Fieldwork explores life with diabetes in Zanzibar

The social network plays a key role in diabetes patients’ decision making, new research finds.
A man with diabetes with his doctor and family during an interview in Kivunge, Zanzibar. Photo by Anna Knauer Elley
In Zanzibar, close family members often have a strong influence on the decisions people with diabetes make about their treatment – and how well they comply with that treatment. 
In response, the local health system should increase its focus on the role of family in diabetes patients’ care, acknowledging that patients are closely integrated in a larger social network in order to secure more effective treatment and better outcomes. 
These are among the key conclusions of fieldwork conducted in 2017 by Anna Knauer Elley and Lise Schou Andreasen, two researchers from the Institute of Medical Anthropology at the University of Copenhagen. The fieldwork was made possible by support from the NCD Support Programme Zanzibar, WDF11-593, which helped facilitate qualitative interviews, participant observation and focus group interviews with both patients and clinical staff.
Through close observation and in-depth interviews, the study hopes to provide new insights into how perceptions of diabetes, limited resources and other factors affect how people with diabetes select and deselect treatment options. 
Ms. Elley and Ms. Andreasen chose to focus on type 2 diabetes in Zanzibar because rising obesity rates are placing residents at increased risk of developing lifestyle diseases, and because the number of social studies within the field of diabetes in Zanzibar is still limited. 
“Our collaboration with the National NCD Programme has provided us with the unique opportunity to explore how residents of Zanzibar cope with the everyday struggles of life with type 2 diabetes,” Ms. Andreasen explains.  
“The aim is that our study will contribute to relevant discussions within regional diabetes research and also to provide thorough insight on how type 2 diabetes is locally managed and understood.”
Providing new insights
For an archipelago such as Zanzibar, where many citizens are greatly affected by limited resources, the increasing spread of NCDs is a major threat to the economic and social development of health care and the general wellbeing of the population. 
For this reason, in 2012 the Zanzibar Ministry of Health introduced an NCD programme with the support of WDF to inform residents about the health implications of changing lifestyles and diets on the archipelago, and improve NCD prevention and care. 
A close collaboration with NCD Programme Manager Omar Mwalim allowed Ms. Elley and Ms. Andreasen to gain insights into how people with diabetes navigate Zanzibar’s health care system. They also investigated why some patients combine clinical treatment with alternative forms of treatment, and found that this is often a result of encouragement from the social network or due to limited resources.
Ms. Elley and Ms. Andreasen expect to share their final findings in their Master’s thesis, which is set to be published in December 2018.
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