130 Chapter 5 Table 4 - Sub-themes describing recommendations by healthcare workers with illustrative quotes (Eswatini, 2022) Sub-themes Illustrative quote NCD management guidelines “The guidelines (TB and HIV) are clear and good for me, but we need a clear guideline on the NCDs aspect because for now much attention is given to TB and ART forgetting about NCDs” R3 “I think the national guidelines of TB care are really good, and we refer to them a lot, and they have been updated I think around 2019, but we are struggling on the management of TB and, I feel like if there can be proper guidance to that aspect” R9 “… there should be a proper guideline on the NCDs aspect” R21 Healthcare worker training “… I am more equipped in DM; I think more training needs to be done in the area of NCDs since it is where most of us are lacking” R1 “I wouldn’t say I am well equipped on balancing TB and DM, my knowledge is mostly on TB hence I am lacking training on the DM aspect, thus I suggest that more training must be done on the DM aspect since I only know the general aspect of DM such that if I can face a patient who is critical with DM I wouldn’t know how to assist.” R2 “I suggest that there should be more training for healthcare workers, more in-service training is also important as well. I strongly suggest that facilities must be visited by the doctor at least twice a month” R17 Patient documentation tools “… the MoH needs to ensure that all the required tools (documentation) are available in the facilities as stipulated in the national guideline.” R6 Improve diagnostics “One can advise that screening TB patients for DM is important but not only using the random or fasting blood sugar but using the oral glucose tolerance test” R5 “I would also strongly suggest that the HbA1c test be made available to facilities, it is very accurate for diagnosing DM and also to monitor patients who are living with DM” R11 “… we also need the HbA1c test because for now, we are not doing the best care whether for TB or DM patients” R21 Drugs “…also availing the medication because it’s one of the many challenges that we see, one drug being available then the next day it’s not then you are supposed to use another drug that won’t help” R21 Patient support and Health Education “I think it (standard of care) can be improved, especially supporting the patients with food since some of them are facing diet issues” R13 “… health education, regardless of the shortage of drugs we have also noticed that patients are not eating well, and they must be taught about the importance of a balanced diet and that of exercise” R5 Discussion Most of our survey respondents (n=20) indicated they have integrated DM care into TB services, but the implementation varies as some services are not routinely available with frequent stock-out of essential medication and commodities required for the care of TB patients with NCD comorbidities (Figures 1 & 2). The participants indicated there are no standardized guidelines and SOPs for the management of TB patients with any of the NCDs including DM. The random/fasting blood glucose test was commonly used for screening and diagnosis, while there is limited access to HbA1c required to estimate glucose regulation in the past three months and follow-up. Participants were concerned
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