Nomsa H. Malete

Non-adherence to diet and exercise recommendations amongst patients with type 2 diabetes mellitus attending Extension II Clinic in Botswana

Abstract Background Patients diagnosed with type 2 diabetes mellitus in Extension II Clinic in Botswana have difficulty in adhering to the lifestyle modifications recommended by health care practitioners. Poor adherence to lifestyle recommendations leads to poor control of the condition and consequently to complications. Objectives The aim of the study was to determine reasons for poor adherence to lifestyle recommendations amongst the patients. The objectives were to determine: reasons for poor adherence to dietary requirements, exercise recommendations, the support they had in adhering to the recommendations, and their understanding of the role of dietary and exercise requirements in the management of their condition. Method This was a cross-sectional descriptive study. The sample comprised of 105 participants. Data on participants’ baseline characteristics and adherence to dietary and exercise habits were analysed using the SPSS 14.0 version. Results The sample of 104 participants comprised of 61 (58.7%) women. The rates of non-adherence to diet and exercise were 37% and 52% respectively. The main reasons for non-adherence to diet were: poor self-discipline (63.4%); lack of information (33.3%) and the tendency to eat out (31.7%). The main reasons for non-adherence to exercise were: lack of information (65.7%); the perception that exercise exacerbated their illness (57.6%) and lack of an exercise partner (24.0%). Conclusion There was a relatively high rate of non-adherence to both diet and exercise recommendations by patients suffering from type 2 diabetes mellitus at Extension II Clinic, Botswana, with non-adherence to exercise recommendations more common.

Reasons for non-compliance among patients with hypertension at Vanga Hospital, Bandundu Province, Democratic Republic of Congo: A qualitative study

ABSTRACT Background Hypertension is a serious public health challenge in both economically developing and developed countries. Patients on outpatient medication for hypertension at Vanga Hospital in the Democratic Republic of Congo (DRC) often present with uncontrolled hypertension and some with hypertension emergencies. On enquiry, the problem appeared to revolve around compliance. Method The study was a qualitative, descriptive study using the focus group interview technique for data collection. Subjects were purposely selected. Interviews were conducted from 23 March to 19 July 2006. Three focus groups were formed: The first was heterogeneous in terms of gender (five males and three females), the second homogeneous (six males) and the last also homogeneous (six females). The group members varied with respect to characteristics such as place of residence, occupation and educational standard. The data collected were analysed using the thematic analysis method within grounded theory. Results Five themes emerged as possible explanations for non-compliance: Side effects discouraged patients from taking medication; patients took medication only when they experienced perceived symptoms of hypertension; poor knowledge of the disease and the medication used; lack of support by family members; and difficulty in obtaining antihypertensive medication. Conclusion Side effects of the medication, lack of information and support, difficulty in obtaining the medication and the fact that the disease is mainly silent played a major role in the poor adherence to hypertension medication. Sustained health promotion and education should be undertaken at all levels of patient contact to ensure good compliance.

How the families of the victims of suicide through self-incineration function before and after the event—a qualitative assessment

Abstract Background Durkheim defines suicide as all death resulting directly or indirectly from a positive or negative act of the victim himself or herself, which he or she knows will produce this result. Suicide is as old as human history itself. It is most frequently seen as a fatal sequel of psychiatric illnesses and it is thought that suicide only occurs in a state of insanity, and that it is by itself a special form of insanity. Health workers, especially family practitioners, are constantly confronted by family tragedies, which they have to deal with competently. It is therefore imperative that a health worker contextually understand a family tragedy, such as when a family member commits suicide through self-incineration. Between 1987 and 1998, Matsulu Township, Mpumalanga experienced a high incidence of suicide through self-incineration. Each victim either ingested or doused him or herself with inflammable liquid (usually kerosene) and set his or her body alight. This gruesome form of suicide, and the increased frequency of occurrence, horrified the families and reverberated through the township. This phenomenon drew the principal researchers attention and resulted in this study. The principal researcher was the only family practitioner in the township during this period. It was hoped that the knowledge gained from this study would form the basis for interventions in similarly affected families in the future. The focus was on the surviving family members, in order to learn about the family dynamics before and after the events, and how the family dealt with the event. Although studies that focused on the role of doctors in suicide prevention found that there is little predictive power for the suicide candidates, which means that there were no identifiable factors directly associated with suicide outcome, information gleaned from the affected families could be used profitably in community campaigns and by support groups. Methods The aim of the study was to understand how the families of those who committed suicide through self-incineration functioned before and after the event. In-depth interviews were conducted with six focus groups selected purposively from 36 affected families. Interviews were conducted in Siswati, audiotaped, transcribed and translated into English. Themes and sub-themes were identified. To enhance the trustworthiness of the information gathered, the data were triangulated. Results Themes identified were a shocking experience, no chance of survival, triggering factors, mystery, emotional and physical scars, and coping strategies. The perception of witchcraft being responsible for suicide featured prominently in the data analysed. Conclusions The functioning of the families affected by the suicide of a member through self-incineration was markedly reduced after the events. It is recommended that attention be given especially to the perception of witchcraft being responsible for suicide, and that grief support groups be established in the community to assist affected families cope better with the loss.