title: The quality of care of diabetic patients in rural Malawi: A case of Mangochi district.
abstract: BACKGROUND
  Diabetes mellitus is a global public health problem. In Malawi, the prevalence of diabetes is 5.6% but the quality of care has not been well studied.
  
  
  OBJECTIVE
  The aim of this study was to assess the quality of care offered to diabetic patients in Mangochi district.
  
  
  METHODS
  This was a cross sectional descriptive study. Quantitative data were collected using a questionnaire from a sample of 75 diabetic patients (children and adults) who attended the Diabetes Clinic at Mangochi District Hospital between 20012 and 2013. Qualitative data were also collected using semi-structured interviews with eight Key Informants from among the District Health Management Team. Frequencies and cross-tabulation were obtained from the quantitative data. Patients' master cards were checked to validate results. Clinical knowledge about diabetes, care practices and resources were the themes analysed from the qualitative data.
  
  
  RESULTS
  Among the 75 participants interviewed, 46 were females and 29 males. The overall mean age was 48.3 years (45.6 for females and 53.3 for males). More than half of patients had little or no information about diabetes (40.0 % (n=30) and 22.7 (n=17) respectively. The majority of patients were taking their medicines regularly 98.7% (n=74). Only 17.3% (n=13) reported having their feet inspected regularly. Fifty-six percent of patients were satisfied about services provision. Some nurses and clinicians were trained on diabetes care but most of them left. Guidelines on diabetes management were not accessible. There were shortages in medicines (e.g. soluble insulin) and reagents. Information Education and Communication messages were offered through discussions, experiences sharing and posters.
  
  
  CONCLUSIONS
  Quality of diabetes care provided to diabetic patients attended to Mangochi hospital was sub-optimal due to lack of knowledge among patients and clinicians and resources. More efforts are needed towards retention of trained staff, provision of pharmaceutical and laboratory resources and health education.
authors.affiliation: Albaraka Charity Trust, Mama Kadija Clinic, Mangochi, Malawi.
authors.forename: A A
authors.initials: AA
authors.lastname: Assayed
authors.affiliation: Department of Community Health, College of Medicine, University of Malawi, Blantyre Malawi.
authors.forename: A S
authors.initials: AS
authors.lastname: Muula
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi ; Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: M J
authors.initials: MJ
authors.lastname: Nyirenda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011787:Quality of Health Care; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult