DIABETES AWARENESS AND MANAGEMENT IN SEMI-URBAN COMMUNITIES: A CASE STUDY OF ENUGU STATE UNIVERSITY TEACHING HOSPITAL

ABSTRACT

Diabetes mellitus is a rapidly growing non-communicable disease burden in Nigeria, particularly in semi-urban communities where awareness deficits, limited healthcare access, and cultural barriers to disease management intersect to create poor health outcomes. This study examines the level of diabetes awareness and management practices among patients and community members in semi-urban communities served by Enugu State University Teaching Hospital (ESUTH). A cross-sectional mixed-methods study was conducted among 350 participants comprising diabetic patients, caregivers, and community health workers, utilising validated questionnaires, in-depth interviews, and clinical record reviews. The findings showing that 61.4% of respondents had poor awareness of diabetes symptoms and risk factors, and only 38.2% of known diabetic patients demonstrated adequate self-management practices. recommendations for community-based diabetes education programmes, strengthened health system linkages, and culturally sensitive patient empowerment strategies. This study provides critical evidence for improving diabetes care in semi-urban Nigeria and contributes to the broader discourse on non-communicable disease management in resource-limited settings.

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

In 2021, the IDF cited that there were approximately 537 million adults aged 20-79 years living with diabetes mellitus in 2021, representing 10.5% of the global adult population (IDF, 2021). The economic burdens of diabetes are enormous, with the worldwide health spending due to the illness amounting up to USD 966 billion in 2021. In addition to direct costs of health care, diabetes has colossal indirect costs in the form of lost productivity, early disability, and the burden of caregiving (Bommer et al., 2018).

Diabetes mellitus refers to a category of metabolic disorders characterised by chronic hyperglycaemia caused by defects in insulin secretion, insulin action or both (American Diabetes Association [ADA], 2022). The disease has multiple manifestations, the main ones being Type 1 diabetes mellitus (T1DM), Type 2 diabetes mellitus (T2DM), and gestational diabetes, with T2DM occupying about 90-95 percent of all cases worldwide (International Diabetes Federation [IDF], 2021). Diabetes and its complications, such as diabetic retinopathy, nephropathy, neuropathy, and cardiovascular disease, are a significant cause of global morbidity, mortality, and economic burden, with the disease alone claiming about 6.7 million lives in 2021 alone (IDF, 2021).

The region is in the midst of one of the fastest-growing diabetes epidemics in the world, with the IDF projecting that the number of people living with diabetes in the region will almost triple between 24 million in 2021 and 55 million in 2045 (IDF, 2021). As the most populous African country, Nigeria has a disproportional share of this burden, with national estimates of diabetes prevalence ranging between 1.7% and 7.1% of the adult population based on the diagnostic criteria and study population selected (Ogbera and Ekpebegh, 2014; Uloko et al., 2018). According to more recent estimates, the actual burden might be even greater because of a large percentage of undiagnosed cases, especially in the semi-urban and rural settings where screening facilities are available only to a limited extent (Adeleke et al., 2022).

Semi-urban communities, which are characterised by a combination of urban and rural traits such as partial access to healthcare services, a mix of economic activities, and transitional patterns of diet and lifestyle are especially susceptible to the twin burden of underdiagnosed diabetes and inefficient disease management. Most of these communities lack the specialist care, diagnostic infrastructure, and patient education resources found in larger urban centres, and do not share the mostly subsistence-based physical activity patterns that can protect rural populations against type 2 diabetes (Akinpelu et al., 2022).

Enugu State University Teaching Hospital (also known as ESUTH) is a major referral hospital in the semi-urban communities in Enugu and environs such as Ebonyi, Anambra, and Kogi. The diabetes clinic at the hospital serves hundreds of patients each month and with whom no awareness and management practices have been studied. This research thus seeks to establish the research gaps in terms of diabetes awareness and management practices among people living in semi-urban communities where ESUTH is based.

The epidemiology of diabetes in Nigeria is changing rapidly with such factors as urbanisation, changing dietary patterns, physical inactivity and the ageing of the population. Instead, hospital based research has recorded high levels of undiagnosed diabetes and poor glycaemic control in those with diagnosed diabetes and less than 30% of the patients in most facilities were maintaining desired levels of HbA1c below 7% (Chinenye et al., 2019). The poor control drivers are multifactorial, including deficient patient education, economic constraints to medication and monitoring supplies, inconsistent attendance at the clinic, and cultural beliefs that prevent compliance with lifestyle modification recommendations.

Diabetes awareness or a knowledge of the causes of the disease, the signs and symptoms, the risk factors, complications, and the management strategies is an important pre-condition to the effective prevention and self-management. Surveys that have been conducted in different settings in Nigeria have recorded alarming gaps in the level of awareness of diabetes even in the seemingly educated settings (Okafor, 2012). With limited exposure to health education campaigns, usage of traditional medicine, and cultural beliefs attributing diabetes to spiritual causes or noodoo taboos instead of metabolic dysfunction, awareness deficits are compounded by limited exposure to health education campaigns, usage of traditional medicine, and cultural beliefs that attribute diabetes to spiritual causes or noodoo taboos rather than metabolic dysfunction (Okonkwo & Okafor, 2021).

The catchment area of ESUTH includes populations with a rapid socioeconomic transition, with an increasing incidence of western dietary patterns, decreased activity, and even higher rates of obesity - all of which are known risk factors of T2DM. The data of the diabetes clinic in the hospital indicate a substantial lack of awareness and self-management, but no systematic research based in the facility is available. This paper fills this gap in a holistic manner.

1.2. STATEMENT OF THE PROBLEM

Although the burden of diabetes is increasing steadily in Nigeria, there are huge gaps that remain unaddressed in terms of awareness and management practices especially in semi-urban communities. Deficits in diabetes awareness at ESUTH and the communities it serves directly translate into late diagnoses, inadequate glycaemic control, high rates of preventable complications, and high healthcare expenditures on individuals, families and the health system. Late presentation and with complex complications such as diabetic foot ulcers that require amputation, end-stage renal disease, and proliferative retinopathy is not uncommon, implying a very poor awareness and management at a community level.

The particular contours of diabetes awareness deficit/es (in terms of symptom recognition, risk factor knowledge, self-monitoring practices, dietary management, or medication adherence) have not been systematically recorded within the semi-urban catchment communities of ESUTH. Moreover, the factors that facilitate or hinder successful diabetes self-management in such an environment, such as health literacy, socioeconomic capacity, social support networks, and healthcare provider-patient communication, have been ill characterised.

As long as there is no clear understanding of these awareness and management gaps, the design and implementation of specific diabetes education and management support programmes to semi-urban populations in Enugu State will not be optimal one. This research will fill these noticeable knowledge and practice gaps with a passionate empirical enquiry that will offer a background of evidence-based interventions.

1.3 OBJECTIVES OF THE STUDY

The broad objective of this study is to assess diabetes awareness and management practices in semi-urban communities served by ESUTH. The specific objectives are to:

1. Assess the level of diabetes awareness (knowledge of symptoms, risk factors, and complications) among community members and patients in ESUTH's catchment area.
2. Evaluate the self-management practices of diabetic patients attending ESUTH, including dietary adherence, physical activity, medication compliance, and self-monitoring.
3. Identify the socio-demographic and psychosocial factors associated with diabetes awareness and self-management practices in the study population.
4. Examine the barriers to effective diabetes management among patients in semi-urban communities served by ESUTH.
5. Recommend evidence-based strategies to improve diabetes awareness and management in semi-urban communities in Enugu State.

1.4 RESEARCH QUESTIONS

This study is guided by the following research questions:

1. What is the level of diabetes awareness among community members and patients in ESUTH's catchment area?
2. How adequate are the self-management practices of diabetic patients attending ESUTH?
3. What socio-demographic and psychosocial factors are associated with diabetes awareness and self-management in the study population?
4. What barriers impede effective diabetes management among patients in semi-urban communities served by ESUTH?
5. What evidence-based interventions can improve diabetes awareness and management in semi-urban communities in Enugu State?

1.5 RESEARCH HYPOTHESES

The following null hypotheses are formulated for testing:

H01: There is no significant association between educational level and diabetes awareness among community members in ESUTH's catchment area.

H02: There is no significant relationship between health literacy and self-management practices among diabetic patients at ESUTH.

H03: There is no significant association between socioeconomic status and adherence to diabetes management protocols among the study population.

1.6 SIGNIFICANCE OF THE STUDY

This study holds significant value for multiple stakeholders in Nigeria's health system. For clinicians and health managers at ESUTH, the study's findings on diabetes awareness gaps and management barriers will inform the development of structured patient education programmes, peer support groups, and culturally adapted self-management support tools. These interventions can directly improve glycaemic control, reduce complication rates, and lower the cost of diabetes care at the facility.

For community health workers and primary healthcare personnel in Enugu State, the study provides a detailed profile of community-level awareness deficits that can guide targeted community outreach, health education campaigns, and diabetes screening initiatives. The identification of high-risk subgroups will enable more efficient resource allocation for diabetes prevention efforts in semi-urban settings.

At the policy level, the study's findings contribute to the evidence base needed to strengthen Nigeria's national NCD strategy, expand community-based diabetes care pathways, and ensure that semi-urban populations are not marginalised in the design of national health programmes. The study also enriches the academic literature on diabetes management in LMICs, contributing to global understanding of the challenges and opportunities in non-communicable disease control in transitional communities.

1.7 SCOPE OF THE STUDY

This study is conducted within the catchment area of Enugu State University Teaching Hospital, Enugu, encompassing both patients attending the hospital's diabetes clinic and community residents in selected semi-urban communities within Enugu North, Enugu South, and Igbo-Eze South Local Government Areas. The study is limited to adults aged 18 years and above. Data collection was conducted between March and August 2023. The study does not investigate Type 1 diabetes specifically, focusing primarily on Type 2 diabetes mellitus, which constitutes the vast majority of cases in the study setting.

1.8 DEFINITIONS OF TERMS

Diabetes Mellitus: A group of metabolic diseases characterised by hyperglycaemia resulting from defects in insulin secretion, insulin action, or both, diagnosed using fasting plasma glucose ≥7.0 mmol/L or 2-hour plasma glucose ≥11.1 mmol/L during an oral glucose tolerance test, per WHO/ADA criteria.

Diabetes Awareness: The level of knowledge an individual possesses regarding the definition, symptoms, risk factors, complications, prevention, and management of diabetes mellitus.

Self-Management: The individual's ability to manage symptoms, treatment, physical, psychosocial, and lifestyle changes inherent in living with a chronic condition such as diabetes, encompassing dietary modification, physical activity, medication adherence, and glucose monitoring.

Semi-Urban Community: A community that exhibits characteristics of both urban and rural settings, typically located on the periphery of urban centres with partial access to urban services and infrastructure.

Glycaemic Control: The degree to which blood glucose levels are maintained within target ranges, commonly assessed through HbA1c (glycated haemoglobin) measurement.

Health Literacy: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

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