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Knowledge towards diabetes and its chronic complications and associated factors among diabetes patients in University of Gondar comprehensive and specialized hospital, Gondar, Northwest Ethiopia
Diabetes mellitus (DM) is a complex disease that affects many organ systems, resulting in problems such as the deteriorating health of the population and rising health care costs. Awareness about diabetes and its complications is important to reduce diabetes-related morbidity and mortality. Thus, this study aimed to assess the knowledge of DM and its chronic complications and associated factors among diabetic patients in University of Gondar Compressive Specialized Hospital, Gondar (UoGCSH), Northwest Ethiopia.
Method
A cross-sectional study was employed at the diabetic care service of UoGCSH from August 1, 2021–September 10, 2021. Interview-guided self-administered questionnaire and a chart review were used for data collection. Univariate and multivariate logistic regression was computed to know the association between variables.
Results
The knowledge score regarding diabetes was 85.6% in this study whereas the knowledge score about the chronic complications of diabetes was 58.8%. Age being 26–45 years old (AOR = 0.333,95% CI:0.12–0.918), educational status being able to read and write (AOR = 0.253, 95% CI:0.094–0.683), duration of diabetes diagnosis greater than 10 years (AOR = 2.827, 95% CI:1.458–5.481), and occupational status of being a daily laborer (AOR = 2.531, 95% CI:1.030–6.221) were significantly associated with knowledge regarding chronic complications of DM.
Conclusion
This study demonstrated higher knowledge scores regarding DM and its chronic complications. Age, educational status, duration of diabetes diagnosis, and occupational status have a significant association with knowledge of subjects regarding chronic complications.
Diabetes mellitus (DM), also known as diabetes, is a severe chronic illness that occurs when the serum glucose levels in these patients are high because their body does not produce insulin, or only inadequately, or cannot use the insulin it produces.
DM is a complex disease that affects many organ systems, resulting in problems such as the deteriorating health of the population and rising health care costs.
The global escalation of diabetes is being influenced by the aging population, sedentary lifestyles, and poor diet, which is expected to triple the weight of the disease in the next 25 years. In addition, inadequate diabetes education and self-care practices contribute to poor glycemic control and complications such as diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, etc.
Elevated blood sugar levels cause widespread risk of cardiovascular disease by more than one mechanism, along with insulin resistance, inflammation, and endothelial dysfunction. In addition, accelerated blood sugar levels have been linked to a not uncommon number of different underlying metabolic threats, along with hypertension, dyslipidemia, and significant obesity. The risk is also strongly influenced by smoking and little physical activity.
In contrast, patients with excellent knowledge and understanding of diabetes can adhere to the principles of self-management and have documented better glycemic control along with better health outcomes.
Regarding optimum management of the problem, it requires an individual to be aware and be familiar with the nature and consequence of the disease, its risk factors, management, and chronic complications.
Diabetes-care practices and related awareness amongst type-2 diabetes patients attending diabetes OPD at a tertiary care hospital in southwestern Saudi Arabia.
Therefore, awareness regarding DM and its chronic complications has a crucial impact on good diabetic control which plays a key role in preventing diabetic complications.
DM is one of the most common conditions that healthcare professionals often face. Worldwide, the superiority rate among adults was predicted to be 4% due to DM in 1995 and is expected to rise to 5.4% by 2025.
An estimated 4.2 million adults and the elderly in the 20- to 79-year-old age group are projected to die from diabetes and its complications in 2019, the equivalent of one death every 8 s. Deaths Worldwide from all reasons in people in this age group almost half (46.2%) of diabetes-related deaths, some in the 20–79 age group, occur in people under 60, the current age group. This effect is characterized by premature mortality and diminished livelihoods from diabetes-related headaches. Diabetes also has a massive financial impact on countries, health structures and, while medical care needs to be financed “out of pocket”, for people with diabetes and their families.
Lower limb amputation in people with diabetes is 10–20 times greater now no longer unusual vicinity compared to people without diabetes. It has been predicted that, globally, a lower limb (or part of a lower limb), is misplaced to amputation every 30 s attributable to diabetes. 60 Foot ulcers and amputations are greater now no longer strange vicinity in low- and middle-income countries than in high-income countries.
People with diabetes who have foot ulcers bear fitness fees 5 incidences better than those without foot ulcers. Compared to humans with diabetes without foot ulcers, the value of care for humans with diabetes and foot ulcers is 5.4 incidences better within the 12 months of the primary episode and 2.6 incidences better within the 12 months of the second episode.
A study done in Addis Ababa reported that the overall mortality of hospitalized patients was 89 deaths (21.0%), and the main complications in the admission were diabetic foot ulcers and cardiovascular disease.
Knowledge of diabetes and its chronic complications can assist in early detection and reduction of the incidence of complications. The level of knowledge about chronic complications of diabetes among diabetics who visit UoGCSH has not been studied yet. A study that measures the baseline knowledge of the target population is the very first job to be performed for designing health education programs. Moreover, such a study is vital for the appropriate and efficient use of limited resources to address any health condition. Up to now, there are no studies that have been conducted regarding knowledge of chronic complications of diabetes among diabetes patients in UoGCSH. Thus, this study aimed to assess the level of knowledge of DM and its chronic complications and associated factors among diabetic patients in UoGCSH, Northwest Ethiopia.
2. Methods
2.1 Study design, period, and area
A cross-sectional study design was conducted in UoGCSH from August 1, 2021–September 10, 2021. The University of Gondar is one of the oldest and most well-established higher education institutions in the country and its hospital is found in Gondar town, Northwest Ethiopia, Amhara regional state; Gondar town is located at 738 km far from Addis Ababa to north and 180 km from Bahir Dar to north direction. UoGCSH is one of the oldest institutions in Ethiopia. UoGCSH contains the main referral hospital, in Keble 16. It has been producing several professionals since 1954. It is one of the centers of excellence in the country, especially concerning the health sector. According to the chronic outpatient department staff, it is estimated that 4000 diabetic patients come within three months. Diabetic patients in this hospital come for follow up especially on Tuesday and Friday to the chronic outpatient department.
Source population: This includes all diabetes patients who came to UoGCSH within the past one month.
Study population: This includes all diabetes patients who fulfill the eligibility criteria.
Inclusion criteria.
•
Diabetic patients who are on follow up
•
Age older than 18 years
•
Includes all patients initially diagnosed with DM.
Exclusion criteria.
•
The presence of gestational DM
•
Diabetes patients admitted to wards or critically ill patients
•
Those unable to answer the questionnaire because of dementia, psychosis or profound deafness were excluded from the study
2.2 Sample size determination, and sampling technique
Convenience sampling technique was employed to select participants who came to the chronic outpatient department of UoGCSH for routine medical checkups as well as a refill. So, using this sampling technique 320 subjects who came to the chronic outpatient department during the study period were recruited.
Were.
✓
n-is a sample size
✓
N-the total population size (it is estimated that 2700 DM patients visit the chronic outpatient department within the 3 months).
✓
e−is the acceptable sampling error at a 95% Confidence interval.
Assuming a 5% non-response rate sample size will be 365.
And using the correction formula as follows
nf = 320 is the final sample size.
Dependent variables: Dependent variables include; Knowledge towards DM and knowledge towards chronic complications of DM.
Independent variables: Independent variables include; age, sex, residence, marital status, occupation, educational status, income, duration since diagnosis as diabetic, family history, use of herbal medication, smoking status, and type of DM.
2.3 Operational definitions
•
Cardiovascular diseases (CVD): Diseases and injuries of the circulatory system: the heart, blood vessels of the heart, and the system of blood vessels throughout the body and to (and in) the brain; generally, refers to conditions that involve narrowed or blocked blood vessels.
Hyperglycemia: A raised concentration of glucose in the blood. It occurs when the body does not have enough insulin or cannot use the insulin it does have to turn glucose into energy. Signs of hyperglycemia include great thirst, dry mouth, weight loss, and the need to urinate often.
Assessment of the level and associated factors with knowledge and practice of diabetes mellitus among diabetic patients attending at FelegeHiwot hospital, Northwest Ethiopia.
Hypoglycemia: A low concentration of glucose in the blood. This may occur when a person with diabetes has injected too much insulin, eaten too little food, or has exercised without extra food.
Assessment of the level and associated factors with knowledge and practice of diabetes mellitus among diabetic patients attending at FelegeHiwot hospital, Northwest Ethiopia.
Knowledge scoring: Subjects who answer a question both in the general diabetes knowledge and knowledge regarding chronic complications get one if they answer it correctly and 0 if they did not get the correct answer.
Knowledge, attitude, practices and their associated factors towards diabetes mellitus among non diabetes community members of Bale Zone administrative towns, South East Ethiopia. A cross-sectional study.
Knowledge, attitude, practices and their associated factors towards diabetes mellitus among non diabetes community members of Bale Zone administrative towns, South East Ethiopia. A cross-sectional study.
Knowledge, attitude, practices and their associated factors towards diabetes mellitus among non diabetes community members of Bale Zone administrative towns, South East Ethiopia. A cross-sectional study.
Poor chronic complications of diabetes knowledge: A person who has a knowledge score of diabetes itself below the score of seven is regarded to have poor chronic complications of diabetes knowledge.
Good chronic complications of diabetes knowledge: A person who has a knowledge score of diabetes itself above the score of 7 is regarded to have good chronic complications of diabetes knowledge.
2.4 Data collection tool and data collection process
The data collectors were appropriately skilled in the data collection tool before data collection. Several published articles were reviewed to prepare the data collection tool.
Knowledge, attitude, practices and their associated factors towards diabetes mellitus among non diabetes community members of Bale Zone administrative towns, South East Ethiopia. A cross-sectional study.
Interview-directed self-administered questionnaires and a chart review were employed for data collection. Patients with diabetes mellitus who were unable to write and read were interviewed. The questionnaire was divided into 4 main sections including demographic information (age, marital status, gender, religion, and residence), socioeconomic information (educational status, work status, monthly income), diabetes history, and knowledge-related information. The collected data were checked and cleared every day for consistency and completeness before processing. During data gathering, three trained health professionals were recruited and supervised by two MSc graduate health professionals. Finally, the fulfillment and completeness of all questions were checked by the data collectors and principal investigator.
2.5 Data processing and analysis
The collected data was entered into Statistical package for social science (SPSS) version 20 and was analyzed. Descriptive statistics such as frequencies and percentages were used. A binary logistic regression was used to identify predictors of awareness of diabetes and its complications. On bivariable analysis, variables with a p-value < 0.25 were entered into a multivariable logistic regression model. p ≤ 0.05 were used to declare statistically significant variables in the final model.
3. Results
3.1 Socio-demographic characteristics of study subjects
Out of 320 subjects, 52.8% were males and 44.1% of the subjects were in the age group of 46–65 which accounts for most of the subjects. Regarding religion, most of the subjects were Orthodox 69.4% followers and most of the subjects were married 65.9%. The majority (74.7%) of the subjects were from urban areas. Of all participants, 24.1% were above high school but did not reach campus and 28.8% of the participants were housewives (Table 1).
Table 1Socio demographic characteristics of diabetes patients.
Of all participants, 37.8% were diagnosed as diabetics within the past 5 years and most of the subjects (74.4%) did not have a family history of diabetes. Regarding counseling programs of DM, 43.4% of the subjects never attended these sessions. Half (49.7%) of the subjects were on oral agents and dietary modification as their treatment. Regarding herbal medicine use, most of the subjects (83.8%) did not use herbal medicine and most of the subjects (84.7%) have their blood glucose checked in Hospitals. Regarding comorbid chronic conditions, 66.3% of the subjects were free from comorbidities and 94.7% were nonsmokers. Concerning complications, 73.4% of the participants had no medically confirmed diabetic complications and 63.4% of the subjects were type II diabetes patients (Table 2).
Most of the subjects (62.5%) did not know that diabetes can affect any part of the body. Most of the subjects (67.8%) knew family history as the leading risk factor of diabetes. Regarding symptoms of poorly controlled diabetes, tiredness was reported by 81.6% of the subjects and the leading health risk factor reported by most of the subjects was hyperlipidemia (79.1%). Regarding lifestyle modification, diet was reported by 95.3% of the subjects as an effective lifestyle modification strategy. The majority (95.9%) of study subjects think controlling blood glucose is crucial in their fight with diabetes and 48.1% think that blood pressure monitoring is essential (Table 3). Of all participants, 85.6% had a good awareness of diabetes mellitus (Fig. 1).
Table 3Knowledge about diabetes among diabetic patients.
Variable
Categories
Frequency (yes)
%
What is Diabetes?
Diabetes is a raised blood sugar only
123
38.4
Diabetes is a disease which affects any part of the body
3.4 Knowledge about chronic complications of diabetes
Most of the subjects (76.6%) know that nephropathy is a complication of diabetes, and 71.6% of them did know diabetic neuropathy and 92.5% of them reported diabetic retinopathy as a complication of diabetes. Heart diseases as a complication of diabetes were reported by 78.1% of the subjects and foot ulcer was reported as a complication by 91.3% of the participants. Hyposexual dysfunction was reported by 58.1% of the subjects as a chronic complication of diabetes and 87.5% of the subjects reported that hypertension can be caused by diabetes. More than half (66.6%) of the subjects reported numbness of the extremities and most of them (92.2%) contemplate that regular retinal examination is necessary. Most of the participants (95%) think foot care is essential and 93% of the subjects think wearing a tight shoe is not good. Half of the subjects think blood donation is not good for diabetics and 85.9% of the participants think that urinalysis is crucial (Table 4). Generally, 58.8% of the subjects had good knowledge of the chronic complications of DM (Fig. 2).
Table 4Knowledge about chronic complications of DM.
Variables
Frequency (correct)
%
Diabetes can bring kidney diseases
245
76.6
Diabetes can bring Neuropathy
229
71.6
Diabetes can bring Retinopathy (blurred vision)
296
92.5
Diabetes can bring heart diseases
250
78.1
Diabetes can bring Diabetic foot ulcers
292
91.3
Diabetes can bring Hypo sexual dysfunction
186
58.1
Diabetes can bring Hypertension
280
87.5
Have you ever felt loss of sensation in arms and legs
213
66.6
Diabetics should go for regular eye check-up
295
92.2
Diabetics should care for their toes and feet
304
95.0
Diabetics should not wear tight shoes
297
92.8
Diabetics should make regular visits to the eye doctor
276
86.3
Diabetics should not donate blood
160
50.0
Diabetics should check their renal function (urinalysis
3.5 Assessing whether or not patients are told by their physicians about risks and glucose-lowering methods of DM
Most of the subjects (54.10%) said that their doctor always tells them to lower their cholesterol and 63.80% of the subjects were always told to follow a healthier diet. Regarding physical activity, 48.40% of subjects reported that their doctor always told them to be physically active and 70% were also always told to lower their blood glucose levels. More than half (54.10%) of the subjects were always told to quit smoking. Blood pressure-lowering was told to 46.90% of the subjects by their physicians and 47.80% of the subjects were sometimes counseled on the need of losing weight to avoid diabetic complications (Fig. 3).
Fig. 3Assessing whether or not patients are told by their physician about risks and methods of glucose lowering methods of DM.
3.6 Assessment of patient perception toward diabetes mellitus complication
Of all participants, 38% feel that they have no risk of stroke, 31.9% of the subjects feel that they have some risk of kidney problems, 32.5% of them feel that hyperlipidemia poses a great risk at them, 27.8% of the subjects think that they were at a greater risk of hypertension, 28.1% of the subjects feel that they were at some risk for a heart condition, 29.7% of the subjects feel that no risk of heart attack, 40.9% of the subjects feel a great deal of risk, 40.6% also feel that they have a great deal of risk, and 38.1% feared that they have a great risk of limb amputation (Fig. 4).
Fig. 4Assessment of patient perception toward DM complication.
3.7 Factors associated with awareness of diabetes and its chronic complications
Age, educational status, residence, duration of DM, and work status were significant at 0.25 so they were entered into the final regression model. Age, educational status, duration of DM therapy, and occupational status showed a significant association with good knowledge at a 5% level of significance. So, people in the age group of 26–45 years were 66.7% (AOR = 0.333, 95% CI: 0.12–0.918) less likely to have good knowledge towards chronic complications of diabetes as compared to people less than the age of 25 years. People who can read and write were 74.7% (AOR = 0.253, 95% CI: 0.094–0.683) less likely to have good knowledge towards chronic complications of diabetes as compared to people who are unable to read and write. And people who are diagnosed with DM before 10 years were 2.827 times (AOR = 2.827, 95% CI:1.458–5.481) more likely to have good knowledge towards chronic complications of DM as compared to people whose first diabetes diagnosis did not reach 5 years. Finally, people who are daily laborers were 2.531 times (AOR = 2.531, 95% CI: 1.030–6.221) more likely to have good knowledge towards chronic complications of diabetes as compared to people who work as civil servants (Table 5).
Table 5Factors associated with awareness of chronic complications of DM among diabetic patients.
Variable
Knowledge status (n = 320)
OR (95% CI)
Poor N (%)
Good N (%)
COR
P
AOR
P
Gender
Male
68(40.2)
101(59.8)
1
–
–
Female
64(42.4)
87(57.6)
0.915(0.586–1.429)
0.697
–
–
Age
0.083
≤25
23(60.5)
15(39.5)
1
1
26–45
28(36.8)
48(63.2)
2.629(1.2–5.9)
0.018
0.333(0.12–0.918
0.034
46–65
57(40.4)
84(59.6)
2.26(1.1–4.7)
0.029
1.042(0.466–2.33)
0.919
>65
24(36.9)
41(63.1)
2.62(1.15–5.96)
0.022
0.909(0.459–1.799)
0.783
Education
0.022
0.052
Unable to read and write
40(55.6)
32(44.4)
1
1
Read and write
26(45.6)
31(54.4)
1.49(0.741–2.996)
0.263
0.253(0.094–0.683)
0.007
Grade 1-8
18(41.9)
25(58.1)
1.74(0.81–3.73)
0.157
0.505(0.192–1.328)
0.166
Grade 9-12
27(35.1)
50(64.1)
2.32(1.2–4.5)
0.013
0.476(0.178–1.275)
0.140
Higher education and Above
21(29.6)
50(70.4)
2.98(1.49–5.93)
0.02
0.742(0.322–1.714)
0.486
Work status
0.004
0.350
Civil servant
22(31)
49(69)
1
1
Merchant
20(31.7)
43(68.3)
0.965(0.46–2)
0.925
1.688(0.610–4.669)
0.313
Daily laborer
17(48.6)
18(51.4)
0.475(0.207–1.1)
0.80
2.531(1.030–6.221)
0.043
House wife
37(40.2)
55(59.8)
0.667(0.347–1.3)
0.225
1.754(0.618–4.979)
0.291
Farmer
36(61)
23(39)
0.287(0.139–0.593)
0.01
1.901(0.843–4.285)
0.122
Residence
Urban
88(36.8)
151(63.12)
1
1
Rural
44(54.3)
37(45.7)
0.49(0.294–0.816)
0.006
1.114(0.572–2.172)
0.751
Duration of DM
0.004
0.008
<5
60(49.6)
61(50.4)
1
1
5–10
48(43.6)
62(56.4)
1.27(0.756–2.134)
0.366
1.331(0.752–2.355)
0.327
>10
24(27)
65(73)
2.664(1.479–4.798)
0.001
2.827(1.458–5.481)
0.001
Family history of DM
0.816
Yes
28(43.1)
37(56.9)
1
–
No
95(40)
142(60)
1.119(0.643–1.95)
0.69
–
Unknown
8(47)
9(53)
0.851(0.292–2.486)
0.768
–
AOR (Adjusted odds ratio), COR (Crude odds ratio), N (Knowledge), CI (confidence interval) and P (Significance).
The crude odds ratio for the independent variables affecting diabetes knowledge was calculated; gender, age, educational status, work status, residence, and duration of diabetes were possessing significance below 0.25 were entered into the final regression model. However, there was no significant association in the final regression model between the participants' knowledge score regarding diabetes itself and the associated factors (Table 6).
Table 6Factors associated with awareness of DM among diabetic patients.
Variable
Knowledge status (n = 350)
OR (95% CI)
Poor N (%)
Good N (%)
COR
P
AOR
P
Gender
Male
29(17.2)
140(82.8)
1
1
Female
17(11.3)
134(88.7)
1.633(0.858–3.108)
0.136
0.584(0.235–1.453)
0.247
Age
0.09
0.114
≤25
10(26.3)
28(73.7)
1
1
26–45
12(15.8)
64(84.2)
1.905(0.737–4.923)
0.183
0.430(0.121–1.533)
0.193
46–65
14(9.9)
127(90.1)
3.24(1.306–8.039)
0.011
0.994(0.35–2.82)
0.990
>65
10(15.3)
55(84.7)
1.964(0.732–5.274)
0.18
1.636(0.638–4.196)
0.306
Education
0.602
Unable to read and write
12(16.7)
60(83.3)
1
1
Read and write
10(17.5)
47(82.5)
0.940(0.374–2.363)
0.895
0.317(0.076–1.323)
0.115
Grade 1-8
7(16.3)
36(83.7)
1.029(0.371–2.851)
0.957
0.358(0.09–1.423)
0.145
Grade 9-12
11(14.3)
66(85.7)
1.2(0.493–2.921)
0.688
0.384(0.095–1.547)
0.178
Higher education and Above
6(8.4)
65(91.6)
2.167(0.765–6.136)
0.145
0.486(0.145–1.630)
0.243
Work status
0.247
0.564
Civil servant
8(11.3)
63(88.7)
1
1
Merchant
6(9.5)
57(90.5)
1.206(0.39–3.69)
0.742
1.268(0.344–4.676)
0.721
Daily laborer
7(20)
28(80)
0.508(0.17–1.54)
0.231
2.704(0.802–9.118)
0.109
House wife
12(13)
80(87)
0.847(0.33–2.2)
0.732
1.64(0.462–5.827)
0.444
Farmer
13(22)
46(78)
0.449(0.17–1.17)
0.102
1.216(0.371–3.988)
0.747
Residence
Urban
30(12.6)
209(87.4)
1
1
Rural
16(19.8)
65(80.2)
0.58(0.3–1.14)
0.113
1.097(0.460–2.613)
0.835
Duration of DM
0.182
0.347
<5
23(19)
98(81)
1
1
5–10
12(10.9)
65(80.2)
1.917(0.9–4)
0.09
1.754(0.791–3.891)
0.167
>10
11(12.4)
78(87.6)
1.66(0.77–3.62)
0.199
1.538(0.646–3.659)
0.331
Family history of DM
0.553
–
Yes
9(13.8)
56(86.2)
1
–
No
33(13.9)
205(86.1)
0.998(0.45–2.21)
0.997
–
Unknown
4(23.5)
13(76.5)
0.522(0.139–1.96)
0.336
–
Legend- AOR (Adjusted odds ratio), COR (Crude odds ratio), N (Knowledge), CI (confidence interval) and P (Significance).
This study was conducted to assess the level and associated factors with knowledge of diabetes and its chronic complications. Most of (85.6%) the study participants had good knowledge regarding diabetes. This displayed higher when compared to a previous similar study conducted in Mangalore (35%),
A Cross sectional study to determine the prevalence of Diabetes Mellitus and its household awareness in the rural field practice areas of a medical college in Mangalore-A Pilot Study.
Knowledge of Diabetes and Diabetic Retinopathy Among Rural Populations in India, and the Influence of Knowledge of Diabetic Retinopathy on Attitude and Practice.
This difference can be explained by the studies done in Tarlai, Malaysia, Mangalore, and Sudan were only in rural societies while both rural and urban societies were included in the current study. The study showed that the mean (±SD) knowledge score of study subjects was 18.95(±4.50). This study had demonstrated a higher level of knowledge regarding diabetes as compared to studies done in Lebanon,
whose mean (±SD) knowledge scores were 2.34 ± 0.88 and 11.0 ± 3.32, respectively. The knowledge score of this study was also higher as compared to the study done in Bahirdar whose knowledge score was 12.71(±3.73).
Assessment of the level and associated factors with knowledge and practice of diabetes mellitus among diabetic patients attending at FelegeHiwot hospital, Northwest Ethiopia.
The finding of this study is higher when compared to the others. This is may be due to most of the study's participants (75%) residing in an urban area where there are organized diabetic facilities and almost half of the subjects are above high school in their educational status which may explains their higher knowledge scores.
In this study, more than half (55.6%) of the subjects thought that diabetes can affect any part of the body and is not characterized by raised blood sugar only. This is higher when compared to the study done in Bahirdar which was only 46.8%.
Assessment of the level and associated factors with knowledge and practice of diabetes mellitus among diabetic patients attending at FelegeHiwot hospital, Northwest Ethiopia.
81.6% of the subjects of this study reported tiredness to be the leading symptom of poorly controlled diabetes which was only 27% in the study done in Bahirdar,
Assessment of the level and associated factors with knowledge and practice of diabetes mellitus among diabetic patients attending at FelegeHiwot hospital, Northwest Ethiopia.
Which may be due to the fact that most of this study's participants are housewives and are prone to long and tiresome hours of household chores that they noticed being tired as a leading symptom. 79.1% of this study's subjects reported hyperlipidemia as a leading health risk factor of diabetes which was only reported by only 38.5% of the subjects of the Bahirdar study. This is due to the fact that 54.1% of this study's participants are always told to lower cholesterol by their doctors.
Regarding lifestyle modification, most of the subjects (95.3%) reported diet as a preferable lifestyle measure. However, a study conducted in Bahir Dar revealed that only 47.6% of the subjects reported diet as a preferable lifestyle measure.
Assessment of the level and associated factors with knowledge and practice of diabetes mellitus among diabetic patients attending at FelegeHiwot hospital, Northwest Ethiopia.
This difference may be due to the counseling of the participants to follow a healthier diet by their physicians in the current study. In this study, the majority of (75.3%) subjects believed that eating too much fat and sugar can lead to diabetes and this value was lower when compared to the study done in Nepal (78.8%).
More than half (67.8%) of the subjects of the current study believed that family history plays a key role in diabetes but this figure was lower when compared to the study conducted in Nepal (78.8%).
This is due to the fact that most of the participants of this study did not have a family history of diabetes.
Concerning chronic complications, 58.8% of the current study subjects had good knowledge towards chronic complications of diabetes this figure is higher when compared to the study's done in Addis Zemen (48.5%) (30), Ghana (45.9%),
This is due to the fact that most of the subjects in this study were from urban areas and almost half of this study participants were above high school that explains their high scores. However, compared to the Irish study,
whose score was 81.4% it was lower and this is clear that the Irish are mainly urban residents with higher educational status.
In this study, nephropathy was reported as a chronic complication of diabetes by 76.6% of the subjects. This figure is lower than a study done in Dhaka (98.6%),
the reason for the relatively higher values of this study was that most of the current study participants reported that they at least feel some risk of kidney problems. The majority (71.6%) of participants reported neuropathy as a chronic complication of diabetes which was higher than a study done in Dhaka,
This difference may be due to most of the current study subjects having some concerns regarding neurologic injury. Retinopathy was reported by almost 93% of the study subjects which was higher than studies done in Ghana (45.0%),
Diabetic foot ulcer was reported to be a chronic complication of diabetes by 91.3% of the participants which was higher than the studies conducted in Ghana,
This difference may be due to the fact that most of the participants in this study had a great deal of risk and feel some risk of the diabetic foot so that, these high figures are expected.
In the current study age, educational status, duration of DM therapy, and occupational status showed a significant association with good knowledge at a 5% level of significance. This finding is in line with the study conducted in Ghana.
Participants in the age group of 26–45 years were 66.7% less likely to have good knowledge towards chronic complications of diabetes as compared to people less than the age of 25 years. This may be due to getting more counseling in this age group when compared to younger age groups and people in this age group can retain the information when compared to the elderly.
Participants who were diagnosed with diabetes before 10 years were 2.827 times more likely to have good knowledge towards chronic complications of diabetes as compared to participants whose first diabetes diagnosis did not reach 5 years. This is probably due to the fact that these participants have lived a decade with diabetes and have heard better information regarding diabetes mellitus. Daily laborers participants were 2.531 times (AOR = 2.531, 95% CI: 1.030–6.221) more likely to have good knowledge towards chronic complications of diabetes as compared to participants who work as civil servants. This is probably due to the fact that most of the hypoglycemic episodes of diabetes were exhibited in individuals whose daily activities require strenuous physical activities.
4.1 Limitation of the study
As the study is cross-sectional and depends on self-reported assessment, under-reporting is more likely to occur. Moreover, during assessment of knowledge of patients on DM chronic complications, even though the interviewers carried out it carefully, respondents may have replied socially acceptable responses which may cause an overestimation of awareness of study participants.
5. Conclusion
This study has demonstrated a higher level of awareness regarding diabetes and its chronic complications. Age, educational status, duration since diabetes diagnosis, and occupational status have a significant association with the patient's awareness of chronic complications of diabetes.
5.1 Ethical consideration
The school of Pharmacy on behalf of the University of Gondar institutional ethical review committee provided ethical clearance with a reference number of SOP/262/2013. Upon this clearance, additional written informed consent was taken with included study subjects before the interview. Confidentiality of information was maintained by avoiding the recording of patients’ names and keeping the data anonymous. Finally, personal identifiers were excluded during the data presentation.
Availability of data and materials
Most of the data is included in the manuscript. Additional can be found from the corresponding author based on reasonable request.
Funding
No funding to report.
Declaration of competing interest
The authors declares that they have no competing interests.
Acknowledgment
We would like to acknowledge University of Gondar for material supports.
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