title: A comparative study of the quality of care and glycemic control among ambulatory type 2 diabetes mellitus clients, at a Tertiary Referral Hospital and a Regional Hospital in Central Kenya.
abstract: BACKGROUND
  Peripheral public health facilities remain the most frequented by the majority of the population in Kenya; yet remain sub-optimally equipped and not optimized for non-communicable diseases care.
  
  
  METHODS
  We undertook a descriptive, cross sectional study among ambulatory type 2 diabetes mellitus clients, attending Kenyatta National Referral Hospital (KNH), and Thika District Hospital (TDH) in Central Kenya. Systematic random sampling was used. HbA1c was assessed for glycemic control and the following, as markers of quality of care: direct client costs, clinic appointment interval and frequency of self monitoring test, affordability and satisfaction with care.
  
  
  RESULTS
  We enrolled 200 clients, (Kenyatta National Hospital 120; Thika District Hospital 80); Majority of the patients 66.5% were females, the mean age was 57.8 years; and 58% of the patients had basic primary education. 67.5% had diabetes for less than 10 years and 40% were on insulin therapy. The proportion (95% CI) with good glycemic was 17% (12.0-22.5 respectively) in the two facilities [Kenyatta National Hospital 18.3% (11.5-25.6); Thika District Hospital 15% (CI 7.4-23.7); P = 0.539]. However, in Thika District Hospital clients were more likely to have a clinic driven routine urinalysis and weight, they were also accorded shorter clinic appointment intervals; incurred half to three quarter lower direct costs, and reported greater affordability and satisfactions with care.
  
  
  CONCLUSIONS
  In conclusion, we demonstrate that in Thika district hospital, glycemic control and diabetic care is suboptimal; but comparable to that of Kenyatta National Referral hospital. Opportunities for improvement of care abound at peripheral health facilities.
authors.affiliation: Public Health Department, P.O.BOX 24218, Nairobi, 00502, Kenya. mmwavua@gmail.com.
authors.forename: Shillah Mwaniga
authors.initials: SM
authors.lastname: Mwavua
authors.affiliation: Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya. Ndungu_edward@yahoo.com.
authors.forename: Edward Kiogora
authors.initials: EK
authors.lastname: Ndungu
authors.affiliation: Partnership for Advanced Care and Treatment (PACT), Centre of Excellence, University of Nairobi, Nairobi, Kenya. mutaikk@gmail.com.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Mutai
authors.affiliation: Department of Clinical Medicine and Therapeutics', School of Medicine, University of Nairobi, Nairobi, Kenya. joshingetich@gmail.com.
authors.forename: Mark David
authors.initials: MD
authors.lastname: Joshi
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000191:economics; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006297:Health Services Accessibility; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000191:economics; D007630:Kenya; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards*; D062606:Tertiary Care Centers / Q000592:standards*
chemical_list: D006442:Glycated Hemoglobin