DIABETES SELF MANAGEMENT KNOWLEDGE AND FOOT COMPLICATIONS AMONGST TYPE 2 DIABETES PATIENTS AT JOOTRH, KISUMU COUNTY, KENYA

Transcription

1 DIABETES SELF MANAGEMENT KNOWLEDGE AND FOOT COMPLICATIONS AMONGST TYPE 2 DIABETES PATIENTS AT JOOTRH, KISUMU COUNTY, KENYA BY LUCY KAGEHA KAVINGUHA KRCHN, MSN

2 INTRODUCTION Diabetes mellitus is a chronic disease that is currently classified among the leading noncommunicable disease of public concern. Non communicable diseases, with diabetes being the lead cause, accounted for over 55% hospital admissions and 50% hospital deaths (HMIS, 2012)

3 Increasing trend in the prevalence of diabetes, 30 million in 1985, 230 million in 2006 to a projected 582million by 2035 (IDF, 2014).

4 STATEMENT OF THE PROBLEM Poor diabetes self management has been linked to increased complications Level of knowledge about diabetes self management amongst the diabetic population is unknown

5 Diabetes patients account for 70% of all lower limb amputations in Kenya (MOH, 2010). Though anecdotal evidence shows that there is high prevalence of foot complications, this is yet to be studied.

6 Foot complications Foot complicatio ns have the capacity to diminish a person s quality of life

7 Foot complications

8 Foot complications The risks of lifetime diabetes related complication could be as high as 25%

9 Foot complications

10 STUDY OBJECTIVE To examine the association between diabetes self management knowledge and foot complications

11 CONCEPTUAL FRAMEWORK INDEPENDENT VARIABLES DEPENDENDT VARIABLE OUTCOME SOCIODEMORAPHIC FACTORS clinical information Diabetes self management knowledge Foot complications Resources available

12 METHODOLOGY The study adopted a cross sectional descriptive survey design Study site was JOOTRH Target population was type 2 diabetes patients Data was collected using a researcher administered questionnaire. Diabetes knowledge was assessed using the diabetes knowledge test adopted from Michigan Diabetes Research Centre

13 Clean and completed questionnaires were entered into spss version 20. Chi square statistics was used to determine if there is any association between the variables P values were used to show significance of relationship or difference Significant P values were used as criteria for further logistic regression Odds ratio were also used to determine degree/ strength of association Results were presented in form of percentages, mean and bar graphs.

14 DEMOGRAPHIC CHARACTERISTICS The response rate was eighty one percent. 78% of the respondents were aged above 41 years with a mean age of 43 years, out of this 64% were males and 36% were females.

15 Demographic characteristics: Marital status Marital status Single Married Separated/Divorced Widowed 9% 10% 4% 77%

16 Demographic characteristics: level of education 45% 40% 35% 30% % 25% 20% 40% No formal education Primary secondary college 15% 33% university 10% 17% 5% 0% 3% Level of education 7%

17 RESULTS AND DISCUSSION Demographic Variables Knowledgeable Yes No OR Variable Characteristic N(%) N(%) (95% CI) P Value Age (Years) Below 50 29(72) 11 (28) Above 50 20(49) 21(51) ( ) Gender Male 36(69) 16(31) Female 13(45) 16(55) ( ) Marital status Married 43(69) 19(31) Not Married 6(32) 13(68) ( ) Primary and Below Level of education Secondary and Above 8(28) 21(72) ( ) (79) 11(21)

18 people with diabetes (>8years) were likely to be more knowledgeable (OR: 3.2; 95% CI ). Respondents who were aware of diabetic educators at JOOTRH were also more knowledgeable(p=0.001 OR; 8.3( ) than those who stated otherwise.

19 Logistic regression analysis of predictors of diabetes self management knowledge Predictor variable 95% C.I.for EXP(B) B S.E. Wald Df Sig. Exp(B) Lower Upper Age Sex M_Status Education Availability of Diabetic educator Constant

20 22.2% of the respondents had experienced a diabetic foot related complication. 72.2% who had a diabetes related foot complication were also not knowledgeable on diabetes self management.

21 Level of education (OR: 95% CI 0.26( , P value 0.01) Use of special foot wear (OR: 1.2; 95% CI , P value=<0.001), daily foot care (OR: 0.12; 95% CI , (P value=<0.001) Availability of diabetes educators (OR: 0.07; CI , P value =<0.001) significantly influence development of foot complications.

22 RELATED STUDIES Similarly studies conducted by Xu, Pan, and Liu (2010) Perara and DeSilva, and Perara (2013), concluded that indeed patients who had secondary level education and above were more knowledgeable than their counterparts with primary education and below.

23 Contrary to the current study, the same study by Perara DeSilva (2013) concluded that females were more knowledgeable than their male counterparts. This difference might have been brought about by the fact that majority of the respondents in my study were males(64%)

24 However a study by Abdo & Mohamed (2010), revealed significant low levels of knowledge among females (31%), not educated and older age knowledge (78% and 72%). Similarly, a study by Abu-Qamar (2014) diabetes self management knowledge was a key component in the prevention of foot ulceration, which was one of the most common causes for hospitalization for patients with Type 2 diabetes.

25 Jalilian, Motlagh, Solhi and Gharibnavaz (2014), self-management participation is vital to success in the treatment of diabetes, which demands motivation, knowledge and compliance to a difficult and complex lifetime regimen.

26 CONCLUSION The study therefore concludes that patients at JOOTRH are knowledgeable on diabetes self management and that knowledge of diabetes self care is dependent on knowledge of diabetes, however more efforts are needed to realize 100% of the patients being knowledgeable as opposed to the current 60.5%. The study further established that development of foot complications was associated with the patients knowledge on self care.

27 RECOMMENDATIONS Diabetic educators should give diabetes management health education every day before patients see clinicians. The study recommends more intensive foot care education with subsequent follow up either through telephone call or home visit as most patients who developed foot complications reported examining their feet only at the clinic. The study also recommends that the government of Kenya through Ministry of Health should ensure adequate capacity building and training of diabetes specialists. This will increase knowledge of patients and subsequently reduce number of foot complications

28 THANK YOU.