Diabetes & Metabolic Syndrome: Clinical Research & Reviews 13 (2019) 2025e2031 Contents lists available at ScienceDirect Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx Original Article Affordability effect of diabetic medicine on Patient's treatment adherence case study: Itojo Hospital in Ntungamo District Tumusiime Cathbert article info abstract Article history: The objective of this study was to assess the affordability effect of diabetic medicine on patient's Received 1 April 2019 treatment adherence among patients aged 18 and above who sought treatment at IH diabetic clinic. Accepted 21 April 2019 Dedication: I dedicate this research to my The source of data was primary which was collected by the researcher from IH. The independent dear parents Mr & Mrs Muhanguzi E Moses variable was considered as affordability of the diabetic medicine and adherence was the dependent for their endless care and tireless parental variable in this study. Findings showed that Sex, marital status, education level, estimated monthly in- and financial support.May God bless them come were significantly associated with treatment adherence at the bivariate level. abundantly, my siblings Talbert and Patricia, The objectives of the study were looking at the affordability effect of diabetic medicine and awareness my relatives for their dedicated support and among the patients. It was found out that there is a statistically significant relationship between the two to my dear friends who have been with me variables. through this academic struggle. Basing on the findings of the study, it is recommended that more sensitization should be put in place to help patients be informed about their health, to be educated and also made aware of how to take good care of themselves especially on the side of females as well as be trained on how to have a strong financial base as this can help improve on affordability of medicine. © 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved. 1. Introduction determined precisely and is likely to vary across the many regions. However, it seems that they all add to the financial burden of dia- 1.1. Background betes on those affected. It should also be remembered that the prices represent only a portion of the actual costs of diabetes Treatment adherence is essential in the management of Dia- treatment, they do not include healthcare costs, costs due to betes. Adherence to diabetes treatment leads to improved glucose complications or those associated with the behavioral changes that control and reduces the risk of disease complications. Affordability having diabetes entails. refers to a product's cost versus the ability and willingness of In developed countries like the United States, more than 23 people (as well as health systems and third-party payers) to pay for million people have diabetes mellitus, although about one third of it. Diabetes is defined as a defect in the body's ability to convert these cases are undiagnosed [2]. Affordability issues were identi- glucose (sugar) to energy. fied as a barrier to access to diabetes supplies in at least four Poor adherence to medication regimens is common, contrib- countries: uting to substantial worsening of disease, death and increased Bulgaria, Lithuania Poland and Romania. This is according to the health-care costs. Hence, practitioners should always look for poor International Diabetes Federation publication, affordability seems adherence and can enhance adherence by emphasizing the value of to be a problem for many people with chronic conditions. Previous a patient's regimen, making the regimen simple and customizing studies have found adherence to diabetes treatment generally to be the regimen to the patient's lifestyle [1]. The contribution of price sub-optimal ranging from 23% to 77%, In addition, these studies determination factors to the overall affordability issue could not be have generated varied results of the factors associated with non- adherence to diabetes treatment, it is further suggested that data- bases on how to evaluate the cost-effectiveness of programs [3]. Many individuals are influenced by traditional beliefs, myths and Abbreviations: ADA, American Diabetes Association; BSTA, Bachelors in statis- misconceptions regarding the causes, symptoms and care of dia- tics; DM, Diabetes Mellitus; IH, tojo Hospital; IDF, International Diabetes Federa- tion; UDA, Uganda diabetes association; USA, United States of America; MOH, betes and continue to seek alternative measures for curing their Ministry of Health; MS, Medical Superintendent; WHO, World Health Organisation. condition. E-mail address: [email protected]. https://doi.org/10.1016/j.dsx.2019.04.029 1871-4021/© 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved. 2026 T. Cathbert / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 13 (2019) 2025e2031 However, the disease is not only a problem for the individual but relationship between the affordability effect on treatment adher- is also a societal challenge because of its serious complications and ence so as to be guided by facts in implementing policies and to be cost of treatment. Meanwhile, public awareness and understanding able to come up with proper decision making,this will minimise of diabetes remains very low in certain areas [3]. The data indicated complications amongst diabetic patients. a high median, Cameroon and Kenya showed particularly high It is going to help health workers in creating awareness about values, thus poor affordability. Furthermore adherence to diabetic the financial aspect in relation to adherence to diabetic treatment treatment has been reported to range from 20 to 60% in Africa and how they can improve it to help diabetic patients through (Neiheisel et al., 2014). procuring enough medicine from the national medical stores to Many diabetic patients are usually admitted with complications cater for the patients. which would have been controlled with treatment if access to medicine was affordable as it would reduce the rate at which dia- 1.6. Scope of the study betes develops. Patient interviews while straight forward and inexpensive are The study was carried out at Itojo hospital located in Ntungamo clearly limited by their subjective nature, this is according to a District along Mbarara-Kabale high way 52 km from Mbarara town study conducted in Ethiopia in 2011 on medication adherence in and it involved diabetic patients who attended the diabetic clinic at diabetes and self-management practices. the hospital. Finally, according to the study that was done at Mulago in The research was done on the affordability of prescribed med- Uganda, it was found out that the rate of adherence to diabetic icine in relation to patients’ response to diabetic treatment for a treatment was 28.9% which is below average of 50% and therefore period of four months (MayeSeptember 2016). this research was needed to provide an understanding of afford- ability of diabetic medicine on its treatment adherence. 2. Literature review 1.2. Problem statement 2.1. Adherence to diabetic treatment Adherence is a key factor to healthcare outcome in all aspects of According to the World Health Organisation adherence is medical care including diabetic care. The rate of adherence to dia- defined as “the extent to which the patient follows medical in- betic treatment according to studies in USA has indicated that less structions.” (WHO, 2003) than 50% of patients adhere whereas in Africa it is about 41% and it [5] Therapeutic adherence means that the patient observes the stands at around 28.9% in Uganda. medical recommendations, taking the medication, and maintaining Adherence to medications is not routinely measured in clinical a lifestyle as recommended by clinicians. practice as diabetes is a common problem in every health practice In this study, focus was on diabetic adherence. Adherence to according to Ref. [4] and the review of studies shows that insuffi- diabetic treatment was determined through self-reports of how cient literature has been documented on the affordability of the patients had been taking medication one week prior to the inter- medicine prescribed to the patients diagnosed with diabetes. view. Patients were specifically asked to recall if they missed any Presently, there is no single measure accepted as the gold doses of medication on a day by day basis over a period of seven standard to relate medication adherence with affordability, because days. The number of times doses were missed were calculated all commonly employed methods have weaknesses. By using the basing on the patients medication regimen which was obtained patients part of income spent on medication, the researcher carried from their medical forms. out a study on the affordability effect of prescribed medicine in A patient's ability and willingness to follow a prescribed relation to treatment adherence. regimen directly influences the effectiveness of that therapy. One factor was the patient's ability to read and understand medication 1.3. Main objective instructions. Patients with low literacy may have difficulty under- standing instructions; this ultimately results in decreased adher- The main objective of the study was to assess the affordability of ence and poor medication management. Issues of low literacy must medicine prescribed to diabetic patients and its effect on treatment be recognized and strategies designed with this limitation in mind. adherence. Adherence rates for patients