MANAGEMENT OF TYPE 2 DIABETES MELLITUS BY DIABETIC CLIENTS IN NYANDARUA SOUTH SUB COUNTY KENYA
Introduction:
1.0 INTRODUCTIONrn1.1 Background to the StudyrnDiabetes is one of the commonest non-communicable diseases of the 21st centuryrnInternational Diabetes Federation 2013. In 2013 382 million people had diabetes globallyrnwith 90 of the cases being type 2 Diabetes Mellitus WHO 2013. In 2015 the globalrnburden of diabetes was estimated to be 415 million people with a global prevalence of 8.3rnand the IDF estimated that this figure was likely to rise to 642 million by the year 2040rnInternational Diabetes Federation 2015. This rise in Type 2 Diabetes Mellitus T2DM isrnassociated with demographic and social changes such as globalization urbanization agingrnpopulation and adoption of unhealthy lifestyles such as consumption of unhealthy diets andrnphysical inactivity International Diabetes Federation 2015. Type 2 Diabetes Mellitus andrnits associated complications have been reported to increase dramatically and this resulted inrn1.5 million deaths worldwide in 2012 WHO 2013. Globally in every six 6 seconds arnperson dies from diabetes which has resulted into 5.0 million deaths by 2015 InternationalrnDiabetes Federation 2015.rnAfrica has the fastest growth rates of overweight and childhood obesity which are risk factorsrnfor T2DM later in life Rossouw et al. 2012. The youth of sub-Saharan Africa arernparticularly vulnerable to T2DM due to a lifetime accumulation of risk factors such as earlyrnweight gain 0-5years childhood obesity malnutrition and sedentary lifestyle Azevedorn2008. While childhood diabetes mellitus cases were typically type 1 there has been a rapidrnincrease in the development of obesity-associated T2DM among children Tuei et al. 2010rnLee et al. 1995. Overall diabetes-induced deaths in sub-Saharan Africa significantlyrnincreased from 2.2 in 2000 to 6 in 2010 International Diabetes Federation 2012. Thesernrates were highest amongst persons between 20 and 39 years the most economicallyrnproductive members of peri-urban populations International Diabetes Federation 2009. Inrn2010 43 million children 5 years were overweight globally with 35 million of thesernchildren living in developing countries Rossouw et al. 2012.rnType 2 Diabetes Mellitus is rapidly emerging as a major health problem in Kenya making uprnover 90 of all reported cases of diabetes which is mainly caused by sedentary lifestylesrnChristensen et al. 2006.rnMany children and adolescents remain undiagnosed due to a lack of health education andrnservices as well as poor consensus of the diagnostic criteria of metabolic syndrome inrnchildren Mayosi et al. 2009. This delays initiation of treatment with the clients developingrnsevere complications Mayosi et al. 2009. Management of T2DM entails intensive lifestylernmodification for those at risk of diabetes and aggressive treatment for those with the disease.rnIneffective management of the condition increases the occurrence rate of chronicrncomplications of diabetes that the countrys health care system is ill-prepared for both inrnrecurrent expenditure and facilities KNDS 2010rn1.2 Statement of the ProblemrnA high proportion of undiagnosed cases of diabetes mellitus end up with irreversiblerncomplications imposing a huge economic burden to the individual family community andrnthe health care system International Diabetes Federation 2009. In 2012 diabetes resulted inrn1.5 million deaths worldwide making it the 8th leading cause of death The global burden ofrndiabetes was estimated to be 415 million people with a global prevalence of 8.3 and the IDF estimated that this figure was likely to rise to 642 million by the year 2040 IDF 2015.rnThe prevalence of diabetes in Kenya was 4.7 IDF 2013. The prevalence of T2DM inrnNyandarua South sub-County was 10.8 which was higher compared to the countrysrnprevalence MOH 2013. This raises a concern on the management of T2DM by diabeticrnclients in Nyandarua South sub-County.
Objectives:
1.3 Specific Objectivesrni. To establish the level of knowledge on recommended management interventions forrntype 2 diabetes mellitus among T2DM clients in Nyandarua South sub-County.rnii. To establish practices applied by T2DM clients in self-management of type 2 diabetesrnmellitus in Nyandarua South sub-County.rniii. To determine the influence of socio-demographic factors on management of type 2rndiabetes mellitus among T2DM clients in Nyandarua South sub-County.
Methodology:
2.1 Study DesignrnA descriptive cross-sectional facility based design was used. This design enabled descriptionrnof management of T2DM by the respondents at one point in time during the study withoutrninfluencing their behaviour in any way. The design was appropriate to the study becausernscreening enrolment management and follow up care for diabetic clients take place withinrnhealth facilities.rn2.2 Study Variablesrn2.2.1 Dependent VariablesrnThe dependent variable for the study was management of type 2 diabetes mellitus by T2DMrnclients in Nyandarua South sub-County Kenyarn2.2.2 Independent VariablesrnThe independent variables for the study included:-rni. Level of knowledge on management interventions for T2DM causes and signs ofrnpoor blood sugar diabetic diet foods that elevate blood sugar level body weightrnmanagement complications and their preventionrnii. Practices for management of T2DM blood glucose control use anti-diabetic drugsrnself blood glucose monitoring regular meal composition exercise and body weightrnmonitoring.rniii. Socio-demographic and economic characteristics of the respondents age genderrnmarital status level of education employment status and income levelrn2.3 Location of StudyrnThe study was carried out in Nyandarua South sub-County Nyandarua County. NyandaruarnCounty is located in the central part of Kenya with a total surface area of 3245.2km and arntotal population of 596000 KNBS 2013 The sub-County has two 2 main health facilitiesrnNorth Kinangop Catholic hospital and Engineer sub-County hospital. The facilities serve asrnthe main centres for provision of care and follow up services to diabetic clients includingrnmonthly clinical review health education weight and blood sugar monitoring and nutritionalrncounseling..4 Study PopulationrnThe study population included T2DM clients attending diabetic clinic for their monthly checkrnup. The clients were limited to the sampled health facilities North Kinangop Catholicrnhospital and Engineer sub-County hospital in the sub-County.rn2.5 Sampling ProceduresrnThe study was conducted in two 2 health facilities within Nyandarua South sub-County.rnPurposive sampling method was used in the selection of Nyandarua South sub-County. Thisrnwas due to the observed increase in the number of T2DM clients admitted with diabetesrnrelated complications. Probability proportionate to size PPS strategy was used to obtain thernnumber of respondents from each facility. Systematic random sampling method was used tornselect consenting respondents as they met the inclusion criteria until the required sample sizernfor the study was obtained. A sample size of 294 respondents was used.rn2.6 Data CollectionrnThe data collection tool for the study was a semi-structured questionnaire which soughtrninformation on the participants socio-demographic characteristics level of knowledge onrnrecommended management interventions for T2DM and management practices for T2DM.rnThe interviewer would introduce him/herself to the participant and having obtained anrninformed consent he/she would read out the questions to the participant as they were on thernquestionnaire and allow the participant to respond appropriately without any influence.rn2.7 Data Management and AnalysisrnAfter the data was collected it was cleaned for identification of incomplete or inaccuraternresponses. The data was then coded and entered in the excel software Microsoft office Excelrn2010 and exported into the Statistical Package for Social Sciences IBM SPSS version 20.0rnSPSS Inc USA for analysis. Descriptive statistics were computed to generate frequenciesrnmean median and standard deviation. Proportions for categorical data were computed whilernmean and standard deviation were reported for age. Chi-square test was used to examinerndifferences in proportions between socio-demographic variables and the dependent variable.rnA P-value of less than 0.05 P0.05 at 95 CI was considered significant for all statisticalrnanalysis. Bivariate analysis was computed to determine the association between socio-rndemographic characteristics and management of T2DM.rnTo determine the level of knowledge a Likert scale was used. Each correct response from therncluster questions was assigned a score of 1.0 and each incorrect score was allocated 0. Thernoverall score for each individual was calculated for all the nine 9 questions on knowledge.rnThe maximum expected score was 9. The cut off point was 5 out of the maximum 9. Thernoverall mean level of knowledge score on causes signs foods increasing blood sugarrncomplications prevention management interventions and whether one knew that T2DM isrncontrollable was computed. Anyone scoring less than 3 was termed as having poorrnknowledge between 4 and 5 as having average knowledge while above 5 was classified asrnhaving good knowledge. The results were summarized and presented in graphs and tables.rn2.8 Logistical and Ethical ConsiderationsrnThis study was approved by Kenyatta University Graduate School and ethical approval torncarry out the study was obtained from Kenyatta University Ethics Review CommitteernKUERC. Authority to conduct the study was sought from the National Commission forrnScience Technology and Innovation NACOSTI. Administrative authorization to carry outrnthe study was sought from administration of both North Kinangop Catholic hospital and Engineer sub-County in Nyandarua South sub-County. Informed consent was obtained fromrneach prospective participant prior to their participation in the study. Participants identityrnremained anonymous throughout the study to guarantee privacy. The study participants werernassured of confidentiality of the information they gave. Copies of signed consent forms werernkept in a lockable cabinet and access controlled by the researcher.
Findings:
Results:
Majority of participants 83.3 had never been screened for DM except at thernpoint of diagnosis. A small proportion of the participants 28 had good knowledge onrnT2DM management interventions. Practices applied by the clients in managing T2DMrnincluded diet exercise taking diabetic medications and monthly weight monitoring.rnConclusions made from the study are that there was low level of knowledge on T2DMrnmanagement interventions practices for management of T2DM that participants appliedrnincluded diabetic diet exercise drug therapy and weight monitoring though fairlyrnundertaken. Level of education and income significantly influenced clients management ofrnT2DM.
Conclusion:
Publication Information
Author(s):
Focus County(s):
Nyandarua County
Programme Area(s):
Non-Communicable Diseases
Research Priority Area(s):
diabetes
Disease Domain(s):
Diabetes
Document History:
Publication Date: 19.Jun.2019
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