Self-care, foot problems and health in Tanzanian diabetic patients and comparisons with matched Swedish diabetic patients

Abstract: The overall aim was to study self-care, foot problems and self-perceived health in 150 consecutively invited Tanzanian diabetic patients and to compare them with gender- and age-matched Swedish diabetic patients (n=150) from a middle Sweden area. The main study was cross-sectional and took place at a diabetes clinic in Dar es Salaam. All patients answered questions about their self-care satisfaction, diabetes knowledge and skills, and educational needs. Foot examination also included questions about foot-care and perceived foot problems. The patients' health was assessed using the SF-36 general health questionnaire. The Swahili version of SF-36 was pre-tested in 518 Tanzanian diabetic patients showing an acceptable validity and reliability. Glycaemic control was measured by HbA1c. The results indicated that 45% of Tanzanians and 43% of the Swedes reported satisfaction with their self-care. The Tanzanian patients reported that following doctor's advice was the most important factor necessary for feeling well, whereas the Swedish patients emphasised diet and exercise. Lack of drugs and education were reasons of dissatisfaction in the Tanzanian group, whilst the Swedes were dissatisfied with their own behaviour. None of the Tanzanians monitored their blood glucose themselves, whilst 50% of the Swedes did it on a daily or weekly basis. Significantly more Swedes than Tanzanians knew the interaction between insulin, food and exercises, and how to manage hyperglycaemia and hypoglycemia. The Tanzanians wanted more education about diabetes, treatment and injection technique, whereas the Swedes wanted education about psychological aspects of diabetes, foot-care and oral anti-diabetic treatment. Foot problems reported in the Tanzanian group were pain, numbness and pricking sensations, whereas the Swedes reported ingrown toenails, pain and fissures. Seven Tanzanians and one Swede had foot ulcers. Twenty Tanzanians and 103 Swedes reported to inspect their own feet. The Tanzanians had significantly poorer self-perceived health and glycaemic control than the Swedish patients. A follow-up study was performed with the Tanzanian group of patients after two years. Many patients did not return for the second investigation and 70 patients were re-assessed. They showed an improved self-perceived health and a significant decrease in HbA1c-value. In conclusion the results indicated that Tanzanian patients needed better access to a continuous and regular supply of diabetes drugs. Furthermore the Tanzanians' burden of diabetes influenced their possibilities to work, whilst Swedish patients were hindered in social activities. In both countries the importance of regular foot inspections of the patients' feet should be emphasised. Glycaemic control and self-perceived health seemed to be poorly related and for that reason diabetes nurse specialists need to use both measures in order to guide the patients towards the goals experiencing a good health despite having diabetes.