Abstract:

Background: Diabetes is a chronic, lifelong condition that affects the body’s ability to use the energy found in food. There are three major types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes.

All types of diabetes mellitus have something in common. Normally, the body breaks down the sugars and carbohydrates in glucose. Glucose fuels the cells in your body. But the cells need insulin, a hormone, in the bloodstream in order to take in the glucose and use it for energy. With diabetes mellitus, either the body doesn’t make enough insulin, it can’t use the insulin it produces, or a combination of both.

Type 1 diabetes is also called insulin-dependent diabetes. It used to be called juvenile-onset diabetes, because it often begins in childhood. Type 1 diabetes is an autoimmune condition. It’s caused by the body attacking its own pancreas with antibodies. In people with type 1 diabetes, the damaged pancreas doesn’t make insulin. This type of diabetes may be caused by a genetic predisposition. It could also be the result of faulty beta cells in the pancreas that normally produce insulin.

Type 2 diabetes, the pancreas usually produces some insulin. But either the amount produced is not enough for the body’s needs, or the body’s cells are resistant to it. Insulin resistance, or lack of sensitivity to insulin, happens primarily in fat, liver, and muscle cells. By far, the most common form of diabetes is type 2 diabetes accounting for 95% of diabetes in adults.

Diabetes presents of multi-faceted challenge to health systems in Tanzania and beyond. Globally, diabetes prevalence is increasing and is responsible for 5% of all deaths annually (1). The 2010 diabetes prevalence is 285 million people and expected to increase to 438 million people by 2030 (2). Given current projections, without urgent action, mortality due to diabetes is expected to increase by 50% in the next 10 years (1). Sub-Saharan Africa, like the rest of the world, is experiencing an increasing prevalence of diabetes alongside other non-communicable diseases (3). In 2010 12.1 million people were estimated to be living with diabetes in Africa, and this is projected to increase to 23.9% million by 2030 (4). In Sub-Saharan Africa this trend is emerging in a region grappling with high rates of communicable diseases-including the highest global prevalence of HIV (5).

Diabetic patients often require a large number of prescription drugs and incur high out-of-pocket costs for medications and medical expenses. Several risk factors for cost-related non-adherence (CRN) have been identified, including lack of health insurance coverage, high out-pocket payment, comorbidities, and poor mental health. This study estimates burden of out-of-pocket expenditures for prescription drugs and the burden of these costs in relation to income among the diabetic patients attending clinic at Bugando medical centre.

Study Objective: To identify burden faced by patients with diabetes due to out-of-pocket medication cost and associated risk factors.

Methodology: In this cross section study, the study population will consist of all adults patients with diabetes treated with hyperglycemic medical care from diabetes clinic at Bugando medical centre hospital, respondents will report whether they had underused prescription medications due to cost pressures or had experienced other financial problems associated with medication costs such as forgoing basic necessities.

Results: A total of 350 participants eligible for the study were recruited. Majority of them (82.9%) were having insurance for their diabetes care cost. The most common source of income in small business is by 42.9% and majority had an average income ranging from 150,000 TSH to 200,000 TSH with an average cost of diabetes care more than 30,000 TSh per one month. Meanwhile the 31% had no income at all because some are retired, students or just house wives.

Conclusion: This study found that at Bugando medical centre diabetes clinic, few patients with diabetes underuse their medications because of out-of-pocket costs because most of them are covered with insurance. Diabetic patients’ perceptions of the costs and benefits of their treatment may contribute to their rates of underuse, along with the therapy’s actual financial burden