Medication adherence, its associated factors and implication on glycaemic control in patients with type 2 diabetes mellitus: A cross-sectional study in a Malaysian primary care clinic

Introduction: Medication adherence and metabolic control remain suboptimal among patients with diabetes mellitus in Malaysia despite the clear benefits of reduced vascular complications and mortality risk. This study examined the factors associated with medication adherence and glycaemic control in patients with type 2 diabetes mellitus in a primary care clinic. Methods: This cross-sectional study was conducted in a public health clinic in Pagoh, Johor, among 386 patients recruited via systematic random sampling. Data were obtained using a validated 7-item structured questionnaire, glycated haemoglobin (HbA1c) test and medical record review. Logistic regression analysis was performed to determine the factors associated with medication adherence. Results: The mean patient age was 60.04±10.75 years, and the mean HbA1c level was 8.3±2.0%. Approximately 60.3% of the participants were adherent to their medication, and an increasing age was significantly associated with medication nonadherence (adjusted odds ratio [OR]: 0.959; confidence interval [CI]: 0.934–0.985). Medication adherence (adjusted OR: 2.688; CI: 1.534–4.708) and use of combined oral medications (adjusted OR: 5.604; CI: 3.078–10.203), combined oral medications with insulin (adjusted OR: 23.466; CI: 8.208–67.085) and insulin only (adjusted OR: 6.528; CI: 1.876–22.717) were associated with good glycaemic control. Older age (adjusted OR: 0.954; CI: 0.923–0.986) and Malay ethnicity (adjusted OR: 0.284; CI: 0.101–0.794) were associated with poor glycaemic control. Conclusion: Suboptimal medication adherence and glycaemic control are prevalent in primary care settings, especially among elderly patients. Counselling should be targeted to patients and their caretakers to improve medication adherence and optimise metabolic control

Caeserian section and demografic factors in Muar Hospital, Johor , 1997

A pregnant mother who cannot deliver vaginally has to undergo caesarian section. Caesarian section is a process by which a baby is delivered via a cut through anterior abdominal wall and uterine wall. The objective of this exercise is to study the case series of caesarian section in Muar Hospital and to study its relationship with maternal sociodemografic factors such as ethnic, parity, socioeconomic factors, residence, height and weight gain as a predictors. A case-control study was carried out in Muar Hospital from June, 1996 till December, 1996. The target population was mothers who delivered f. at the hospital. Cases of 210 mothers who delivered by caesarian section were gathered with its control of 210 mothers delivered vaginally by frequency matching for age. Information gathered via treatment record kept at the Hospital Record Office. Study , showed that the most frequent caesarian section performed in the hospital was I emergency caesarian section (65.71%) as compared to elective (34.29%). The most frequent indication noted were repeat caesarian section ( 18.1% ) followed by fetal distress (13.81%) and disproportion (13.81%). Univariate analysis showed that there was no significant association between caesarian section with parity, ethnicity and education status. However, caesarian section was significantly associated with maternal working status, family income, residence, the status of antenatal care, height and weight gain. (p value <0.05). After controlling for confounder by multivariate analysis, caesarian section was found significantly associated to the status of antenatal care, residence, height and weight gain. (p < 0.05). Odds ratio for a pregnant lady to undergo caesarian section was 2.6 if she was to have poor antenatal care, 2.8 if she lived in town, 3.4 if she had a short stature of less than 145 cm and 88.9 if she gained weight more than 0.5 kg per week. Thus, antenatal care, maternal residence, height and weight gain may be used as a predictor for caesarian section in a pregnant lady. Steps must be taken by the health staff to improve the nutritional status of the children, so that malnutrition is really abated in the country .Malnutrition may lead to stunted growth. The health staff should improve the quality of antenatal care given as well as mothers should be motivated to participate as well. Mothers with weight gain problem should be given diet counseling. Therefore, a dietician is needed during an antenatal clinic session