factors hindering attitude to treatment among patients with type-2 diabetes mellitus in the niger...
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FACTORS HINDERING ATTITUDE TO TREATMENT AMONG PATIENTS WITH TYPE-2 DIABETES MELLITUS IN THE NIGER
DELTA, NIGERIA
by
AGOFURE OTOVWE
and
OYEWOLE OYEDIRAN E.DEPARTMENT OF HEALTH PROMOTION AND EDUCATION
FACULTY OF PUBLIC HEALTH
UNIVERSITY OF IBADAN
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Introduction• Diabetes is a chronic disease primarily defined by high levels of glucose in the
blood, giving rise to risk of tiny blood vessel damage
• It is the sixth leading cause of death worldwide, with mortality figure of 3.2 million annually (Morbidity Mortality Weekly Report, 2002)
• Type-2 Diabetes mellitus could be well managed if patients adhere strictly to treatment regimen
• However, patient’s attitude to treatment recommendations has been shown to influence level of adherence to treatment
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Statement of problem• Attitude to treatment recommendations rates are typically lower
among patients with chronic conditions (Jackevicius et al., 2002).
The observed reasons for these trends are:
-poor clinic accessibility and drug availability
-high costs of treatment and care
-inadequate supplies of trained staff and equipment
-use of alternative health care providers among others
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Justification
In view of the need to prevent or delay the development of diabetes complications, diabetic patients should be empowered to manage their illness better by:
• determining their attitude to treatment
• identifying possible factors hindering attitude to treatment
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ObjectivesBroad objective: To investigate factors hindering attitude to
treatment among patients with type-2 diabetes mellitus in the Niger Delta, Nigeria
Specific objectives:
• To determine attitude of type 2 diabetic patient to treatment
• To identify possible factors hindering adherence to treatment
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MethodologyStudy design: A descriptive cross-sectional design was adopted
Study population: The target population were all the type-2 diabetic patients aged 35 years and above that attended the out-patient diabetic clinic within the study period
Instrument for data collection: A semi-structured interviewer-administered questionnaire was used to collect the data
Sample size determination: An estimated sample size of 350 was calculated
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Methodology cont’dSampling procedure: Purposive sampling method was adopted
among all consenting patients
Data analysis: Data generated were analysed using SPSS version 15.0. Descriptive statistics was used to evaluate frequency distribution. Chi-square test and logistic regression were performed to test for associations between variables of interest with level of significance set at p<0.05
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Methodology cont’d• The attitude to medication treatment was measured by a 14-point scale graded;
partial (0-8) and strict (>8)
• While the attitude to dietary treatment was measured by a 4-point scale graded; partial (0-2) and strict (>2)
ETHICAL CONSIDERATION: The study followed the ethical principles guiding the use of human participants in research, which include Respect for persons, Beneficence, Non–maleficence and Justice
• Ethical approval was obtained from Delta State Ministry of Health
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Results• Table 1: Socio-demographic characteristics and attitude to
treatment
Note: Red coloured figures represents attitude to medication treatment
Black coloured figures represents attitude to dietary treatment
Variable (Age in years)
Frequency (%)N=350
Attitude to treatment Poor Good
45-54 104(29.7%) 33(9.4%) 34(9.7%) 72(20.6%) 71(20.3%)
55-64 113(32.3%) 40(11.4%) 45(12.9%) 73(20.9%) 68(19.4%)
Male 137(39.1%) 46(13.1%) 79(22.6%) 91(26.0%) 90(25.7%)
Female 213(60.1%) 76(21.7%) 86(20.0%) 137(39.1%) 134(38.3%)
Married 273(78.0%) 93(26.6%) 97(27.7%) 181(51.7%) 177(50.6%)
No formal education 34(9.7%) 13(3.7%) 12(3.4%) 21(6.0%) 22(6.3%)
Tertiary education 98(28.0%) 35(10.0%) 34(9.7%) 63(18.0%) 64(18.3%)
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Results cont’d• Table 2: Measurement of attitude to treatment
Attitude to treatment Frequency(%) N=350
Poor attitude to medication treatment 122(34.90%)
Good attitude to medication treatment 228(65.10%)
Poor attitude to dietary treatment 126(36.0%)
Good attitude to dietary treatment 224(64.0%)
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Results cont’dTable 3: Determinants of Poor Attitude to medication treatment
Variables df P-Value OR 95% CI
Desire to take many drugs for
treatment
1 0.004 2.08 1.268-3.406
Lack of faith in the efficacy of prescribed drugs alone
1 0.000 3.047 1.857-4.999
Urine test is not necessary if I take
my recommended drugs regularly
1 0.001 3.954 1.723-9.072
Routine blood test is not necessary if I take recommended drugs regularly
1 0.000 100.443 15.637-645.202
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Results cont’d
Table 4: Factors hindering attitude to treatment
Variables Frequency (n=350)(%)
Difficulty in sticking to recommended diet
242(69.1%)
Long queues and waiting times at the clinic
231(66.0%)
Side effects from recommended drugs
205(58.1%)
Burden of ingesting or injecting drugs
199(56.9%)
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CONCLUSION AND RECOMMENDATION
• Multiple drug combination as part of treatment regimen and compliance with prescribed diets are among the several factors hindering attitude to treatment recommendations among the study population
• Thus, patient counseling and health education on diabetic care with emphasis on improving attitude to medication and dietary treatment regimen should be organised regularly for diabetic patients among many other strategies
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REFERENCES
• WHO, 2008. Peer Support Programs in diabetes. A report of World Health Organization Consultation, 5-7 November 2007
• Morbidity Mortality Weekly Report, 2002. Social Economic Status of women with diabetes United States 2000. A CDC weekly Report, Retrieved October 19, 2008
• Jackevicius, C. A., Mamdani, M. and Tu, J. V. 2002. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. Journal of the America Medical Association 288:462-7.
• Beran, D. and Yudkin, J. 2006. Diabetes care in Sub-Saharan Africa. Lancet 368:1689-1695
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THANK YOU FOR YOUR ATTENTION