title: Accessing diabetes care in rural Uganda: Economic and social resources.
abstract: Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients' journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system.
authors.affiliation: a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Jannie
authors.initials: J
authors.lastname: Nielsen
authors.affiliation: b St. Francis Hospital Nsambya , Kampala , Uganda.
authors.forename: Silver K
authors.initials: SK
authors.lastname: Bahendeka
authors.affiliation: a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Ib C
authors.initials: IC
authors.lastname: Bygbjerg
authors.affiliation: a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark.
authors.forename: Dan W
authors.initials: DW
authors.lastname: Meyrowitsch
authors.affiliation: c Department of Anthropology , University of Copenhagen , Copenhagen , Denmark.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Whyte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D036301:Qualitative Research; D012424:Rural Population; D012923:Social Class; D014454:Uganda
keywords: Type 2 diabetes; Uganda; diabetes treatment; therapeutic journeys; therapy management group