Management of Diabetes Mellitus at the Household Level Using Community Health Strategy in Embu County, Kenya.
Hussein, Salim Ali
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The community health strategy (CHS) focuses on empowering the communities to take control of and over their health. This approach aims to improve the health status of Kenyan communities by initiating and implementing health care actions that focus on the whole life cycle. Globally Diabetes Mellitus (DM) causes a mortality of 1.6 million each year and morbidity of about 422 million people. DM causes 1% of the mortality in Kenya and 2% of the population in Kenya has DM. In 2019 Embu County was the 5th leading County in DM morbidity and the 6th leading county in DM mortality in Kenya. Kenya adopted the Community Health Strategy in 2006 as an approach to reduce the worsening health indicators. This study assessed the management of Diabetes Mellitus at the household level using the community health strategy in Embu County. It was a cross sectional study using 422 household participants in Embu County. The 60 households sampled in each location was equally distributed among villages in each location Purposive sampling was used to select all the 30 Community Health Volunteers (CHVs) that had been trained on DM management at the household level and were interviewed. CHVs’ knowledge on management of DM was tested. Interviewer administered questionnaires and assessment questions were used to collect data. Key informant interviews were used on CHS managers. Data was analyzed using SPSS version 25. The results showed that CHVs in Embu County had poor scores in managing diabetes in the study area. The health system factors that were positively associated with performance of CHVs were leadership and governance with (adjusted odds ratio [AOR] 5.0; 95% confidence interval [CI] 22.214.171.124), financial support AOR 2.23; 95% Confidence interval [CI] 0.20, 6.00) and availability of kits and commodities [AOR 4.00, (Odd ratio=4.00; 95% CI=1.21, 7.8) Level of knowledge of CHVs on Diabetes Management was also positively associated with DM management at household level in particular level of knowledge of prevention and treatment of DM by CHVs increases the odd of DM management at (Adjusted Odd ratio [AOR] 12.0; 95% Confidence Interval [CI]0.901, 33.3) as well as level of knowledge of CHVs to define and classify Diabetes (Odd ratio=13.9; 95% CI=2.00, 23.9) At the same knowledge of CHVs to identify signs and symptoms of diabetes was found to increases the odd of DM management by (Adjusted Odd ratio [AOR] =8.90; Confidence Interval [CI] 4.56, 33.00). The qualitative findings reinforced the quantitative results by indicating that refresher training, workload, and in-kind incentives were important determinants of performance. Major recommendation was as follows; that there is a need for continued use of CHVs to be the focal point for diabetes management, improved staffing of the facilities where community units are linked in order to strengthen referrals and linkage systems especially taking into consideration the spatial distribution and population density. This will improve support supervision from Community Health Extension Workers (CHEWs) to CHVs during their community work.