Volume 12 (1), 2010

Knowledge Attitude and Practices of Women with Diabetes about their Disease.

Devgun P Singh Tejbir Deepti SS

www.ijmch.org

INDIAN JOURNAL OF MATERNAL AND CHILD HEALTH

To study the knowledge, attitude and practices (KAP) of women with diabetes about their disease. 1

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Knowledge Attitude and Practises of Women with Diabetes about their Disease.
Devgun P*, Singh Tejbir,**^, Deepti SS***^

*Assistant Professor, Deptt. Of Community Medicine, SGRDIMSAR ,Sri Amritsar. ** Professor,.*** Assistant Professor, ^Deptt. Of Community Medicine, Govt. Medical college, Sri Amritsar.

Correspondence Dr Priyanka Devgun Email drdevgunpriyanka @rediiffmail.com

ABSTRACT

Objectives: To study the knowledge, attitude and practices (KAP) of women with diabetes about their disease.

Setting: Urban Health Training Centre (UHTC) attached to the Department of Community Medicine, Govt. Medical College, Amritsar, Punjab. Period of study: March 2002- June 2003. Study design: Cross sectional.

Results: The current status of diabetes and the KAP of 81 women enrolled in the stipulated period were elicited. Key words: Women, diabetes, knowledge, attitude, practises

Methodology: A diabetes clinic was especially set up at UTHC to screen out women suffering from diabetes and on oral hypoglycaemic drugs for at least one year. A pre tested proforma was administered to such participants and a random blood sugar test was conducted to assess their diabetes status.

Sample size: 81 females suffering from diabetes for at least one year and taking oral hypoglycaemic drugs for the same.

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INTRODUCTION

Diabetes is emerging as a major health concern in both developing and developed countries. As the knowledge about diabetes is increasing, paradoxically, it is becoming more difficult to define diabetes. Perhaps, it can be best defined as a heterogeneous group of diseases characterized by a state of chronic hyperglycaemia resulting from diverse aetiologies, environmental and genetic factors working together. (1)

It is predicted that there will be 42% increase in diabetics in developing countries by 2025. (2) Worldwide, there are more female than male diabetics. Utilising the standard WHO criteria, 2.4% of the rural and 4-11% of the urban dwellers were found to be diabetic with the potential for further rise in coming decades. (3)

The present study was conducted to know the knowledge, attitude, practices (KAP) of women with diabetes which might give some insight into the future management of the disease. MATERIALS AND METHOD The present study was conducted at Urban Training Health Centre attached to the department of Community Medicine, Government Medical College, Amritsar between March 2002 to June 2003. A Diabetes Clinic was especially set up for the purpose of the study. Free blood sugar testing facility, health education on non pharmacological measures and advice on life style modification for better management of the disease was given in this clinic. A total of 250 diabetics who had the disease for least a year and who were on oral hypoglycaemic drugs were enrolled in the study after taking their formal consent. There were 169 males and 81 females in the study. The enrolled subjects were administered a pretested proforma to know their knowledge, attitude and practices about their disease and were subjected to a random blood sugar test to know their current status of diabetes. The data so collected were compiled and statistically analysed to reach certain conclusions Socioeconomic scale was calculated using modified Kuppuswami scale. (4) OBSERVATIONS AND DISCUSSION

Table I: Distribution of Subjects according to Age Group. Age group 30-39 40-49 50-59 60-69 Total 70 and above N Percentage 08.6 18.5 51.9 17.3 100 03.7

07 15 42 14 81 03

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Majority of female diabetics were in the age group of 50-59 years followed by diabetics in the age group of 40-49 years. Table II: Distribution of Subjects according to Educational Status. Educational status Professional Graduate N Percentage 8.7 6.2 4.9 50.7

07 05 12 01 04 11 81

Intermediate High school Middle school Illiterate Total

41

14.8 1.2

Primary school

13.6 100

41 (50.7%) females enrolled in the study were graduates.

Table III: Distribution of Subjects according to Socioeconomic Status. Socioeconomic status Upper Upper middle Lower middle Upper lower Lower lower Total N Percentage 6.2 18.3 35.8 7.4 33.3 100

05 15 29 06 27 81

Modified Kuppuswami scale was applied to classify the socioeconomic status. 29 (35.8%) of the subjects belonged to lower middle class. Joslin reported that diabetes is a disease affecting extremes of socioeconomic status. The reason for the apparent contradiction in this study might be because the settings UTHC largely caters to middle class. (6)

INDIAN JOURNAL OF MATERNAL AND CHILD HEALTH,2010 Table IV: Family history of diabetes. Relation to diabetic Father Mother N

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16 05 22 04 37

Percentage 19.7 6.1 27.2 5.0

Paternal side Do not know

Maternal side

45.7

A large number of female diabetics 37 could not tell whether or not they had diabetes in their family. 3 females had diabetes in both the parents. Diabetes tends to run in families. A person with a family history of diabetes is 2-4 times as likely to develop diabetes as someone without a family history. (7) Table V: Opinion about Cause of Diabetes. Cause of diabetes N* 16 29 Percentage 19.7 35.8 37.0 2.4 7.4 3.7 3.7 1.2 6.1 *Multiple Responses Inheritance from parents was rated as the leading cause of diabetes followed closely by excessive sweet consumption. 24.6

Evil deeds in the past

Inherited from parents Stress/ Tension Drugs / disease Do not know Others

Excess sweet consumption 20 30 2 6 3 3 1 5

-Less physical activity -Obesity -Infections -Junk food

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Table VI: Distribution according to opinion about whether Diabetes is Curable or Controllable according to Educational Status. Belief Curable 9 Controllable 6 (18.2%) 39 (81.3%) Total

Up to intermediate Total

Graduate and above DF=1 =31.3

2

27 (81.8%) 36 (44.4%)

(18.7%) p<0.001

33 (40.7%) 48 (59.3%) 81 (100%)

45 (55.6%)

More literate female diabetics opined that diabetes is controllable while the lesser literate group believed that the disease is curable. This difference in opinion between the two literate groups was highly significant. Table VII: Distribution according to belief whether Diabetes is passed on to Children according to Educational Status. Belief Passed on 8 (24.2%) 45 (93.8%) 2=41.8 Not passed on 25 (75.8%) 28 (34.6%) 3 (6.2%) Total

Up to intermediate Total

Graduate and above

33 (40.7%) 81 (100%)

DF=1

53 (65.4%)

48 (59.3%) p<0.001

Diabetes can be passed on to children was believed by 8 of the lesser literate group and 45 of the better literate group. This difference in opinion between the two literate groups was highly significant. Table VIII: Distribution of Diabetics according to RBS (Random blood sugar) levels. RBS level Classification Uncontrolled Controlled N Percentage 67.9 100 32.1

<=200mg% >200 mg% Total

55 81

26

Over two third of the women were classified as having uncontrolled diabetes on random checking of blood sugar levels. 6

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Table IX: Distribution according to Efforts made to increase Knowledge about the Disease according to Educational Status Effort N Row %s 2 (6.1%) 34 (70.8%) 2=36.8 N Row % Total

Up to intermediate Total

Graduate and above

31 (93.9%) 45 (55.6%) 14 (29.2%) p<0.001

33 (40.7%) 48 (59.3%) 81 (100%)

DF=1

36 (44.4%)

The more literate group of diabetes made more effort to increase their knowledge about their disease and this difference is statistically significant. Table X: Distribution according to Resource used to increase Knowledge. Resource used Doctor Books N Percentage 25.9% 16.0% 2.5% 20.9% 22.2%

21 13 2 17 18

Other diabetics Internet

Relatives and friends

Table XI: Distribution according to Measures adopted to maintain Euglycaemia. Measure adopted Dietary advice Regular exercise N Percentage 28.4% 83.9% 50.6% 20.9%

Most favoured resource was the doctor followed closely by relatives and friends.

34

Regular medication Fenugreek, jamun

23 68 41

41.9%

Alternate medicine/ therapy bitter

gourd, 17

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Most of the diabetics relied on regular medication to be euglycaemic. 50.6% diabetics simultaneously tried alternate medicine and therapies. Only 28.4% females followed a regular exercise regimen to control their blood sugar levels. Table XII: Distribution according to the Knowledge about Complications of Diabetes. Diabetes affects organ/ organ N system Eyes Kidneys Heart Musculoskeletal system Urinary system Nerves Genital tract Percentage 83.9% 90.1% 45.6% 14.8% 80.2% 4.9% 41.9% 32.0% 22.2%

68 73 37 12 65 4 34 26

18

Gangrenous foot DO not know

In a study done by Rossing, it was found that 25-46% patients with diabetes developed clinically detectable nephropathy despite best management (8). Diabetes adversely affects the kidneys was known to 73 (90.1%) out of 81 female diabetics Loss of vision due to open angle glaucoma and cataract are more common in diabetics. (9)

42 (51.9%) subjects enrolled in the study were between 50-59 years of age. 41 (50.7%) of them were graduates. Of the 81 female subjects enrolled, as many as 55 (67.9%) had uncontrolled sugar levels on spot check. Diabetes was considered controllable, inheritable and efforts to increase knowledge about diabetes were significantly more by subjects who were graduates and above. Doctor was the most favoured resource to increase knowledge about diabetes by 21 (25.9%) followed by relatives and friends of diabetics as a source of information in 18 (22.2%) patients Stress and tension was rated as the leading cause of diabetes by 30 (37%) subjects followed closely by inheritance in 29 (35.8%) and excessive sweet consumption by 20 (24.4%). A large number 37 (45.7%) could not tell about any family history of the disease. When asked on measure to be followed to maintain controlled sugar levels, 68 (83.9%) chose regular medication and 41 (50.6%) opted for alternate therapies. Renal complications was cited as the most frequent complication by 73 (90.1%). There were 169 male diabetics in the study and the observations in males largely paralleled those in females with insignificant differences.

INDIAN JOURNAL OF MATERNAL AND CHILD HEALTH,2010 REFERENCES

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1. WHO Technical Report Series, No. 646, 1980.

2. King H, Aubert AE, Herman WH. Global burden of diabetes mellitus-Present and Future. Diabetes Care 1998; 21:1414-31. 3. Leowski JR. Prevalence and control of diabetes mellitus. Report of intercountry workshop, Dhaka, SEA/NCD/40, April 1998: 27-30. 4. RBI Annual Report 2001, RBI Bulletin, November 2001.

5. Singh H. Effect of extract of freshly sprouted fenugreek seeds syndrex NIDDM 1998:71-75. 6. Joslin EP. The prevention of diabetes mellitus. JAMA 1921; 76:79-84. 7. www.migeneticsconnection.org/Family%20Health%20History/diabetes%20fact%20c ard.pdf.

8. Rossing P, Jacobsen P, Parving HH. Unchanged incidence of diabetic nephropathy. Diabetes 1995; 44: 739-943. 9. WHO Technical Report Series, No. 844, 1994.