Knowledge and skills of clinical officers to manage patients with hypertension and type 2 diabetes mellitus at rural healthcare facilities in Kisumu county, Kenya

Abstract

While cost, inadequate supplies and training remain the major barriers to manage Non-communicable diseases (NCDs) globally, the knowledge and skill of clinical officers (CO) to manage patients with hypertension and type 2 diabetes mellitus (HTN&T2DM) remain poorly understood. This study investigated knowledge and skills of COs to care for patients with HTN&T2DM in rural healthcare facilities in Kisumu County, Kenya. The study determined ability to assess risk factors, examination, investigation, treatment, follow up patients and availability and use of resources. A total number of 146 [63 female (43.2%) and 83 males (56.8%)] COs were recruited into the study. The results showed that training in both hypertension and type 2 diabetes mellitus (OR=2.525, 95% CI; 0.708-9.006, P=0.153), knowledge of predisposing risk factors to HTN&T2DM (OR=9.256; 95% CI: 3.936-21.768; P<0.001), complete physical examination (OR=18.111, 95 CI; 1.433-228.884, P=0.025), ability to identify first-line medication for treatment of HTN (OR=2.116, 95% CI; 0.968-4.628, P=0.060) or T2DM (OR=5.250, 95% CI; 1.376-20.036, P=0.015), patient follow-up (OR, 18.627; 95% CI, 3.902-88.912; P<0.001) and availability of guidelines for the management of hypertension (OR, 21.339; 95% CI, 8.197-55.863; P<0.001) and diabetes mellitus (OR, 5.443; 95% CI, 2.290-12.934; P<0.001), simultaneous prescription anti-hypertension medication and advice on lifestyle modification strategies (OR, 10.305; 95% CI, 1.059-100.290; P=0.044) were all associated with the appropriate management of patients presenting with HTN&T2DM by clinical officers. In conclusion, COs’ knowledge of predisposing risk factors, physical examination, and knowledge of first-line medication, follow up strategy and access to guidelines are key to appropriate management of patients with HTN&T2DM. The study recommends COs to be trained on risk factors, physical examination and first line medications for HTN&T2DM to improve their performance and further, provision of follow up strategy and guidelines/protocol.