ABSTRACT
The study aimed at assessing the knowledge and
attitudes of diabetes clients on self-management practices in public hospitals
in the Upper West Region of Ghana. The research was a cross-sectional survey.
It adopted stratified sampling technique to select 201 respondents. A
questionnaire was used in the study for data collection with a reliability
coefficient of 0.8.The data was analysed using the SPSS version 21. The
findings of the study revealed that diabetic patients are highly knowledgeable
about the disease. Also to a greater extent patient demonstrated a positive attitude
toward diabetes. The study also revealed to a significant extent that patients
hadfew barriers regarding self-management practices. The clinics provided
several services to diabetic patients. It was also evident that diabetes
patients to a greater extent adhere to prescribed self-management practices.
There was also significant relationship between knowledge and attitudes of
diabetes clients and self-management practices. It further revealed that
demographic factors have no effect on self-management practices. Finally, there
was a significant difference among the hospitals and their self-management
practices.
CHAPTER ONE
INTRODUCTION
According to Berhe, Demissie, Kahsay and Gebru(2012), 60% of
all deaths globally are as a result of non-communicable diseases including
diabetes. It is further stated that 80% of deaths due to diabetes occur within
low and middle income countries, of which Ghana is no exception.This study is
related to several
previous works done by other researchers such as Rodrigues,,
Zanetti,, dos Santos, Martins, Sousa, & Teixeira(2009) on knowledge and
attitude: important component in diabetes education and that of Mohammadi,
Karim, Talib&Amani (2015) on knowledge, attitude and practices on diabetes
among type 2 diabetic patients in Iran.
Background to the Study
According to World Health Organization (WHO) (2014), Diabetes
mellitus (DM) is a chronic progressive metabolic disorder characterized by
hyperglycaemia mainly due to absolute or relative deficiency of insulin
hormone. Because of the hyperglycaemia, diabetes mellitus affects every system
of the body especially if maintaining a normal glucose level is not achievable.
There are three most common types of diabetes mellitus namely; type 1 diabetes,
type 2 diabetes and gestational diabetes (Berhe et al.,2012.). Type 2 diabetes
mellitus is mostly associated with resistance to insulin action and inadequate
secretion of insulin. It is characterized by hyperglycaemia and also associated
with several complications such as vascular, macro vascular and neuropathic
complications (Berhe et al.,2012).
A WHO (2011) Global status report on
Non-Communicable Diseases (NCDs), postulated that NCDs including type 2
diabetes mellitus (T2DM) will become the leading cause of death on the African
continent by 2030. There has been a drastic increase in the prevalence of type
2 diabetes over the past decades due to the perpetual increase in obesity
(Kyrou & Kumar, 2010). Adisa, Alutundu and Fakeye (2009) added that there
has been a continuous increase in the incidence of type 2 diabetes globally.
Diabetes mellitus seems to be a major emerging clinical and
public health problem. According to WHO estimates in 2007, 190 million people
suffer from diabetes world-wide and about 330 million are expected to be
diabetic by the year 2025 (Lorenzo, Williams & Hunt, 2007). It is the
leading cause of blindness, and lower-limb amputations. Concerning mortality,
adults with diabetes have rates of stroke and death from heart disease that are
about 2 to 4 times higher than adults without diabetes (Soderberg, Zimme,
&Tuomilehto, 2005). According to World Health Organization (2006), at least
171 million people worldwide suffer from diabetes and it is more prevalent in
developed countries. The American Diabetes Association (2006), reported about
20.8 million people with diabetes in United States alone, while in developing
countries, increase in prevalence is expected to occur especially in Africa,
where most cases are likely to be found by 2030. This increase in incidence of
diabetes in developing countries follows the trend of urbanization and
lifestyle changes including perhaps and most importantly a “Western – Style”
diet, WHO (2006).
The prevalence of diabetes mellitus
is high among populations in the Middle-East countries despite the fact that
all researchesshowed that diabetes remains under diagnosed in this part of the
region (Al-Adsani, Moussa, & Al-Jasem, 2009). Egypt had been estimated to
be the 9th country in the prevalence of diabetes in the world. Recent changes
in physical activity and dietary patterns have promoted the development of
diabetes and if different preventive and control activities are not adopted, by
the year 2025, more than 9 million Egyptians (13% of the population above 20
years old) will have diabetes (Tan, Yong, Wan, & Wong, 2007). In Nigeria
though no estimate of the individuals suffering from diabetes has been made, in
a recent screening exercise carried out in Warri and Sapeleinvolving 787
people, 65% were diabetic and hypertensive (Urhobo National Association of
North America, 2004). Also at University of Nigeria Teaching Hospital in Enugu
the number of patients that attend the Wednesday diabetic clinic is alarming.
According to Berhe et al. (2012), 85-95% of all diabetes
cases in high-income countries are Type 2 and that 90% of all diabetes cases in
Sub-Saharan
Africa including Ghana is also type 2. The 6th edition of the
International Diabetes Federation (IDF) Atlas (2013) reported that figures
regarding diabetes in Africa arequite startling. It stated that over 21 million
people within the ages of 20-79 years had diabetes with a prevalence rate of
5.1% and this figure is projected to double by the year 2035. This means that
currently, 1 in 20 adults have diabetes. It was estimated that the cost of
total diabetes related health expenditure was 4.5 billion USD and is expected
to increase to 6.4 billion USD by the year 2035. The report adds that 480,900 deaths in
Africa were diabetes related and 75.1% of these deaths are diabetes patients
under 60 years of age (Berhe et al., 2012).
Evidence of the dramatic costs of treating diabetes and its
complications were found in the CODE-2 study (Massi-Benedetti, 2002), which
reported the total direct costs of type 2 diabetes (T2D) to be 29 billion Euros
in 1998. Ten million people with T2D were noted in eight European Union
countries: representing up to 15 % of national health care spending.
Nevertheless an European Union audit conducted in 2006 revealed the
incompleteness of existing data regarding this problem, and moreover, the lack
of specific programs to address it. The rise in diabetes was generally
attributed to obesity, sedentary life style and unhealthy diets.
Finding by Shafer, (2000) on diabetes explained that itwas
characterized by a disorder in metabolism of carbohydrate and subsequent
derangement of fat and protein metabolism. Furthermore, disturbance in
production and action of insulin, a hormone secreted by the islets of
Langerhans in the pancreas wasalso implicated in the disease (Shafer, 2000). In
addition to insulin, aging, over weight and several other hormones affect blood
glucose level there-by preventing glucose from entering the cells (Clavell,
2005). This leads to hyperglycemia, which may result in acute and chronic
complications such as diabetic keto-acidosis, coronary artery disease,
cerebrovascular disease, kidney and eye diseases, disorders of the nerves and
others (Iwueze, 2007).
The management of diabetes poses a challenge to the medical
and nursing staff as well as to the patients themselves. Since diabetes is a
chronic disease, most diabetic patients need to
continue their treatment for the rest of their lives. The emphasis is usually
therefore, on the control of the condition through a tight schedule of blood
glucose and urine sugar monitoring, medication and adjustment to dietary
modification (American Diabetes Association, 2006; Iwueze, 2007). Such a
chronic condition requires competent self-care, which can be developed from a thorough
understanding of the disease process and the management challenges by the
patient and family members. This pre-supposes a need for some form of diabetes
education and counseling for the patient and family members. According to
Colbert (2007) educating and supporting diabetic patients in managing their
daily lives were important goals of diabetic patients care.
Unfortunately, about a third of the people suffering from
diabetes may not be aware of it early considering the insidious onset and
development (Iwueze, 2007). Regrettably too, many who were diagnosed with the
condition demonstrate fears about the future and a general distaste because of
the predominant misconceptions about the disease and its management. This is
heightened by the superstitious explanation of causation of diseases dominant
in Africa where most diseases are caused by “poison” and/or “evil spirits”.
Some of these problems highlighted could be taken care of if patients and
indeed the general public were exposed to diabetes education (Iwueze, 2007).
The report concerning Ghana by the International Diabetes
Federation (IDF) (2013) was much more serious. The report claimed that 440,000
adult populations in Ghana within the ages of 20-79 years had diabetes with a
national prevalence of 3.35% (1 in every 30 adults), and that the total cost of
diabetes per person was 148.4 USD. Eight thousand,
five hundred and twenty eight deaths in Ghana are diabetes related, of which
72.4% are diabetes patients under 60 years. According to WHO (2014), NCDs were
estimated to account for 43% of total deaths in Ghana of which diabetes
contributed 2%. Diabetes is also said to be among the top 4 causes of mortality
due to non-communicable diseases.
Problem Statement
While the Ghana Health Service (GHS) is highly focused on
mitigating infectious diseases, NCDs currently contribute significantly to
illness, disability and deaths in the country with diabetes, cardiovascular
diseases, cancers, and chronic respiratory diseases on the lead. It is
estimated by the National Diabetes Association that not less than 4 million
Ghanaians suffer from diabetes, three out of every nine Ghanaian across the
county. This has resulted in more than five thousand deaths every year (Kubi,
&Okertchiri, 2016).Also, a study by Shaw, SicreeandZimmet(2010) further
estimated a substantial increase in diabetic cases by 2030. The burden of
diabetes and other NCDs are projected to increase owing to a myriad of factors;
unwholesome lifestyles, ageing and rapid urbanization.
It was in response to this that the Ministry of Health (MOH)
introduced the Regenerative Health and Nutrition Programme (RHNP) in 2006 and
further developed a health policy which clearly prioritizes the promotion of
healthy lifestyles and healthy environments.
It is indicated in the Ghana Health Sector 2013 Program of
Work that there had been an increase in the incidence of non-communicable
diseases in the country. To avert this and also prevent unwarranted deaths, a
call was made to all and sundry to adopt a healthy
lifestyle and routine check-ups. The document also provided some core programs
that were to be undertaken to achieve the aims of the health sector of which
was to scale up and improve management of diabetes and hypertension (MOH,
2013).
Moreover, various researchers had attempted to explore
various dimensions of NCDs in the country, for instance whereas Aikins et al.
(2012) focused on lay representations of chronic diseases among rural and urban
Ghanaians, other such related studies channeled their focus on acceleration of
control and prevention of non-communicable diseases in Ghana, spatial
distribution of hypertension, pattern of cardiovascular disease mortality in
Ghana (Owusu-Sekyere, Bonyah, &Ossei, 2013; Bonsu 2013; Sanuade, Anarfi,
Aikins, de-Graft &Koram, 2014) without any targeting the Upper West Region.
Available records in the Upper West Region shows that
diabetes cases were 397 in the year 2011, 552 in the year 2012, 681 in the year
2013 and 761 in the year 2014. These demonstrated continuous increase in cases
since the year 2011. The record from January to December, 2014 also revealed
that cases were widely recorded in almost all the municipal and district
hospitals in the region as indicated;Waregional hospital=169, Lawra district
hospital=82, Nadowli district hospital=71, Jirapa district hospital=34, Nandom
district hospital=24 and Tumu district hospital=5 (Ghana Health Service (GHS),
2015). Despite the rising records of diabetes within the chosen study area, the
inability of diabetes patients to keep their glycaemic levels within the normal
range may be due to several factors including inadequate knowledge and poor
attitude regarding self-care management and inappropriate
application of already existing strategies to control diabetes by the care
provider (World Health Organization and Department of Non-communicable Disease
Surveillance, 1999). Nevertheless, not much is known regarding how the
knowledge and attitude ondiabetes affect self-care management practices of
diabetes patients among the citizens of Ghana.
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