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Decentralization Matters: Association of Adherence to Treatment and Distance for the Management of Non-Communicable Diseases in Rural Tanzania

Author

Listed:
  • Paolo Belardi

    (Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania
    These authors contributed equally to this work.)

  • Noemi Bazzanini

    (Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania
    These authors contributed equally to this work.)

  • Francesca Cera

    (Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania)

  • Katunzi Mutalemwa

    (Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania)

  • Francesca Tognon

    (Doctors with Africa CUAMM, 35121 Padua, Italy)

  • Emmanuel Ndile

    (Muhimbili National Hospital, Dar-es-Salaam P.O. Box 65000, Tanzania)

  • Alessandro Mele

    (Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania)

  • Rehema Itambu

    (Doctors with Africa CUAMM, Iringa P.O. Box 11, Tanzania)

  • Rhoda Naftali

    (Tosamaganga Regional Referral Hospital, Iringa P.O. Box 11, Tanzania)

  • Bernard Kakala

    (Tosamaganga Regional Referral Hospital, Iringa P.O. Box 11, Tanzania)

  • Veronica Kayombo

    (Tosamaganga Regional Referral Hospital, Iringa P.O. Box 11, Tanzania)

  • Benjamin Mfaume

    (Tosamaganga Regional Referral Hospital, Iringa P.O. Box 11, Tanzania)

  • Bruno Ndunguru

    (Iringa District Council, Iringa P.O. Box 108, Tanzania)

  • Samwel Marwa

    (Iringa District Council, Iringa P.O. Box 108, Tanzania)

  • Mario Saugo

    (Doctors with Africa CUAMM, 35121 Padua, Italy)

Abstract

Since March 2019, a non-communicable diseases program has been established at hospital level, with enrollment and clinical reassessment every 6 months. Since July 2023, monthly enrollment and visits have also been conducted at health center level. This study aimed at assessing the adherence to scheduled follow-up visits following the decentralization of the integrated NCDs program from Hospital to Health Center level and investigate factors influencing follow-up adherence. The study was performed in a rural district in Iringa Region, Tanzania. Adherence was measured at both levels. Multivariate regression analysis was conducted to describe socio-demographic and clinical factors influencing attendance at the 6-month hospital-level visit. Among 2198 patients enrolled at the hospital level, weighted adherence over 42 months was 40.8% (95% CI 39.0–42.6%) at the 6-month visit. Multivariate analysis revealed that as the distance from the hospital increased, the probability of attendance decreased (OR 0.17; 95% CI: 0.08–0.39). Among 571 patients enrolled at the residence level, adherence over the first 10 months of program implementation was 91.6% (90.4–92.8%). The findings showed that distance was by far the most important barrier to follow-up adherence and suggested that decentralizing the program from the hospital to peripheral health centers may ensure high follow-up rates.

Suggested Citation

  • Paolo Belardi & Noemi Bazzanini & Francesca Cera & Katunzi Mutalemwa & Francesca Tognon & Emmanuel Ndile & Alessandro Mele & Rehema Itambu & Rhoda Naftali & Bernard Kakala & Veronica Kayombo & Benjami, 2024. "Decentralization Matters: Association of Adherence to Treatment and Distance for the Management of Non-Communicable Diseases in Rural Tanzania," IJERPH, MDPI, vol. 21(11), pages 1-14, November.
    • Handle: RePEc:gam:jijerp:v:21:y:2024:i:11:p:1506-:d:1519948
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    References listed on IDEAS

    as
    1. Maria Agata Miselli & Francesco Cavallin & Samwel Marwa & Bruno Ndunguru & Rehema John Itambu & Katunzi Mutalemwa & Monica Rizzi & Giulia Ciccarelli & Simone Conte & Stefano Taddei & Gaetano Azzimonti, 2021. "An Integrated Management System for Noncommunicable Diseases Program Implementation in a Sub-Saharan Setting," IJERPH, MDPI, vol. 18(21), pages 1-13, November.
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