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ORIGINAL ARTICLE
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 151-157

Knowledge, attitude, and practices associated with type 2 diabetes mellitus among patients attending a tertiary health facility in North-East Nigeria


1 Department of Public and Community Health, Novena University, Ogume, Delta State, Nigeria
2 Department of Optometry, University of Benin, Benin City, Nigeria
3 Department of Health and Social Care, Waltham International College, Barking, United Kingdom
4 Department of Community Health, Taraba State College of Health Technology, Takum, Taraba State, Nigeria

Date of Submission28-May-2021
Date of Decision10-Jul-2021
Date of Acceptance10-Jul-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Dr. Otovwe Agofure
Department of Public and Community Health, Novena University, Ogume, Delta State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njecp.njecp_18_21

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  Abstract 


Background: Poor management of diabetes mellitus (DM) has resulted in increased morbidity and mortality among patients. Likely factors contributing to this trend include inadequate knowledge, attitude, and diabetes management practices among patients. Aim: This study was therefore designed to assess the knowledge, attitude, and practices associated with type 2 DM in patients attending Federal Medical Center, Jalingo Taraba State. Materials and Methods: The study was a cross-sectional study carried out among 286 type 2 diabetes patients selected purposively. A validated questionnaire was used to collect the data, and it comprised of four sections, namely sociodemographic characteristics, knowledge of DM, attitude toward DM, and DM management practices. The collected data were entered into IBM SPSS 23.0 and were analyzed using the descriptive and inferential statistics with the level of significance set at 0.05. Results: Most of the respondents 104 (35.62%) were aged 50–59 years and 163 (55.8%) were females. Besides, 89.0% of the respondents demonstrated good knowledge of DM, whereas 56.8% exhibited good attitude toward DM and 81.8% demonstrated good DM management practices. Knowledge of DM showed a significant association with attitude and practice of DM management (P < 0.05). Conclusion: Knowledge, attitude, and practice remain vital in the management of DM and prevention of complications. Therefore, more efforts must be channeled into improving and sustaining the knowledge, attitude, and practices of patients to improve their quality of life.

Keywords: Attitude, cross-sectional studies, diabetes mellitus, knowledge, Nigeria, patients, quality of life


How to cite this article:
Maiyaki TF, Odjimogho S, Okandeji-Barry OR, Agofure O, Enoch M. Knowledge, attitude, and practices associated with type 2 diabetes mellitus among patients attending a tertiary health facility in North-East Nigeria. Niger J Exp Clin Biosci 2021;9:151-7

How to cite this URL:
Maiyaki TF, Odjimogho S, Okandeji-Barry OR, Agofure O, Enoch M. Knowledge, attitude, and practices associated with type 2 diabetes mellitus among patients attending a tertiary health facility in North-East Nigeria. Niger J Exp Clin Biosci [serial online] 2021 [cited 2022 Jan 21];9:151-7. Available from: https://www.njecbonline.org/text.asp?2021/9/3/151/331550




  Introduction Top


Diabetes mellitus (DM) is defined as a metabolic disorder characterized by abnormal blood glucose levels as a result of deficiency in insulin secretion, insulin action or both.[1] Type 2 DM (T2DM) one of the types of DM represents over 90% of cases worldwide.[2] It is estimated that about 25% of the world population in both developed and developing countries is affected by DM.[3] DM could lead to enervating complications such as blindness, lower limb amputation, and premature death if not properly controlled.[4] The observed increase in DM has been attributed to behavioral and lifestyle changes such as sedentary lifestyle, overly rich nutrition, reduction in physical activities, and obesity.[5] Report shows that the biggest challenges experienced by health-care providers are the issues of addressing the continued needs and demands of individuals with DM.[6] Kheir et al.[7] revealed very poor adherence to treatment regimens due to poor attitude toward the disease and poor health literacy among the general public. The obvious postulation is that poor knowledge of DM is directly proportional to poor attitude and inadequate practices toward DM management. Thus, morbidity and mortality tend to reduce through improved knowledge of DM which directly influences the attitude and practices of patients with T2DM and also decrease the likelihood of onset of complications.[8] Consequently, patients who were knowledgeable about T2DM are more likely to take ownership of their condition and become involved in their treatment.[6],[8],[9],[10] However, a study reported poor knowledge of DM among patients in North-East Nigeria,[11] whereas other studies reported poor knowledge, attitude, and practices of DM.[12],[13] Therefore, the importance of knowledge, attitude, and practice toward DM management cannot be overemphasized and it is necessary to assess the knowledge, attitude, and practices toward DM among patients. Hence, the rationale of the study was to determine the knowledge, attitude, and practices associated with T2DM among patients attending Federal Medical Center (FMC), Jalingo Taraba State.


  Materials and Methods Top


Study design

A descriptive, cross-sectional design which utilized quantitative data was employed in the study.

Study area

This study was carried out in FMC which is the largest referral hospital within Jalingo metropolis and also a tertiary health facility.

Study population

The study population consists of T2DM patients from 30 to 70 years attending FMC Jalingo within the period of the study.

Inclusion criteria

The inclusion criteria were consenting T2DM patients aged 30–70 years, attending FMC Jalingo during the study period and are willing to participate in the study.

Exclusion criteria

The exclusion criteria were T2DM patients aged below 30 years and above 70 years and unwilling participants. Furthermore, excluded were patients with major additional life-threatening morbidity or complication that impairs their ability to understand the nature or purpose of the study. T2DM patients who met the eligibility criteria were identified, briefed on the objectives of the study, and selected purposively following verbal consent. All eligible consenting T2DM patients attending the FMC on the clinic days were enrolled for the study.

Sample size determination

The sample size was determined using the Cochran sample size formula. According to a similar study carried out by Adibe et al.[14]



Z = 95% confidence level or 1.96

P = 75.16% or 0.7516 knowledge of diabetes self-care

d = 0.05



Therefore, the sample size was 286 T2DM patients.

Sampling technique

The purposive sampling was used to select the study respondents who met the inclusion criteria.

Study instruments

The instrument for data collection was a pretested questionnaire comprising four Sections A-D. Section A assessed sociodemographic characteristics of the respondents, Section B assessed knowledge of DM, Section C assessed the attitude of the respondents toward DM and Section D determined the practices toward the management of DM among the respondents. Both interviewer and self-administered method of data collection was adopted to collect information from each respondent. The data were collected on clinic days after assuring selected subjects of their confidentiality and informed consent was obtained after explaining the objectives of the study to the participants. Overall 286 questionnaires were distributed, but only 284 were returned giving a response rate of 99.31%.

Data management and analysis

To improve the validity and reliability of the study, the questionnaire was pretested at Maitala Hospital Jalingo which runs a dedicated clinic for chronic conditions including DM. The pretest was done among 20 DM patients to assist in restructuring and validating the questionnaire. The Cronbach Alpha reliability test for the study was 0.974. Data retrieved from the questionnaires were analyzed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp). The analyzed data were presented in descriptive statistics, and Chi-square was used to test for the associations between the variables of interest at P < 0.05. A 9-point knowledge scale categorized: 0–5 as poor knowledge of DM and >5 as good knowledge of DM was used to measure the knowledge of DM among the respondents. Similarly, level of attitude toward DM was measured on a 7-point scale Graded 0–3 as poor attitude toward DM while >3 was graded good attitude toward DM. Further, practices toward the management of DM were measured on an 8-point scale Graded 0–4 as poor practices toward the management of DM while >4 was graded as good practices toward the management of DM.

Ethical considerations

Ethical approval for the study was obtained from FMC Jalingo. The study followed the ethical principles guiding the use of human participants in research including seeking informed consent from patients and maintenance of confidentiality.


  Results Top


Sociodemographic characteristics of the respondents

According to [Table 1], a little more than one-third of the respondents 104 (35.62%) were between the ages of 50–59 years followed by 60–69 years 78 (26.71%) and 40–49 years 64 (21.92%), respectively. Furthermore, more than half of the respondents 163 (55.82%) were females, whereas most 126 (43.15%) attained tertiary education and 181 (61.99%) were married.
Table 1: Sociodemographic characteristics of the respondents

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Knowledge of diabetes mellitus among the respondents

As shown in [Table 2], majority of the respondents 269 (92.12%) agreed that DM is caused by high sugar level in the blood while most 216 (73.97%) agreed that DM is hereditary and 249 (85.27%) agreed that DM causes excess glucose in the blood, urine, or both. In addition, almost one-third of the respondents 94 (32.19%) have been managing DM for more than 10 years while majority 245 (83.91%) affirmed that diabetes cannot be cured and 287 (98.29%) affirmed that there are medications for the treatment of DM. In addition, majority of the respondents affirmed to knowing the effect of healthy dietary habit while most 213 (72.95%) believe physical work and exercise is beneficial and more than half of the respondents 171 (58.56%) believes diabetes can be present without symptoms.
Table 2: Knowledge of diabetes mellitus among the respondents

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According to [Figure 1], majority of the respondents 89.0% demonstrated good knowledge of DM while 11.0% demonstrated poor knowledge of DM.
Figure 1: Knowledge of diabetes mellitus among the respondents

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Attitude towards diabetes mellitus among the patients

According to [Table 3], 63 (21.37%) of the respondents disagreed that they dislike been referred to as diabetic, whereas 73 (25.0%) disagreed that if they do not have diabetes they would have been quite a different person and almost half 140 (47.95%) strongly disagreed that diabetes is the worst thing that has ever happened to them. Furthermore, more than half of the respondents 150 (51.37%) disagreed that there is little hope of living a normal life with diabetes while 104 (35.62%) agreed that diabetic diet spoils their social life and 122 (41.78%) agreed that DM can be controlled by taking proper measures.
Table 3: Attitude towards diabetes mellitus among patients

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According to [Figure 2], more than half of the respondents 56.80% exhibited good attitude toward DM while 43.20% exhibited poor attitude toward DM.
Figure 2: Level of attitude toward diabetes mellitus

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Practices towards management of diabetes mellitus among the patients

As shown in [Table 4], most of the respondents 177 (60.62%) affirmed that they, the doctor, family were responsible for DM care while majority 239 (81.85%) affirmed that in the past 2 weeks there was no day they did not take their diabetic drugs and majority 245 (83.91%) affirmed that they have never stopped taking their medication without telling their doctor because they felt worse when taking it and 202 (69.18%) affirmed that when their glucose level is under control they do not sometimes stop taking their medicine. Furthermore, more than half of the respondents affirmed that they do not see it as a burden sticking to diabetes treatment plan while majority 240 (82.19%) agreed that they have never or rarely had difficulty in remembering to take their anti-diabetic medication and 86 (29.45%) affirmed that they engage in physical work or exercise once in a week.
Table 4: Practices toward management of diabetes mellitus among the patients

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According to [Figure 3], majority of the respondents 81.80% demonstrated good management toward DM while 18.20% demonstrated poor knowledge of management of DM.
Figure 3: Practices toward management of diabetes mellitus

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  Discussion Top


The study was designed to assess the knowledge, attitude, and practices associated with T2DM in patients attending FMC, Jalingo, Taraba State.

According to the findings of the study, majority of the respondents demonstrated good knowledge of DM. The observed knowledge in the study was higher than that of previous studies in Nigeria which reported below average good knowledge of DM.[11],[12],[15] Specifically, majority knew that DM was a disease caused by high sugar level in the blood, DM was hereditary and DM cannot be cured. This finding was similar to that of a previous study where the respondents demonstrated knowledge of DM.[16] In addition, most of the respondents had knowledge of DM complications. This is good as it would help the patients adopt healthy DM prevention practices to prevent developing DM complications. This finding was different from that of a previous study where only 13.1% had adequate knowledge of DM complications.[17]

Similarly, about 56.8% exhibited good attitude toward DM while 43.2% exhibited poor attitude towards DM. The finding was lower than that of a previous study where 75% of their respondents exhibited positive attitude towards DM.[15] The study was also similar to a previous study where about 50% of the respondents exhibited good attitude toward DM,[18] but was different from the findings of a previous study where 56.6% of the respondents exhibited poor attitude toward DM.[12] The differences in findings could be attributed to different study settings and designs. In addition, there was a significant relationship between knowledge of DM and attitude toward DM among the respondents. The finding was slightly different from a previous study which showed a weak correlation and nonsignificant relationship between knowledge and attitude toward DM.[15]

The finding of the study showed the respondents demonstrated good practice of DM management. This could be attributed to their knowledge and attitude toward DM. The finding was different from that of a previous study where 51% demonstrated poor practices of DM management.[12] The finding of the study was also higher than the level of practice from a previous study where 50% displayed good practice acceptable practice regarding DM.[18] Furthermore, there was a significant relationship between the knowledge of DM among the respondents and their practice toward DM management. This finding was similar to that of a previous study where respondents knowledge showed a significant association with practice toward DM management.[15]


  Conclusion Top


The study concluded although, good knowledge, positive attitude, and good practices were observed in a very high percentage among the respondents; few of the respondents demonstrated poor knowledge and negative attitude which may lead to poor practices. There is a need to educate individuals with diabetes to improve awareness and effort should be made to improve the process. However, the study recommends improving and sustaining the knowledge, attitude, and practices of DM management among the patients to improve their quality of life. Furthermore, there is a need for the Ministry of Health to develop diabetes education curricula for both patients and health care providers, by so doing patients would be supported all phases of the health-care system and not only when in attendance in the “specialist clinic.”

Acknowledgment

The authors appreciate all patients who voluntarily participated in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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International Diabetes Federation Atlas 2019. Ninth Edition. Available from: https://www.diabetesatlas.org. [Last accessed on 2021 Apr 22].  Back to cited text no. 1
    
2.
International Diabetes Federation Atlas 2017. Eighth Edition. Available from: https://www.diabetesatlas.org. [Last accessed on 2021 May 2].  Back to cited text no. 2
    
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Arumugam G, Manjula P, Paari N. A review: Anti diabetic medicinal plants used for diabetes mellitus. J Acute Dis 2013;2(3):196 200.  Back to cited text no. 3
    
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Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001;414:782-7.  Back to cited text no. 5
    
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Kiberenge MW, Ndegwa ZM, Njenga EW, Muchemi EW. Knowledge, attitude and practices related to diabetes among community members in four provinces in Kenya: A cross-sectional study. Pan Afr Med J 2010;7:2.  Back to cited text no. 6
    
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Kheir N, Greer W, Yousif A, Al Geed H, Al Okkah R. Knowledge, attitude and practices of Qatari patients with type 2 diabetes mellitus. Int J Pharm Pract 2011;19:185-91.  Back to cited text no. 7
    
8.
Ng SH, Chan KH, Lian ZY, Chuah YH, Waseem AN, Kadirvelu A. Reality vs illusion: Knowledge, attitude and practice among diabetic patients. Int J Collab Res Intern Med Public Health 2012;4:723 32.  Back to cited text no. 8
    
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Abdo NM, Mohamed ME. Effectiveness of health education program for type 2 diabetes mellitus patients attending zagazig university diabetes clinic, Egypt. J Egypt Public Health Assoc 2010;85:113-30.  Back to cited text no. 9
    
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Damasceno MM, Zanetti ML, de Carvalho EC, Teixeira CR, de Araújo MF, Alencar AM. Therapeutic communication between health workers and patients concerning diabetes mellitus care. Rev Lat Am Enfermagem 2012;20:685-92.  Back to cited text no. 10
    
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Sabo SY, Moh'd AS, Emenike VI. Assessment of diabetic patients' knowledge and understanding of diabetes mellitus in a north-eastern Nigeria tertiary hospital. SAJ Pharma Pharmacol 2019;6:104.  Back to cited text no. 11
    
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Odenigbo MA, Inya-Osuu J. Knowledge, attitudes and practices of people with type 2 diabetes mellitus in a tertiary health care centre, Umuahia, Nigeria. J Diabetes Metab 2012;3:187.  Back to cited text no. 12
    
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Ardeňa GJ, Paz-Pacheco E, Jimeno CA, Lantion-Ang FL, Paterno E, Juban N. Knowledge, attitudes and practices of persons with type 2 diabetes in a rural community: phase I of the community-based Diabetes Self-Management Education (DSME) Program in San Juan, Batangas, Philippines. Diabetes Res Clin Pract 2010;90:160-6.  Back to cited text no. 13
    
14.
Adibe MO, Aguwa CN, Ukwe CH, Okonta JM, Udeogaranya OP. Diabetes self care knowledge among type 2 diabetes outpatients in south eastern Nigerian. Int J Drugs Dev Res 2009;1:85 104.  Back to cited text no. 14
    
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Anakwue RC, Young EE, Ezenduka CC, Okoli CJ, Madufuro AN, Nnakenyi ID, et al. Assessment of patients knowledge and attitude towards diabetes and its relationship with glycemic control: A cross sectional study in a Nigerian tertiary hospital. Niger J Med 2019;28:46 55.  Back to cited text no. 15
  [Full text]  
16.
Mashige KP, Notshweleka A, Moodley S, Rahmtoola FH, Sayed SB, Singh S, et al. An assessment of the level of diabetic patients' knowledge of diabetes mellitus, its complications and management in Durban, South Africa. S Afr Optom 2008;67:95 105.  Back to cited text no. 16
    
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Obirikorang Y, Obirikorang C, Anto EO, Acheampong E, Batu EN, Stella AD, et al. Knowledge of complications of diabetes mellitus among patients visiting the diabetes clinic at Sampa Government Hospital, Ghana: A descriptive study. BMC Public Health 2016;16:637.  Back to cited text no. 17
    
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Mohammed AA, Hasan Al-Aaragi AN, Merzah MA. Knowledge, attitude, and practice regarding diabetic mellitus among a sample of students at technical institute of Karbala. Med J Babylon 2018;15:164-8.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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