Association between adherence to anti-diabetic therapy and adverse maternal and perinatal outcomes in diabetes in pregnancy

Objectives: To analyse the association between adherence to anti-diabetic therapy (diet, physical activity and medications) and perinatal outcomes.Methods: A cohort design was used. Participants were 157 pregnant women with diabetes, and the setting was Mbuya Nehanda and Chitungwiza Maternity Hospitals, Harare, Zimbabwe.Results: Main outcome measures were maternal and perinatal outcomes. Mean adherence to anti-diabetic therapy was 66.7%. Perinatal outcomes observed were hypertensive disorders (34.5%), Caesarean delivery (45.9%), maternal diabetic ketoacidosis (5.1%), maternal hypoglycaemia (15.9%), and candidiasis (19.7%). Neonatal outcomes were perinatal mortality (15.9%), low Apgar score at 1 minute (26.8%), low Apgar score at 5 minutes (24.8%), macrosomia (33.8%), neonatal hypoglycaemia (15.3%), and neonatal hyperbilirubinemia (7.6%). There were significant associations between adherence and Caesarean delivery (RR 1.9, 95% CI 1.28 to 2.81, p = 0.0014), candidiasis (RR 3.95, 95% CI 1.65 to 9.47, p = 0.002), low Apgar score at 1 minute (RR 2.15, 95% CI 1.16 to 3.98, p = 0.015) and at 5 minutes (RR 1.95, 95% CI 1.03 to 3.69, p = 0.039), and perinatal mortality (RR 3.08, 95% CI 1.11 to 8.52, p = 0.018).Conclusions: Adherence to anti-diabetic therapy was sub-optimal and was associated with some adverse perinatal outcomes. Promotion of adherence, through routine individualised counselling, monitoring and assessment, is vital to minimise adverse outcomes.Keywords: anti-diabetic therapy, diabetes, maternal outcomes, perinatal outcomes, pregnanc

The AIDS crisis: Examining factors that influence use of condoms by young adult Zimbabwean males.

Condoms prevent both unintended pregnancies and HIV/AIDS. Almost 90% of the deaths occurring in hospitals in Zimbabwe are attributed to HIV/AIDS related illness (NACP, 1995). Half of the Zimbabwean army and 15% of the population are thought to be infected (CFU, 1993). Also, 80,000 illegal abortions occur annually in Zimbabwe. The purpose of this study is to examine factors that influence the reported quality of condom use by Zimbabwean men. Pender's Health Promotion model, which includes a set of General Influences and a set of Behavior Specific Influences was used to guide study design and analysis. The sample consisted of 400 Zimbabwean males studying at Belvedere Teachers college and Harare Institute of Technology with a mean age of 24 years (SD = 3.5). The reported quality of condom use in the last 12 months by participants in this sample was measured by four items: 24.6% reported using condoms every time, 27.7% put the condom on every time before the penis entered the vagina for the first time, 29.3% still had an erection every time they withdrew from the vagina and 26.9% held onto the condom every time they withdrew. The sum score of responses to these four items was the dependent variable considered in this study. The higher the score, the higher the quality of condom use. In testing the model, four multiple regression results were examined. First, the quality of condom use score was regressed on all General influences variables. No General Influences variables had significant independent predictive power. Then the quality of condom use score was regressed on the Behavior Specific influences. Attitudes towards condom use, use of marijuana, the situational influences of bars, and condom self-efficacy were independently predictive of the quality of condom use. Next, the full model was tested using all variables in the proposed model. Although 27% of the variance was explained, multicollinearity and severe reduction in sample size led to a reduced model. For that purpose all predictors with significant bivariate relationships with condom use were tested in a reduced model. Using that model, multiple regression indicated that marital status, having been shown how to use condoms, attitudes toward condom use, and use of marijuana were all independently predictive of the reported quality of condom use. These findings are discussed in detail and compared to other findings so as to design effective interventions with Zimbabwean men. The situation in Zimbabwe and these results suggest that family planning programs need to integrate information on both contraceptives and sexually transmitted diseases including AIDS/HIV.Ph.D.Behavioral psychologyHealth and Environmental SciencesNursingPsychologyPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129832/2/9624776.pd

Barriers of Adherence and Possible Solutions to Nonadherence to Antidiabetic Therapy in Women with Diabetes in Pregnancy: Patients’ Perspective

Diabetes in pregnancy contributes to maternal mortality and morbidity though it receives little attention in developing countries. The purpose of the study was to explore the barriers to adherence and possible solutions to nonadherence to antidiabetic therapy in women with diabetes in pregnancy. Antidiabetic therapy referred to diet, physical activity, and medications. Four focus group discussions (FGDs), each with 7 participants, were held at a central hospital in Zimbabwe. Included were women with a diagnosis of diabetes in pregnancy, aged 18 to 49 years, and able to speak Shona or English. Approval was obtained from respective ethical review boards. FGDs followed a semistructured questionnaire. Detailed notes were taken during the interviews which were also being audiotaped. Data were analysed thematically and manually. Themes identified were barriers and possible solutions to nonadherence to therapy. Barriers were poor socioeconomic status, lack of family, peer and community support, effects of pregnancy, complicated therapeutic regimen, pathophysiology of diabetes, cultural and religious beliefs, and poor health care system. Possible solutions were fostering social support, financial support, and improvement of hospital services. Individualised care of women with diabetes is essential, and barriers and possible solutions identified can be utilised to improve care