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

Perceptions and Barriers to Exclusive Breastfeeding in Manicaland, Zimbabwe

The study explored perceptions and barriers to exclusive breastfeeding (EBF) among rural women in Zimbabwe. A descriptive cross sectional design was used with 490 participants (146 men and 344 women). Questionnaires and Focus Group Discussions were held with women 15-49 years who had a child below 2 years and their male partners. The prevalence of exclusive breastfeeding amongst the infants 0 – 6months was 66.8%. Seventy-four and 64.7% of girls and boys respectively were exclusively breastfed. Sixty-three percent of newborns were exclusively breastfed immediately after birth with 32% and 5% of the newborns being initiated within 6 hours and 1 day respectively. Women reported that they were comfortable to exclusively breastfeed for the first 3 months. The top six barriers to EBF were poor support from men(<30%),pressure from in-laws to introduce other foods, scanty knowledge on appropriate infant feeding practices, negative cultural and religious practices and lack of interest in women to exclusively breastfeed. The EBF prevalence was higher amongst young mothers (below 19 years) as compared to older women (20-49 years). EBF practices were lower (58.2%) amongst the more educated women compared to the less educated women (79.2%). The study concluded that community social mobilization should be intensified to increase knowledge and improve perceptions by engaging both men and women and other powerful stakeholders on infant and young child feeding through participatory approaches. Keywords: Exclusive breastfeeding, perceptions, attitudes, knowledg

The effect of intentional nurse rounding and nurse prompt response time to Call system on patient satisfaction, patient complaints, and patient clinical outcome: An Audit trial

Background: Improving patient satisfaction and safety is a critical goal for hospitals around the world. Healthcare providers have increasingly recognized the importance of strategic initiatives and the impact they have on patient outcomes.Objectives: This study examines the effect of intentional nurse rounding and the call system's response times on patient satisfaction, patient complaints, falls, and hospital-acquired pressure injuries (HAPI).Methods: This descriptive study was conducted between December 2017 to August 2018 in a hospital in the United Arab Emirates. The Intentional Nurse Rounding (INR) and Prompt Response to Call System (PRTCS) were introduced in December 2017. It comprised of: (1) hourly nurses’ rounds between 07:00 hours to 23:59 hours and 2 hourly rounds between 24:00 hours to 06:59 hours daily, (2) measurement of nurses’ response time to call bells, (3) leadership rounds to assess patient satisfaction. The outcomes were patient satisfaction, patient complaints, fall rates, and HAPI rates. Baseline data were collected through retrospective reviews of the data on these outcomes in December 2017. The second period of data collection was conducted over eight months after the initiation of the system, from December 2017 to August 2018. The Chi-square test was used to detect significant differences in outcomes pre and post intervention.Results: The overall adherence to the “Intentional Nurse Rounding and Prompt Response Time to Call System” was 91% while the overall patient satisfaction rate was 97% in August 2018. The average response to call time was 1.2 minutes. Patient complaints decreased from 0.75/month to 0.125/month between December 2017 to August 2018. During the same period, the rates of patient falls and HAPI decreased from 1.17/month to 0.38/month and 0.35/month to 0.24/month respectively. Though the observed differences were not statistically significant, there was a promising difference in patient complaints pre and post intervention (P=0.08).Conclusion: Integrating nursing-led strategic initiatives such as intentional nurse rounding and reduced response time to the call bell system can positively impact patient satisfaction, complaints, and clinical outcome

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

Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe: a cross-sectional study

Abstract Background Diabetic foot disease (DF) is a common diabetes-related complication; however, the prevalence and associated risk factors for DF are not well characterised among people living with diabetes (PLWD) in Zimbabwe. This may suggest the unavailability of adequate strategies to diagnose and treat DF in the country. This study aimed to determine the prevalence of DF and associated risk factors for PLWD in Harare, Zimbabwe. Methods This was a cross-sectional study, employing a quantitative approach. In total, 352 PLWD were recruited from 16 primary care clinics in Harare. Sociodemographic and clinical data were collected via face-to-face interviews and clinical records reviews. The DF screening included an evaluation for peripheral neuropathy, ankle-brachial index (ABI), ulceration, and amputation. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs), and KAP was scored using Bloom’s cut-off. Chi-Square goodness-of-fit tests were performed, and regression analyses were used for association analysis. The threshold for significance was p  0.05). Conclusion This study showed that there was a high prevalence of DF (53%) in PLWD in Zimbabwe, and insulin use was protective against DF. There is an urgent need for policy revisions to include foot screening in routine primary care and increasing insulin use for PLWD to prevent complications such as DF as an integral part of primary care