Factors That Influenced Clinic Utilization by Diabetes Mellitus Type II Patients During Covid-19 Pandemic at Kakamega County General Hospital

Abstract

The World Health Organization (WHO) defines Health systems as organizations, people, and actions aimed to promote, restore or maintain health. The system aims to attain a balance between timely interventions for emerging diseases and continued attention to chronic ailments. During the Corona Virus Disease (COVID-19) outbreak, WHO cautioned that older individuals and those with comorbidities like diabetes were at higher risk of severe COVID-19 infection, complications, and deaths. Studies established that Health-related Quality of Life (HRQoL) was significantly different and lower at P<0.001 for the female patients with COVID-19, patients with severe disease at the intensive care units, those who had comorbidity, and those who were much older (age >60 years). Diabetes Mellitus type II (DM II) accounts for 85-89% of the global diabetes disease burden. The disruption of usual care provided to DM II patients by the pandemic guidelines fomented fears that DM II infections and resultant deaths could worsen. This study adopted a cross-sectional mixed method design to collect quantitative data corroborated by qualitative data. The study, which was anchored on the pillar of health service delivery, investigated factors that influenced utilization of Diabetes Mellitus Type II specialty clinics during the COVID-19 pandemic at Kakamega County General Hospital (KCGH). Specific objectives include the influence of individual patient characteristics, complexity of the disease factors, facility factors and COVID-19 restrictions on utilization of specialty clinics. The target population consisted of 467 DM II patients attending the KCGH diabetes specialty clinic, out of which 211 respondents were randomly sampled to provide quantitative data, while qualitative data was gathered from 6 purposely sampled healthcare providers for the Focused Group Discussion (FGD) utilizing interview guide. Ethical approval was obtained from KeMU Science, Ethical and Research Committee, a study permit from NACOSTI and permission to collect data from the KCGH provided by the hospital’s Ethics and Research committee. Quantitative data were analyzed using Statistical Packages for Social Scientists (SPSS) Version 25. The Chi-square test was employed to assess the significance of associations between the outcome and independent variables, and logistic regression was used to determine the predictive odds of factors that influenced DM II clinical utilization. Qualitative data was analyzed based on study themes arising from the objectives. The study established that DM II clinic utilization was 152 (72%). Statistically significant exposure variables at p<0.05, were; age of respondent, good diet control, family support and the ease of getting medication from the patient. Further, the study established the following factors to be significant in predicting DM II clinical utilization at the multivariate level: age (β=\-0.82, OR= 0.44, p=0.029), family support (β=-1.327, OR= 0.26, p=0.005) and ease of getting medications (β=0.832, OR= 2.297, p=0.025) prediction. The study recommends: i) Policy establishment to support the activation and promotion of telemedicine for outpatient clinics, ii) Establishment of comprehensive and sustainable medical supply processes that can withstand pandemic dynamics. II) Development of patient records digitization to avert missing care data that can adversely affect care outcome, iv) Biased policy establishment cognizant of sociodemographic factors’ influence on clinic utilization.