Abstract
The study was designed to determine the prevalence and preventive measures of diabetes among child bearing mothers (CBM) in Owerri North LGA of Imo state from 2004-2013. To achieve these purpose seven specific objectives with corresponding research questions were posed and three null hypotheses were formulated. Ex-post facto research design using the retrospective survey was used for the study. The population for the study was 3560 childbearing mothers and 356 were selected as sample size through simple random sampling technique, also 20, 280 folders from the selected health facilities were used. Inventory proforma and questionnaire forms were used as instruments for the data collection, research formula for prevalence rate, percentage, frequency, counts, mean and chi-square statistics (X2) used for data analysis. The major findings of the study were that; the number of diabetic childbearing mothers in Owerri North LGA from 2004 – 2013 was 46, prevalence rate of Diabetes mellitus among Childbearing mothers in Owerri North LGA was at 2.3 per thousand, the trend of prevalence is fluctuating, the highest prevalence (41.3%) based on age was recorded between age of 40years and above, the highest prevalence (54.3%) according to parity occurred among Childbearing mothers of 4 and above. The highest prevalence of Diabetes mellitus based on level of education (37.0%) occurred among non-formal educated Childbearing mother.. The three null-hypotheses which stated that there were no significant difference in the prevalence of diabetes among Childbearing mothers according to age,parity and level of education respectively was tested using Chi-square at .05 level of significance and all were accepted [ (X2=26.595, P value =.873, df = 36, p=.05), (X2 value =14.810, P value =.675, df =18, p =.05),(X2 value =13.691, P value =.984,df =27, p =.05)].This study found low prevalence rate with fluctuating trend, which prompted the researcher to make some relevant recommendations such as establishing International Diabetes Federation in LGAs, making diabetic laboratory test free, creating awareness on diabetes prevention among childbearing mothers and establishing both secondary and tertiary health facilities with adequate specialists to manage the diagnosed diabetics childbearing mothers and their babies.
CHAPTER ONE
Introduction
Background to the study
Diabetes is one of the leading causes of death in the world over. World Health Organization (WHO) observed that in 2011, it resulted to 1.4 million deaths globally making it the 8th leading cause of death. Also International Diabetes Federation (2007) observed that between 8 and 14 million deaths are caused by diabetes every year in developing countries.In 2013, World Health Organization estimated that about 382 million people have diabetes world wide with Type 2 diabetes making up 90 percent of the cases, this is equal to 3.3 percent of global population. WHOfurther predicted that the number of people with diabetes is expected to rise up to 592 million by 2035.In United States, about 23.7 per cent adult population are diabetic. (American Public Health Association, 2008),and in Nigeria, not fewer than 6 million people have diabetes, especially Type2 diabetes. The above assertions indicated that there is increase in prevalence of diabetes globally and nationally.
Diabetes is described as an excessive discharge of urine due to disorder of the endocrine (hormone) system. It has two types, namely diabetes mellitus and diabetes insipidus. Diabetes Insipidus is defined as a disorder associated with malfunction of the pituitary gland that leads to pituitary imbalance. This study will concentrate mainly on diabetes mellitus which is often referred to as diabetes by medical doctors. Mullen (2000) defined diabetes mellitus as a condition where the body has difficulty in absorbing glucose from the blood and delivers it to the rest of body for its energy needs because of lack of insulin. Weller (2005) opined that diabetes is a metabolic disease characterized by excessive urination (polyuria), hyperglycemia resulting from defect in insulin secretion, insulin action or both. Also Onuzulike (2006) described it as a disorder in which the body cannot convert foods properly into the energy needed for daily activity. The author further described it as a medical condition characterized by chronic increase in blood sugar level and it is due to impaired production of insulin or impaired action of insulin. Gupta and Ghai (2007) asserted that diabetes is a chronic systemic disease characterized by hyperglycemia and glucosuria, resulting from defective B-cell function, diminished responsiveness to insulin or both. Furthermore Walsh and Crumble (2007) defined diabetes mellitus as a heterogeneous group of disorders of carbohydrate, fat and protein metabolism. According to them it is characterized by chronic hyperglycemia, degenerative vascular changes and neuropathy.
Diabetes is seen as a heterogeneous group of disease,Park (2009) opined thatit is characterized by a state of chronic hyperglycemia, resulting from a diversity of etiologies, environmental and genetic factors, acting jointly the underlying cause of disease is the defective production or action of insulin. Insulin is a hormone that controls glucose, fat and amino acid metabolism. Adebayo (2014) defined DM as a condition in which the amount of glucose in the blood is too high because there is not enough of the hormone insulin. Similarly, Medical News (2014) described diabetes mellitus as metabolic disease in which the person has high blood glucose either because insulin production is inadequate or because the body cells do not respond properly to insulin or both. The author further explained that patients with high blood sugar will typically experience polyuria (frequent urination), increasingly thirst (polydipsia) and excess hunger (polyphagia). Lastly, World Health Organization WHO (2014) defined diabetes mellitus as a chronic disease that occurs when the pancreas does not produce enough insulin or when thebody cannot effectively use the insulin it produces. This study will adopt WHO’s definition as the operational definition and types ofDiabetes mellitus were discussed below.
Diabetes mellitus is of two major types and the third is seen only during pregnancy. WHO (2007) classified diabetes into Type 1 or insulin dependent diabetes mellitus (IDDM), Type 2 or non-insulin dependent diabetes mellitus (NIDDM) and gestational diabetes. Type 1 diabetes is also referred to as juvenile or childhood onset diabetes. It is characterized by deficient insulin production, acute onsets and occurs before 30 years of age often before adulthood or during teenage years. Walsh and Crumbie (2007) asserted that Type 1 diabetes is caused by destruction of B-cell in the islets of langerhans of the pancreas. The destruction is due to autoimmune response associated with environmental and genetic factors. It accounts for approximately 10 percent of all cases. Treatment is often with administration of insulin injection. Another type of diabetes mellitus is Type2.
Type 2 is also known as non-insulin dependent diabetes mellitus (NIDDM) is characterized by insulin resistance, which may be combined with relatively reduced insulin secretion. Medical News (2014) revealed that approximately 90per cent of all cases of diabetes worldwide are of this type. It is typically a progressive disease, it gradually gets worse and the patient may probably end up having to take some medications that will improve insulin sensitivity or reduce glucose production by the liver. Often Type 2diabetes occurs after the age of 40years but can develop anytime in the adulthood. It develops as a result of genetic and environmental factors also obese people have much higher risk of developing Type 2 diabetes compared to those with a healthy body weight. Being physically inactive, taking the wrong foods and sugar sweetened drinks also contribute to risk of developing this type of diabetes. The risk is also greater as one gets older and having a close relatives who have suffered diabetes.
Gestational diabetes mellitus (GDM) is another type of diabetes that is first recognizedduring pregnancy especially during the third trimester of pregnancy. Walsh and Crumbie (2007) asserted that among pregnant women who suffer diabetes about 87.5 percentwere first recognized during pregnancy and the cause is pregnancy-related, while 7.5 percent are due to Type 1 and Type2diabetes is responsible for 5 percent. Park (2009) revealed that gestational diabetes is more among women whose country of birth were China, India and Asian than European and Northern African. Park (2009) further observed that in India GDM has been found to be common in women living in urban areas than in rural areas. Unfortunately Adebayo (2014) observed that Nigeria lacks an aggregate data of child- bearing mothers with diabetes.
Gestational diabetes affects females during pregnancy and disappears within 6 weeks of delivery, but many sometimes develop into Type2 diabetes in later life(Nordiquist, 2013). Thisis the key issue of this study, because it is only suffered by childbearing mothers.Wikipedia (2014) opined that recent data shows that GDM prevalence has increased by 16-27per cent in several race/ethnicity groups during the past 20years.Deboer, Baner, Georgieft and Nelson (2005) observed that during normal pregnancy many physiological changes occur, such as increased hormonal secretion that influence blood glucose levels, which can lead to increased excretion of glucose by the kidney and resistance of cells to insulin.Freinkel (2007) opined that gestational diabetes mellitus (GDM) results from women’s inability to secrete sufficient insulin to compensate for the increased nutritional needs of gestationand the production of anti-insulin hormones such as human placental lactogen, prolactin, cortisol and progesterone. The author further explained thatunder listedpeople may be at risk of GDM: small- for- date, large- for date at birth, very short or very tall women, children born by diabetic mothers, pregnant women with past history of gestational diabetes or type 2 diabetes, women of high cholesterol and high degree of obesity. Finally he asserted that GDM is thus a metabolic disorder similar to Type 2 diabetes mellitus.GDM is a form glucose intolerance diagnosed during pregnancy, according to National Institute of Health (2011) it is common among obese women and women with family history of diabetes mellitus. Also it was observed that immediately after pregnancy, 5-10 per cent of the women develop Type2diabetes mellitus. And between 35-60 per cent have the chance of developing DM in 10-20 years.
Childbearing mothers are women who are pregnant or have given birth and still in their reproductive age from 15-49years. They are most vulnerable in the society because of the life threatening challenges and death associated with pregnancy and childbirth. World Health Organization WHO (2009) stated that childbearing mothers should be the important target group in any government policy formation and implementation because of their vulnerability. The author further opined that the maintenance of adequate health of the childbearing mothers and infants is crucial to attainment of optimal maternal health and national development.Childbearing mothers here refer to mothers who are still pregnant up till 6weeks of post natal in Owerri North LGA. In the context of this study, some childbearing mothers develop diabetes due to alteration in production and secretion of pregnancies related hormones which are known as anti-insulin hormones. This can lead to difference in prevalence of DM among CBM and the prevalence of this disease varies depending on the environmental or genetic factors.
Prevalence, according to Weller (2005), means the number of persons who have a specific disease or condition that present in a defined population at one specific point in time. Lucas and Giles (2003) defined prevalence as the total number of casesexisting in a population at a specific period of time. Park (2009) described disease prevalence as all cases of a disease (old and new) existing at a given point in time or over a period of time in a given population. Onwasigwe (2010) defined prevalence of disease as number of people in population that have a disease at a given time,(old and new cases). This study will adopt Onwasigwe’s definition as its operational definition.This isbecause the research seeks to find out the number of childbearing mothers who are diabetic from 2004-2013 in Owerri North LGA.
Prevalence is of two types namely point and period prevalence. Point prevalence is the prevalence at a specific point in time, the specific point may be hour or week. And period prevalence is the prevalence during a given interval, the time interval is usually in months or years.Prevalence can be determined using rate and rate issaid to be measurement of the speed atwhich something happens or number of events within a certain period. In relation to disease condition, it means the number of times a particular disease occurs in a given population. According to Gupta and Ghai (2007) prevalence rate is measured by the number of people in population, who have a disease at a given time, and this includes both old and new cases and is obtained by a cross sectional studies. He further explained prevalence rate is determined by comparing number of existing cases (old and new) of a specified disease during a given period of time interval, over the estimate population at risk per 1000 population.
Prevalence rates are specifically important in chronic diseases. Park (2009) opined that it determines the total workload and is useful tool for health planning. Also it helps in expressing the magnitude of the problem in a community. Lastly periodic estimation of prevalence is useful in studying changes in pattern of disease. He noted that diseases with an acute onset and short duration have low prevalence rate than diseases with sub-acute onset and longer duration, such as diabetes, hypertension and other chronic diseases. This means that the prevalence rate depends upon the incidence and duration of illness, in other words, the longer the duration of the disease, the greater the prevalence.Direction of prevalence rate of diabetes for many years can be reviewed to know whether it is increasing or decreasing using trend.
Trend is defined by Weller (2005)as method of time series data (information in sequence over time). It involves the collection of data from multiple time periods and plotting the data on a chart. Trend shows a general direction in which something is developing or changing, it could be upwards, downwards or fluctuating. Upward trend means that there is steady increase in disease development. Downward trend indicated that there is continuous reduction in number of people affected by the condition. Also trend can be said to be fluctuating, when there is neither steady increase nor decreased condition. Trend when analyzed, will help in prediction of future conditions or outcomes. Trend in this study adopted Weller’s definition as its operational definition because the study intended to review prevalenceof gestational diabetes among childbearing mothers in Owerri North from 2004 to 2013. Trend on prevalence can be influenced by some variables, such as age, level of education, parity,location, marital status, income and many others. But the study will concentrate on age, parity and level of education.
Age according to Park (2009) is a strong contributory factor related to diseases because persons of both extremes of age tend to be most severely affected. The author further stated that chronic and degenerative diseases such as DM show a progressive increase in incidence with advancing age. Diabetes Care (2006) asserted that maternal age is an established risk factor for GDM. American Diabetes Association (2013) recommended that the lowest cutoff age at risk should be 25years and above, based on the research conducted by them.The report observed that the risk increases as maternal age rises in this order, 20-24 years, 25-29 years, 30-34 years, 35-39years, and 40years upward. This indicated that as childbearing mothers are advancing in age, there are at risk of developing gestational diabetes.
Level of education is another important variable that determines the prevalence of gestational diabetes among childbearing mothers.Zimmerman, Steven and Haley (2015) stated that there is a large gap in health statues between high and low education. The authors estimated that by 2011, the prevalence of diabetes mellitus had reached 15 per cent for adults without a high school education compared with 7 per cent for University graduates.Studyconducted by Kang and Park (2008) on influence of education on childbearing mothers’ knowledge revealed that the higher educated one is, the higher the level of knowledge.Therefore if the child bearing mothers are educated up to secondary level, they will have enough knowledge on health issues. This willenable them to adhere to medical instruction on their health and know the importance of regular antenatal care, laboratory investigation and good healthy habit.Since the above study indicated that level of education is related to level of knowledge, this iswhy this study seeks to know if level of education will have effect on prevalence of gestational diabetes among childbearing mothers. Therefore level of education in this studyrefers to academic attainment of the childbearing mothers, whether they attained primary, secondary, tertiary or non-formal education.
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