Burden Of Diabetes Mellitus Among Patients In Thika Level Five Hospital, Kiambu County, Kenya

ABSTRACT

The burden of diabetes is reflected not only in the increasing numbers of people with diabetes, but also in the growing numbers of premature deaths due to diabetes. One measure of burden of disease is disability-adjusted life years (DALYs), which combines estimates of years of life lost due to premature death (YLL) and years lived with disability (YLD) to count the total years of healthy life lost from disease and injury. In Kenya, NonCommunicable Diseases (NCDs) accounts for more than 50% of total hospital admissions and over 55% of hospital deaths. The major NCDs are cardiovascular conditions, cancers, diabetes, and chronic obstructive pulmonary diseases. In Kenya there were 1,976,337 NCDs cases in 2012. Nairobi and Kiambu led all other counties in NCDs with 155,899 and 126,754 cases respectively. The Kenyan health sector is predominantly financed by private sector sources (including out-of-pocket Expenses (OoPE) borne by patients, family members and relatives). However, there are only sparse data available from developing countries on the expenditure on diabetes care. Knowing the medical cost of diabetes is critical to understanding the long-term economic consequences of diabetes prevention. The broad objective of the study was to quantify the burden of Diabetes Mellitus among patients attending Thika level 5 Hospital, Kiambu County, Kenya. The study employed prospective prognostic study design and was carried out in Thika level 5 Hospital, Kiambu County. The study population comprised of diabetic patients attending outpatient diabetic clinic. The respondents were recruited into the study till saturation of 594 respondents. Data was collected for YLL, YLD, Direct costs and Indirect costs. EQ-5D-5L tool was used to measure HRQoL. Data analysis was done using SPSS, Microsoft Excel Worksheet and DISMOD II. The results showed that diabetic patient incurs a mean of KSHs 28,433 within six months (translating to approximately KSHs 56,866 per annum). According to the results from this study,43% was attributed to direct costs while 57% for indirect costs spent by a diabetes patient. A total of 805/1000 DALYs was lost as a result of premature mortality and disability associated with diabetes. Most of the diabetes patients in the study had a reduced Health Related Quality of Life(HRQoL) as per the EQ-5D-5L tool with a mean VAS of 0.55. Knowledge on burden of diabetes especially medical cost of diabetes is critical to understanding the long-term economic consequences of diabetes prevention. Thus, assuming prevention costs can be kept sufficiently low, effective diabetes prevention efforts would likely lead to a reduction in long-term medical costs. The results of this study informs policy makers in Kiambu County and Ministry of Health on need to work towards comprehensive and sustainable solutions in regard to diabetes. Based on the study findings, it is recommended that the National government and Kiambu County government of Kiambu to give priority to diabetes disease by providing free insulin and oral glycemic drugs to diabetes patients. It also recommends that the National government and Kiambu County government to prioritize diabetes care by ensuring all patients subscribe to NHIF and to cover management costs of diabetes, both for outpatient and in-patient services through NHIF, thereby reducing the economic burden of a diabetic patient and also improve HRQoL and reduce DALYs.