Pattern, knowledge and practices of HbA1C testing among diabetic patients in a Kenyan tertiary referral hospital.

BACKGROUND: Glycated haemoglobin (HbA1C) measurement is the currently accepted gold standard biochemical indicator of long-term glycemic control in diabetic patients. The level of knowledge as well as the frequency of use of this test among diabetic patients in Kenya is unknown. The current study aimed to document this among patients attending the diabetes clinic at a national referral hospital in Kenya. METHODS: One hundred and ninety eight diabetic patients (59 male and 139 female) attending the outpatient diabetes clinic at the Kenyatta National Hospital were interviewed on their level of knowledge and use of the HbA1C test, as well as their last HbA1C level. The respondent answers were tabulated, analyzed and summarized. The sample mean, standard deviation and percentages were calculated. RESULTS: Of the 198 patients interviewed, 11 (5.6%) had type I diabetes mellitus (DM) while 187 (94.4%) had type II DM. One hundred and thirty four patients (67.7%) had heard of the HbA1C test while 64 patients (32.3%) had never heard of the test. Forty patients (20.2%) had at one point done the test while 158 (79.8%) had never done the test. The mean HbA1C level of the 40 patients who had at any one time done the test was 8.5 ± 1.7%, with more than 90% having HbA1C > 8%. CONCLUSION: Using self-reported accounts, the current study indicates inadequate knowledge and infrequent testing of HbA1C among diabetic outpatients in Kenya. This lack of knowledge and awareness may lead to increased susceptibility to the development of diabetic complications, and potentially higher healthcare costs among these patients. It is our recommendation that policy makers focus on strategies that address HbA1C test accessibility in Kenya, including financial coverage by the national insurance to access the test in public facilities, so as to effectively monitor and combat DM.

Perceptions of medical students towards healthcare devolution: an online cross-sectional study.

INTRODUCTION: There have been worries concerning the preparedness and capacity of the counties to take over health care services. As the current medical students are going into this new system, we sought their opinions on the issue of devolution. The objective is to assess beliefs and attitudes of medical students towards devolution of healthcare services. METHODS: A cross sectional survey was conducted at University of Nairobi medical school during the period of February-May 2014. Though a calculated random sample of 384 medical students was powerful enough to fulfill our objectives, all eligible medical students were invited by email to fill in a semi structured online questionnaire. Computed results from Google sheets were reported in frequencies and percentages. RESULTS: Data was collected from 191 respondents with majority of them in their clinical years (levels 3, 4 and 5) of study. More participants considered working in private/ mission health institution (40%) after graduating as compared to public or non health institution (30%). The media provided most of information concerning devolution (77%). Few respondents reported using government documents (36%) or public forums (24%) to get information on healthcare devolution. While most of the respondents were of the opinion that health information system (68%), health finance (63%), procurement of medical products (54%), leadership and governance (73) should be devolved, only 18% wanted health personnel to be devolved. Most of the opinions on healthcare devolution were not in agreement with the goal of devolution: more than 50% thought the process would not result in improved efficiency, resource allocation, disease control programs or maintenance of infrastructure. CONCLUSION: Despite the envisioned benefits of healthcare devolution, there is a low opinion among medical trainees concerning these reforms and their implementation. Nevertheless, it is early to speculate whether such viewpoints will be carried to the future once teething problems are dealt with.