; Daivadanam, Meena; Kiguli, Juliet; Etajak, Samuel; Mayega, Roy William.
Afiliação
  • Kasujja FX; Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
  • Nuwaha F; Non Communicable Diseases Phenotype Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
  • Daivadanam M; Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
  • Kiguli J; Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.
  • Etajak S; Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden.
  • Mayega RW; Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
PLoS One ; 16(4): e0250421, 2021.
Article em En | MEDLINE | ID: mdl-33882116
ABSTRACT

BACKGROUND:

Type 2 diabetes is rapidly becoming a significant challenge in Uganda and other low and middle-income countries. A large proportion of the population remains undiagnosed. To understand diagnostic delay, we explored the diagnostic pathways for diabetes among patients receiving care at a semi-urban district hospital in eastern Uganda.

METHODS:

Eligible participants were patients aged 35-70 years receiving care at the diabetes clinic of Iganga district hospital between April and May 2019 and their healthcare providers. Patients were interviewed using an interview guide to collect information on patients' symptoms and their diagnostic experience. A separate interview guide was used to understand the organisation of the diabetes services and the diabetes diagnostic process at the hospital. Using maximum variation purposive sampling, we selected 17 diabetes patients aged 35-68 years, diagnosed within the previous three years, and the three health workers managing the diabetes clinic at Iganga hospital. The data was analysed using ATLAS.ti version 8 to code, organise and track the data segments. We conducted template analysis using a priori themes derived from the intervals of Walter's model of Pathways to Treatment to identify the factors influencing diagnostic delay.

RESULTS:

We identified four typologies a short diagnostic pathway, protracted appraisal pathway, protracted appraisal and diagnostic interval pathway, and delayed treatment pathway. The pathways of patients with protracted appraisal or diagnostic intervals demonstrated strong socio-cultural influences. There was a firm reliance on traditional healers both before and after diagnosis which deferred enrolment into care. Other health system barriers implicated in delayed diagnosis included stock-out of diagnostic supplies, misdiagnosis, and missed diagnosis. Denial of diagnosis was also found to lead to delayed initiation of care.

CONCLUSION:

Reducing diagnostic delay requires addressing both negative socio-cultural influences and the adoption of system-wide interventions to address barriers to timely diagnosis.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diagnóstico Precoce / Diabetes Mellitus Tipo 2 / Diagnóstico Tardio / Acessibilidade aos Serviços de Saúde Tipo de estudo: Diagnostic_studies / Prognostic_studies / Qualitative_research / Screening_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Africa Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Uganda

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diagnóstico Precoce / Diabetes Mellitus Tipo 2 / Diagnóstico Tardio / Acessibilidade aos Serviços de Saúde Tipo de estudo: Diagnostic_studies / Prognostic_studies / Qualitative_research / Screening_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: Africa Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Uganda