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Background: Diabetes is a chronic condition which requires many patients to use medications for the remainder of their lives. While this regimen is demanding, little research has been done on the experiences individuals have with diabetes medication use and the continuity of use, especially patients from rural areas of Tanzania. This study explores the lived experiences of diabetes medication use and the continuity of use among adult diabetes patients from rural communities with limited access to diabetes medicines. Methods: We conducted 19 in-depth interviews to explore patients’ experiences with diabetes medication use and the continuity of use. We employed the 5As of access to care to situate the behavioral practices surrounding diabetes medication use in the study settings. The data analysis followed grounded theory principles, and was conducted with the help of NVivo 9. Results: Study participants expressed positive attitudes toward the use of diabetes medicines, but also concerns about affordability. The patients employed two main strategies for dealing with the cost. The first was to increase their available funds by spending less money on family needs, selling household property, asking family and friends for money, or borrowing cash. They also reported sourcing medicines from pharmacies to save on consultation and laboratory costs. Second, participants reported using less than the recommended dosage or skipping doses, and sharing medicines. The geographic accessibility of diabetes service providers, the availability of medication, and the organization of the diabetes services were also cited as barriers to taking medications and to using them continuously. Conclusions: The strategies employed by the people in this study illustrate their resilience in the face of poverty and failing health care systems. More comprehensive strategies are therefore needed to encourage consistent medication use among people with chronic conditions. These strategies could includ

Background: Diabetes mellitus is an emerging public health problem in Tanzania. For the community and the health system to respond adequately to this problem, it is important that we understand the meanings given to its symptoms, and the care-seeking practices of individuals. Methods: To explore collective views on the meanings given to diabetes symptoms, we conducted nine focus group discussions with adult diabetes patients and members of the general community. To gain a better understanding of how the meanings in the community inform the care-seeking practices of individuals, 19 in-depth interviews were conducted with diabetes patients. The data were analyzed using principles of grounded theory and applying cultural schema theory as a deductive framework. Results: In the communities and among the patients, knowledge and awareness of diabetes are limited. Both people with diabetes and community members referred to their prevailing cultural meaning systems and schemas for infectious diseases to interpret and assign meaning to the emerging symptoms. Diabetes patients reported that they had initially used anti-malarial medicines because they believed their symptoms—like headache, fever, and tiredness—were suggestive of malaria. Schemas for body image informed the meaning given to diabetes symptoms similar to those of HIV, like severe weight loss. Confusion among members of the community about the diabetes symptoms instigated tension, causing patients to be mistrusted and stigmatized. The process of meaning-giving and the diagnosis of the diabetes symptoms was challenging for both patients and health care professionals. Diabetes patients reported being initially misdiagnosed and treated for other conditions by medical professionals. The inability to assign meaning to the symptoms and determine their etiologies informed the decision made by some patients to consult traditional healers, and to associate their symptoms with witchcraft causes. Conclusion: The meanings give

Background: Community participation has the potential to improve the effects of interventions and reduce inequalities in child growth. Multidimensional indicators capture such effects and inequalities. Objective: The objective of this study was to measure the association between multidimensional child growth and community participation in two nutrition-sensitive interventions. Methods: A multidimensional index of child growth (MICG) was calculated with the 5-years-old cohort of the Vietnam Young Lives survey. Young Lives is a unique dataset that has information on community participation in the design and implementation stages of two interventions: a health and a WASH intervention. Community participation during the interventions was recorded retrospectively with interviews at household level. Ordinary least squares and quantile regressions were estimated using data of 240 children. A multidimensional index of child advantage (MICA), sex, and location (urban/rural) were included as control covariates. Results: A positive association (post-hoc statistical power = 0.859) was estimated for community participation during the design stage of the WASH intervention, particularly for the most deprived children (p-value < 0.05). Negative effects were estimated for the health intervention during the design stage (p-value < 0.05) and no significant effects were found for community participation during the implementation stage of the interventions. Instead of the physical dimension, the significant associations in the design stage were related to the non-physical dimension of child growth. Inequalities in multidimensional growth were found for children living in rural areas, but not for female children. Conclusions: The association between community participation and multi-dimensional child growth is indicative of the importance of community participation during the design phase of interventions, in particular for the non-physical dimensions of child growth related to social an