Assessment of Adherence to the Management Protocols and Equipment Availability in PIH Supported Health Centers of Kayonza District and their Implications on Disease Control in Hypertension and Type2 Diabetes.

Background:
Non-communicable diseases (NCDs), particularly hypertension and type 2 diabetes, are emerging health burdens in low- and middle-income countries. According to the World Health Organization, NCDs contributed 50% of total deaths occurred in Rwanda in 2019. The recent Stepwise NCD survey done in Rwanda in 2022 revealed that hypertension and diabetes burden are on the rise with prevalence rates of 16.8% and 2.9% respectively. Despite growing trends of the diseases, there is limited evidence on the status of quality of care in the service delivery in Rwanda. This study aimed at evaluating quality of hypertension and type 2 diabetes care in eight Partners in Health (PIH) supported health centers in Rwinkwavu catchment area through assessing the adherence to the management protocols, availability of resources and their implications on level of disease control in those facilities.

Methods:
A facility based cross sectional study was conducted using 314 patient records enrolled in the period of January 2022 to April 2024 from eight PIH supported health centers in the Rwinkwavu catchment area of Kayonza district, Rwanda. Guided by Donabedian (1988) quality of care assessment framework, the study focused on each single component in three domains of quality of care. A data extraction tool was developed guided by existing management protocol of hypertension and type 2 diabetes in Rwanda. Data was extracted from Electronic Medical Records, and missing information was completed using patient files and registries at health centers. Resource inventory in the facilities was done using a tool programmed in Redcap. Data was downloaded to Excel. All data were cleaned before processing for analysis. Descriptive statistics were used to summarize socio-demographics, resource availability, compliance to the process of care, and level of hypertension and diabetes control. Bivariate analysis was done to assess the association between compliance and disease control, and the association between dependent variables with independent variables. All data analysis was done using SPSS (IBMv.20.0) and p-value set at 0.05.

Results:
The study population was predominantly female (69.7%) and aged 65 years or older (46.8%). Hypertension was more prevalent (85.7%) than diabetes (8.9%) or comorbidity of both conditions (5.4%). Overall adherence to recommended processes of care was low, ranging from 21% to 23% across disease types. While 100% of hypertensive patients and 55% of diabetic patients met the minimum eight of twelve recommended number of visits, there were significant gaps in specific follow-up care elements. Disease control was achieved in 54% of diabetic patients and 42.3% of hypertensive patients. Resource availability varied, with basic equipment universally available but specialized tools often lacking.

Conclusion:
This study reveals gaps in adherence to care processes for the management of hypertension and type 2 diabetes in primary healthcare facilities in Rwanda. While some aspects of care show promise, there is substantial room for improvement in adherence to comprehensive management protocols. These findings highlight the need for targeted interventions to enhance NCD care quality, including standardized tools for patients’ data storage, robust monitoring systems, financing for human resources, capacity building and innovative care delivery models.