Magnitude and Factors Associated With Drop Out of Care Among Children in Long Term Care at Kenyatta National Hospital Diabetic Clinic Between 2012- 2022

Abstract

Background: Diabetes Mellitus being a chronic disease, DM patients require close monitoring and long term follow up for optimal glycemic control. Suboptimal glycemic control leads to multisystem complications. DM can be divided in two main groups: type 1 and type 2. Other types are neonatal diabetes and maturity onset diabetes of the young. Type 1 is more common in children with a prevalence of 4.5% of the world population below 14 years old. The prevalence of LTFU in developed countries ranges between 5- 46% and in Kenya it is estimated at 31% in adults. There is limited data on prevalence of lost to follow up in paediatric patients in general and more so in diabetic patients as well as associated factors. Objectives: Primary: To determine the incidence and the factors associated with retention versus drop out of care among children<16 years with Diabetes mellitus who received care at Kenyatta National Hospital endocrinology clinic during a 10 year period-2012 to 2022. Secondary: To determine the reasons behind dropping out of care from Kenyatta National Hospital among those children who are traceable by telephone. To determine the perceptions of health care workers on facilitators and barriers to retention in care for diabetic children in care at Kenyatta National Hospital Study design: We used a multi-design approach in which we conducted 1) a retrospective cohort study to determine the incidence and factors associated with drop out of care by abstraction of medical records. 2) A descriptive cross sectional design was used to determine the reasons for drop out of care by semi structured interview of parents of LTFU children who were successfully reached through phone call. And we conducted FGD involving healthcare workers for facilitators and barriers to retention in care for diabetic children Method: We included all diabetics patients aged< 16 years followed up at the diabetic clinic in Kenyatta National Hospital between 2012- 2022 excluding those whose files were missing, those with one visit and those who do not give informed consent. For objective 1 and 2, we obtained sociodemographic and clinical information from the patient file. For objective 3, a phone administered questionnaire was used to interview the caregivers of children who had dropped out of care successfully traced. And for objective 4, we conducted focus group discussion for health care workers in diabetic clinic on barriers to retention in care. Ethical approval was obtained from both KNH ERC and the department of paediatrics. We calculated.......................................