The Association Between Socioeconomic Factors and Geographical Distance from Home to Healthcare Facility, and Diagnosis of Diabetes and Hypertension in Rural Uganda Pubblico

Abstract

Objectives. To investigate the relationship between socioeconomic factors and geographical distance from household to health facilities, and diagnosis of diabetes and hypertension in rural Uganda.

Methods. This study was based on data from a cross sectional study in rural Uganda, and included information on 426 individuals from 87 households. Information on personal characteristics, socioeconomic factors, and diabetes and hypertension diagnosis was collected via questionnaires, self-reports, and observation. Participants underwent Fasting Plasma Glucose (FPG) and glycated hemoglobin (HbA1c) tests to determine diabetes status, and blood pressure measurements to determine hypertension status. Chi square test was used to determine the relationship between socioeconomic factors and diabetes and hypertension status. Multinomial logistic regression was used to model associations between geographical distance from home to health facilities, and diabetes and hypertension status. Results are reported as odd ratios (OR) and 95% confidence intervals (CI).

Results. Employment was statistically significantly related to diabetes diagnosis. Education and employment were statistically significantly related to hypertension diagnosis. Compared to those with diagnosed diabetes or hypertension, OR of being undiagnosed did not increase with increasing distance from home to the nearest health facility. (OR:1.02 [95%CI: (0.78,1.34)] and 1.04 [95%CI: (0.79,1.37)] for undiagnosed diabetes and hypertension, respectively). OR of undiagnosed diabetes and undiagnosed hypertension increased with increasing distance from home to hospital with paid weekly diabetes clinic, although not statistically significant (OR:1.04 [95%CI: (0.98,1.05)] and 1.03 [95%CI: (0.99,1.07)] for undiagnosed diabetes and hypertension, respectively). There was no association between undiagnosed diabetes and distance from home to hospital with free monthly diabetes clinic, and the association between hypertension diagnosis and distance to this hospital was not clear. (OR:0.97 [95%CI: (0. 94,1.01)] and 1.00 [95%CI: (0.97,1.04)] for undiagnosed diabetes and hypertension, respectively).

Conclusion. Socioeconomic factors varied in their relation to diagnosis of diabetes and hypertension. This study focused on diagnosis and on geographical distance, aspects that have not been widely investigated by previous Ugandan studies. Further research on the association between geographical distance from household to health facilities and diagnosis of diabetes and hypertension is needed, to provide evidence-based recommendations for planning access to diabetes and hypertension diagnostics in healthcare facilities.

Table of Contents

Chapter One: Introduction ………………………………………………………………….… 1

    Purpose statement ……………………………………………………………………………. 2

    Research objectives ………………………………..…………………………………………. 3

Chapter Two: Review of the Literature …………………………………………………….… 4

    Prevalence of diabetes and hypertension in Uganda ………………………………..…..……. 4

    Awareness of disease status ………………………………..…………………...……………. 5

    Diagnostic criteria for diabetes and hypertension in Uganda …………………………..……. 6

    Access to diagnosis of diabetes and hypertension in Uganda ………………………..………. 7

    Barriers to diabetes and hypertension diagnosis in Uganda …………………………………. 8

    Factors associated with diabetes and hypertension in Uganda ………………………………. 9

    Geographical distance and disease ………………………………………………...…..……. 11

    Conceptual framework ………………………………..……………………...…………..…. 12

Chapter Three: Methods …………………………………………………………………...… 15

    Data ………………………………………………..………………………………..………. 15

    Study setting …………..…………………………..……………………………..…………. 15

    Study population …………………………………..…………………………..……………. 16

    Ethics …………………………………..…………..…………………………………..……. 16

    Variables …………………………………………..……………………………………..…. 17

         Participant characteristics ………………………………...………………………..……. 17

         Socioeconomic factors ……………………………………………………..……………. 18

         Diabetes status variables ………………………….………………………..……………. 18

         Hypertension status variables …………………………….…………………..…………. 20

         Geographical distance variables ………………………….……………..………………. 20

    Statistical analyses ………….……………………..…………………………..……………. 21

Chapter Four: Results ………………………………………………………………..…….… 23

    Characteristics of study participants ………………………………………………..………. 23

    Characteristics of study participants by diabetes status ……………………….....…………. 25

    Characteristics of study participants by hypertension status …………………….....………. 28

    Geographical distances from homes to healthcare facilities ………………………..………. 31

    Models for the association of geographical distance from homes to healthcare facilities and   diabetes status ………………………………..………………….…………………..…………. 31

    Models for the association of geographical distance from homes to healthcare facilities and   hypertension status ………………………………..……………..………………..……………. 34

Chapter Five: Discussion ………………………………………………………..………….… 36

    Major findings ……………………………………..……………………………..…………. 36

    Socioeconomic Factors and Diabetes Status …………………………………..……………. 37

    Socioeconomic Factors and Hypertension Status ………………………………..…………. 37

    Geographical Distance from Homes to Healthcare Facilities and Disease Status ...……..…. 38

    Strengths and Limitations ………………………………..…..………………………..……. 40

    Conclusion ………………………………….……..………………………………..………. 41

    Public Health Implications ………………………………...………………………..………. 42

References ………………………………………………………………………..………….… 43

List of Tables and Figures

Figure 1. Study Conceptual framework ……………………………………………………….. 12

Table 1. Characteristics of study population ………………………………………..…………. 24

Table 2a. Distribution of characteristics of study population by diabetes status ………...……. 27

Table 2b. Distribution of characteristics of study population by hypertension status …..…….. 30

Table 3. Summary of distances from homes to healthcare facilities ………….……..……...…. 31

Table 4a. Multinomial logistic regression models of diabetes status …………………………. 33

Table 4b. Multinomial logistic regression models of hypertension status …………..…...……. 35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Journalism
Parola chiave	Diabetes diagnosis Uganda Socioeconomical factors Geographical distance Hypertension diagnosis Access to healthcare facilities
Committee Chair / Thesis Advisor	Dr. Jannie Nielsen, PhD, Emory University
Committee Members	Dr. Solveig A Cunningham, PhD, Emory University

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