The Evolution of Diabetes Care in the Rural, Resource-Constrained Setting of Western Kenya
Abstract
BACKGROUND: The initial focused effort on addressing the HIV pandemic in ***sub-Saharan Africa has helped set the groundwork for addressing many of the other areas of the health-care system requiring support in resource-constrained settings. With the growing prevalence of diabetes in this setting, the US Agency for International Development—Academic Model Providing Access to Healthcare Partnership (USAID-AMPATH) has begun developing infrastructure to meet the growing need for diabetes care. OBJECTIVE: To describe the evolution of diabetes care in the rural, resource-constrained setting of western Kenya and to analyze preliminary data on the current status of glucose control of patients. METHODS: Through partnerships, USAID-AMPATH has facilitated the provision of basic modalities of diabetes care, including reliable stocks of insulin, hemoglobin A 1c (A1C) testing, and point-of-care glucose-testing supplies. RESULTS: Through the introduction of A1C testing, the poor quality of diabetes care was revealed, as the average A1C for the clinic population was 10.4%, with insulin-dependent patients constituting the majority of individuals with markedly elevated A1C levels. To address this, a contextualized electronic medical record and a cell phone-based home glucose monitoring program were created to improve glycemic control, which has led to significant reductions in A1C levels. CONCLUSIONS: Through the inclusion of clinical data within the electronic medical record, there is an ongoing effort to research various aspects of diabetes care in this understudied population, with the goal of addressing many of the unanswered questions surrounding diabetes care in sub-Saharan Africa. The lessons learned from this pilot program will be used to create sustainable infrastructure for diabetes care in partnership with the Kenyan government and will serve as a model for similar programs.
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In 8 included studies, mHealth interventions connected a patient to a provider, directly facilitating patient access to professional care.
“In 8 studies, mHealth interventions connected a patient to a provider, thus directly facilitating patient access to (professional) care [20, 37, 46, 50, 51, 53–55].”
From A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa (2017) · cites this paper as [54]
(First-contact) providers reported that they needed support in order to follow guidelines.
“Furthermore, (first-contact) providers reported that they needed support in order to follow guidelines [50, 54, 55] and that mHealth could contribute to overcoming barriers to accessing supervision [37, 40–42, 47, 51].”
From A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa (2017) · cites this paper as [54]
Similar predisposing characteristics were reported for providers: positive attitudes, fluency in the language of the locality, and sufficient training to use the technology.
“Similar predisposing characteristics were also reported for providers, i.e., positive attitudes [38, 40, 52], fluency in the language of the locality [46, 54], and sufficient training to use the technology [47, 52].”
From A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa (2017) · cites this paper as [54]
Affordability of telecommunication services and other operating costs was an enabling resource for first-contact providers.
“Enabling resources for first-contact providers were access to basic infrastructure, such as electric power and functioning medical technologies [49, 52], ambulance services and good roads [46, 47], as well as the affordability of telecommunication services and other operating costs [50, 54, 55] (see Table 2).”
From A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa (2017) · cites this paper as [54]
For patients, access to mobile phones was one of the two most important enabling resources necessary for a mHealth intervention to be perceived useful.
“For patients, unsurprisingly, the two most important enabling resources necessary for a mHealth intervention to be (perceived to be) useful were access to mobile phones [37, 45, 46, 50, 53–55] (also possible through borrowing [46, 50]) and the availability of a functioning stable telecommunications network [20, 36, 39, 42, 45, 47, 48, 52, 55].”
From A realist review of mobile phone-based health interventions for non-communicable disease management in sub-Saharan Africa (2017) · cites this paper as [54]
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- Authors
- Pastakia, S. D., Karwa, R., Kahn, C. B., & Nyabundi, J. S.
- Affiliations
- Purdue University in Indianapolis (US)
- Purdue University West Lafayette (US)
- Brown University (US)
- Jak S Nyabundi MBChB MMED, Consultant Physician, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Corresponding author
- Pastakia, Sonak D
- Venue
- Annals of Pharmacotherapy
- Publisher
- SAGE Publications
- Published
- 2011-05-10
- Volume
- 45
- Issue
- 6
- Pages
- 721-726
- ISSN
- 0012-6578 (ISSN-L)
- 1060-0280
- 1542-6270
- OpenAlex
- W2132322537
- Cited by
- 38
- References
- 17
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1 · 2021: 2 · 2020: 3 · 2019: 2 · 2018: 7 · 2017: 5 · 2016: 4 · 2015: 2 · 2014: 3 · 2013: 5 · 2012: 2
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Pharmacotherapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes management, resource-limited settings, rural health care, glycemic control, hemoglobin A1c testing, insulin, point-of-care glucose testing, electronic health records, HIV care integration, sub-Saharan Africa, Western Kenya
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Glucose, Child, Child, Preschool, Diabetes Mellitus, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, International Cooperation, Kenya, Middle Aged, Pilot Projects, Quality of Health Care, United States, Blood Glucose Self-Monitoring, Rural Health Services, Point-of-Care Systems, Cell Phone, United States Agency for International Development, Young Adult, Electronic Health Records
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