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Factors Associated with Low Adherence to Medication Among Patients with Type 2 Diabetes at Different Healthcare Facilities in Southern Bangladesh

Adnan Mannan
Department of Genetic Engineering & Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chattogram, Bangladesh

Md. Mahbub Hasan
Department of Genetic Engineering & Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chattogram, Bangladesh

Farhana Akter
Department of Endocrinology, Chittagong Medical College, Chattogram, Bangladesh

Md. Mashud Rana
Department of Genetic Engineering & Biotechnology, Faculty of Biological Sciences, University of Chittagong, Chattogram, Bangladesh

Nowshad Asgar Chowdhuryd
Office of the Deputy Director, Chattogram Diabetic General Hospital,Chattogram, Bangladesh

Lal B. Rawal
School of Health, Medical and Applied Sciences, Central Queensland University, Sydney Campus, Australia

Tuhin Biswas
ARC Centre of Excellence for Children and Families over the Life Course, The University of Queensland, Brisbane, Australia and Institute for Social Science Research, The University of Queensland, Long Pocket Precinct, Brisbane, Australia

Abstract/ Executive Summary:

Background: Diabetic individuals must adhere to their medications to control their glucose levels and prevent diabetes-related complications. However, there is limited evidence of medication adherence in patients with type 2 diabetes in Bangladesh. Objectives: We assessed the level of adherence and factors associated with low adherence to anti-diabetic medication among patients with type 2 diabetes at different health facilities in southern Bangladesh. Methods: This cross-sectional study included 2,070 patients with type 2 diabetes who presented at five health facilities in the Chittagong Division between November 2018 and June 2019. We assessed medication adherence using a self-reported, structured, eight-item questionnaire and performed multiple logistic regression to investigate the factors associated with low medication adherence. Results: The overall prevalence of low medication adherence was 46.3% (95% CI: 41.4–55.8%) of our study population. Multiple logistic regression analysis revealed that males (OR: 1.37; 95% CI: 1.13–1.67), those with a family income of < 233 USD (OR: 1.54, 95% CI: 1.17–2.03), and those with a diabetic ulcer (OR: 1.42, 95% CI: 1.04–1.94) showed low adherence. Diabetic ulcers, retinopathy, and obesity were relatively more elevated among diabetic patients with low medication adherence. Conclusion: Low medication adherence among patients with type 2 diabetes in southern Bangladesh is a key public health challenge. Factors such as male sex, low annual family income, and diabetic ulcers were associated with low medication adherence. Patient counseling and awareness programs may enhance medication adherence among people with type 2 diabetes. Our findings will help physicians and public health workers to develop targeted strategies to increase awareness of the same among their patients.

Keywords: Medication adherence, Type 2 diabetes, Diabetic ulcer, Chittagong, Bangladesh

Location: Chittagong district, Bangladesh

Start Date: 00-11-2018

End Date: 00-06-2019

Program Area: Risk Management in Agriculture

Commodity: Health hazard

Objectives:

To determine the levels of medication adherence in patients with type 2 diabetes from five health facilities in southern Bangladesh and analyze the factors associated with poor adherence.

Methodology:

This cross-sectional study was conducted between November 2018 and June 2019 among patients attending five health facilities in Chittagong, namely: Chittagong Medical College Hospital, Chattogram Diabetic General Hospital, Center for Specialized Care & Research (CSCR), Popular Diagnostics and Max Hospital. All five facilities are situated in Chattogram, the second-largest city of Bangladesh, and have a capacity of more than 100 beds. They serve around twomillion residents in Chattogram city and adjacent districts. We included adults who were: diagnosed with type 2 diabetes mellitus as per the WHO criteria, taking oral medication for diabetes, registered at a hospital, referred by their attending physician, and residents of Chittagong city. According to our sample size calculation we required 1950 diabetes patients using our inclusion criteria. We excluded patients with other types of diabetes, those with type 1 diabetes, and those with serious illnesses that required hospitalization. Our sample size calculation and inclusion criteria allowed us to enroll 2070 diabetes patients in this study. We collected data from outpatient services at the five selected hospitals in a private setting. We administered a pre-tested, structured questionnaire to collect data. Five study physicians, two research officers, and fifteen research assistants were trained and involved in data collection and the principal and co-principal investigators carried out random cross-checks to ensure the quality of the data. The participants were interviewed face-to-face. Anthropometric measurements, i.e. weight, height, and body mass index (BMI), were measured using standardized protocols and calibrated equipment. Systolic and diastolic blood pressure was measured twice using digital monitors (Omron, SEM-1, Omron Corp., USA) and the patients were asked to rest for at least 10 minutes in the sitting position between readings. The average of the two readings was used for this analysis. The data were cleaned and analyzed using the SPSS 20.0 statistical software (IBM Corporation, Armonk, NY). Descriptive statistics were used to analyze the demographic characteristics of patients and their medication adherence scores. Categorical variables were expressed as percentages and frequencies, whereas mean and standard deviation (SD) was calculated for the continuous variables. Fisher’s exact and Chi-square tests were performed to find the group-wise association for categorical variables.

Source of Information: GLOBAL HEALTH ACTION, 2021, VOL. 14, 1872895

Article Link (Online Journal): https://doi.org/10.1080/16549716.2021.1872895

Funding Source:

Budget:

Total Budget (Tk.) :

Achievement/Findings:

Despite the public health efforts being made to effectively manage diabetes among the population of Bangladesh, increasing medication adherence is still a key challenge among patients with type 2 diabetes in southern Bangladesh. The factors we identified to be associated with low medication adherence among diabetic individuals included male gender, family income of less than 233 USD, diabetic ulcers, and lower consumption of fruits and vegetables (less than 3 times a day). Medication adherence may be even lower in remote areas of the country where access to care is limited. Our findings will help physicians and public health workers identify further factors that cause poor adherence and design innovative interventions to address these and eventually improve medication adherence in Bangladesh.

Knowledge Management: Journal