Barriers to Diabetes Care in a Developing Country: Exploratory Evidence from Diabetes Healthcare Providers
Ejiofor Ugwu *
Department of Internal Medicine, Enugu State University of Science and Technology, Enugu, Nigeria.
Samuel Onung
Department of Internal Medicine, University of Uyo, Akwa Ibom, Nigeria.
Ignatius Ezeani
Department of Internal Medicine, Federal Medical Center, Umuahia, Abia State, Nigeria.
Michael Olamoyegun
Department of Internal Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria.
Olufunmilayo Adeleye
Department of Internal Medicine, Lagos State University, Lagos, Nigeria.
Andrew Uloko
Department of Internal Medicine, Bayero University Kano, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Aims: The morbidities and mortalities associated with diabetes are disproportionately high in low and middle income countries. This study aimed to explore important barriers and facilitators to diabetes care in Nigeria from the perspectives of diabetes healthcare providers (DHPs).
Study Design: A nationwide descriptive survey.
Place and Duration: Onsite (Calabar, Nigeria) and online surveys conducted between September 2016 and March 2017.
Methodology: A validated self-administered questionnaire was used to assess barriers to diabetes care and strategies to improve care among DHPs in Nigeria.
Results: A total of 129 subjects with mean ± SD age and mean ± SD duration of practice of 42.4 ± 7.6 years and 8.5 ± 5.4 years respectively were surveyed. About 84.5% of the respondents perceived diabetes care in Nigeria as being remarkably challenging. The most common barriers identified include: poverty, low diabetes awareness, shortage of trained diabetes care specialists, poor diabetes care knowledge among primary care doctors, and poor knowledge of diabetes self care among patients and other institutional, cultural and religious barriers.
To improve care, respondents recommended, among other strategies, increasing healthcare funding, expansion of national health insurance coverage, introduction of government subsidy on diabetes medications, encouraging local production of diabetes medicines and supplies, increasing public diabetes awareness, periodic training of general practitioners and strict regulation of alternative medicine practitioners and faith healing centers.
Conclusion: This survey identified several barriers to diabetes care in Nigeria and proffered some useful and implementable strategies to improve care. In order to reduce the burden of diabetes in Nigeria and perhaps other countries in SSA, these expert opinions should form the basis for a blue print by major diabetes stakeholders and health policy makers.
Keywords: Barriers, challenges, diabetes care, developing country, Nigeria, sub-Saharan Africa.