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Improving type 1 diabetes management: considerations for a peer support network in Kigali, Rwanda

Fitzpatrick, Emily (2019) Improving type 1 diabetes management: considerations for a peer support network in Kigali, Rwanda. Master Essay, University of Pittsburgh.

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Background: As non-communicable diseases rise in low- and middle-income countries (LMICs), lack of access to care and social support become significant global health concerns. Collaborative work between the Life for a Child (LFAC) program and the Rwanda Diabetes Association (RDA) has improved access to treatment for youth with type 1 diabetes (T1D) in Rwanda. These youth, however, still face barriers in diabetes management. Youth with T1D need reliable methods for communicating problems which impair their continued treatment, and consistent social support from people who understand living with diabetes. Peer-support networks (PSN) are a way to address these social and clinical needs. Drawing on LFAC/RDA data and stakeholder insights, this project explores barriers youth face in diabetes management.
Methods: In June 2018, RDA data, previously collected between June 2009-February 2018, on 1,515 patients across the country were reviewed and analyzed to generate an updated LFAC/RDA registry as a baseline for planned future intensive follow up. Inclusion criteria were: seen in 2016/2017, aged <26yrs old, and received diabetes care primarily at the RDA. Youth were categorized as Kigali residents or out of area. Stakeholder interviews with the RDA and neighboring Tanzania Diabetes Youth Association (TDYA) were also conducted.
Results: Of 216 youth age eligible for the new registry, 9 (4.2%) had died and 26 (12%) were lost to follow-up leaving 181 registered youth, of whom 43 (24%) were non-Kigali residents. Stakeholder interviews indicate that barriers for diabetes management include stigma, lack of emotional support, job insecurity, food insecurity, transportation costs and access to medicine. An outline for expanding currently available peer support programs was developed.
Conclusion: This preliminary analysis provides evidence for the need of a PSN in Kigali that could be scaled up nationally. One objective of the new registry is more rigorous follow up which can be facilitated through a PSN. Peer support would also encourage youth engagement, communication among peers and provide direct social support. The public health significance of this paper is considerable: youth with T1D face high mortality and morbidity with the rising epidemic of diabetes in LMICs and the need for meaningful innovative solutions is paramount.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Fitzpatrick, Emilyemf96@pitt.eduemf96
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairOrchard, Trevororchardt@edc.pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberCostacou, Tinacostacout@edc.pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberDocumet, Patriciapdocumet@pitt.eduUNSPECIFIEDUNSPECIFIED
Date: 28 April 2019
Date Type: Submission
Number of Pages: 61
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 04 Oct 2019 22:04
Last Modified: 01 May 2022 05:15


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