http://doi.org/10.33698/NRF0029 Bina Khongbuh, Indarjit Walia, Surinder Kapoor
Abstract : Prevalence of diabetes is increasing globally and developing countries including India have the maximum increase in the last few years. The prevalence of Type 2 diabetes is 11.6% in urban population, 5.9% in semi-urban population and 2.4% in rural population in India. The present study was undertaken in a rural community of Chandigarh to determine the prevalence of diabetes mellitus and treatment seeking behaviour among adult population. Overall 495 adults in the age group of 35-65 years were included in the study. A pre-tested semi-structured interview schedule and urine analysis for sugar by uristix method was used. For urine sugar positive subjects and those with history of diabetes, blood sugar analysis with glucometer was used. The findings revealed that presence of sugar in urine was in 8.7% of the subjects, and increased level of glucose in the blood was in 9.1% of the subjects. There were 36 (7.3%) subjects with history of diabetes. It was found that 93.3% of them sought treatment for their illness from practioner of different type of medicine. 63.4% went for follow up care when there was problem.
Introduction
Diabetes is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot
Key Words :
Diabetes mellitus, treatment seeking behaviour, adult.
Correspondence at :
Bina Khongbuh
National Institute of Nursing Education, PGIMER, Chandigarh, India.
effectively use the insulin it produces. WHO recognizes two main clinical forms, one in which the body makes very little or no insulin at all and is termed as Type 1 diabetes or Insulin Dependent Diabetes Mellitus (IDDM), which typically appears in childhood or adolescence, and the other in which the body makes insulin, but cannot use it properly, is known as Type 2 diabetes or Non Insulin Dependent Diabetes (NIDDM) which is mild and typically appears first in adulthood and is
exacerbated by obesity coupled with inactive lifestyle. Symptoms of diabetes like feeling tired and sick, frequent urination, excessive thirst, excessive hunger, and weight loss, can develop suddenly or gradually.1,2,3
The number of people afflicted by diabetes is increasing day by day. Today, 3 to 12 percent of the world populations have either established diabetes or the tendency of contracting it in the near futures.5 Prevalence of diabetes is increasing globally and developing countries such as India have the maximum increase in the last few years. Type 2 diabetes mellitus or Non Insulin Dependent Diabetes Mellitus (NIDDM) is the commonest form and accounts for nearly 90-95% of the diabetic population.6,7 The prevalence being 4% in the world, 2.4–4 % in South East Asia region and in India it is 11.6% in urban areas, 5.9% in semi-urban and 2.4% in rural areas. However the prevalence differs from place to place and different studies have shown different figures.8,9
In Indian sub continent, there is a steady increase in the prevalence of diabetes. In Nepal diabetes is steadily increasing from 2.6% in 1990/91 to 5.6% in 1993/94, 9.95% in 1995
and 12.3% in the year 2000 10. In Bangladesh the over all prevalence of diabetes was 4.3%, it was 4.5% among the sub –urban population, and 2.1% in rural population. Six surveys from various rural parts of Pakistan reveal a high prevalence of diabetes, ranges from 11% to 17% in people above 25 years. A recent survey indicates the same prevalence rate of 10-11% in urban and rural males and lower rates in rural females 11,13.In Hawaii it
was 20.4% and in Mauritius it was more common in an urbanized setting, across several ethnic groups (Asian Indians, Chinese, and Creole); prevalence rate was 10-13% 12,13.
Since no information is available regarding the prevalence of diabetes mellitus and treatment seeking behaviour in adult population of village Dhanas, U.T. Chandigarh, a descriptive study was undertaken with the following objectives.
Objectives
- To determine the prevalence of diabetes mellitus among adult population in a rural
- To ascertain the treatment seeking behaviour of diabetic
Materials and Methods
The study design is descriptive in nature and conducted among adult population of village Dhanas, U.T.Chandigarh.
Chandigarh is one of the well-planned cities in North Western part of India with modern architectural splendour. It was named after the local presiding deity “Chandi” the goddess of power. It is situated at the foot of shivalik hills and it is the joint capital of Punjab and Haryana states. Punjab in the Northwest, and Haryana in the Eastern region surrounded it. It is under the rule of Central Government as a Union Territory.
Census 2001 also reveals that Chandigarh has a total of 24 villages and Dhanas is one of these villages.Out of 24 villages of U.T Chandigarh, Dhanas village was chosen purposely for the study, as it was
convenient for the investigator. The study area is situated at a distance of 6 kms from National Institute of Nursing Education (NINE), PGIMER, Chandigarh, and 7 kms from Inter Bus Terminus of Chandigarh.
Dhanas village has approximately 399 houses and 1179 families with a population of approximately 4806.The residents of this area are mostly farmers. A few of them are Government employees such as clerks, peons, malis (gardeners), guards and sweepers. A few of them are petty businessmen and some are milkman.
The target population consisted of all people aged 35-65 years residing in the study area. About 695 subjects were identified during survey, but those who fail to give their consent and those that could not be contacted after three consecutive visits were excluded from the study and in the end only 495 subjects were included in the study. Data was collected during the month of January and February 2005, with a semi-structured and pre-tested interview schedule. Urine analysis for sugar was done by uristix method. For subjects with history of diabetes and those whose urine analysis for sugar was positive, blood analysis for glucose was done with glucometer test strip. Subjects with history of diabetes were further interviewed for their treatment seeking behaviour. Verbal consent was taken from the entire study subject after explaining the purpose and procedure of the study. Respect of human dignity as well as anonymity and confidentiality of the subject, are maintained throughout.
After the data collection, data was coded, tabulated and analyzed by relevant descriptive statistic.
Results
Prevalence of diabetes mellitus
Prevalence of diabetes mellitus in this study is based on presence of sugar in urine by uristix method and further confirmed by increased level of glucose in the blood with glucometer test strip only for urine positive cases and those with history of diabetes. Cut off point for diagnosis of diabetes is presence of sugar in urine and increased level of glucose in the blood equal to or more than 160mg/dl by glucometer test strip. Out of the 495 subjects studied, presence of sugar in urine was found in 43 (8.7%) subjects. and increased level of glucose in the blood in 45(9.1%).
8.7%
91.3%
Fig.1: Prevalence of diabetes Mellitus according to presence of sugar in the urine.
450(90.1%)
Fig.2 : Prevalence of diabetes mellitus according to increased level of glucose in the blood.
Treatment seeking behaviour
Of the 495 subjects included in the study, 36 (7.3%) of them had history of diabetes. (Table 1) Those with no history of diabetes were not asked any further question.
Table1: History of diabetes among the study subject.
N=495
Table 2 : Duration (in years) of diabetes, agency where diagnosed, type of treatment taken, and health agencies utilized, among subjects with history of diabetes.
N =36
Sugar level in blood (mg/dl)
>160 <160
History of diabetes n=30 n=6
History of diabetes f (%)
Duration (in years) f (%) f
Present 36 (07.3)
Absent 459 (92.7)
Out of the 30 subjects with history of diabetes and glucose level in the blood was above 160mg/dl, in 12 (40%) of them the duration of the illness was less than three years. About 18(60.%) were diagnosed at private health agencies and 28 (93.3%) took treatment for their disease from practitioner of various type of medicine. Of the 6 subjects with history of diabetes and glucose level in the blood was below 160mg/dl, duration of the illness was less than 3 years in three of them. Five were diagnosed at government health agencies and all six took treatment for their disease. (Table 2)
<3 12 (40.0) 3
3 – 6 8 (26.7) 2
6 – 9 9 (30.0) –
> 9 1 (03.3) 1
Agency where diagnosed
Private 18 (60.0) 1
Government 12 (40.0) 5
Treatment taken
Yes 28 (93.3) 6
Type of treatment taken
| Allopathic | 24 (80.0) | 5 |
| Local traditional medicine | 1 (03.3) | 1 |
| Allopathic and local traditional medicine |
2 (06.7) |
– |
| Allopathic and home remedies |
1 (03.3) |
– |
| Health agencies | ||
| Private | 16 (53.3) | 1 |
| Government | 11 (36.7) | 4 |
| Traditional healers | 3 (10.0) | 1 |
| Self medication | 1 (03.3) | – |
Regarding follow up-care, of the 30 subjects with history of diabetes and whose glucose level in blood was above 160mg/dl, about Z19 (63.4%) went for follow up care,
when there was problem and 16 (53.3%) monitored their blood sugar once in three months. Of the 6 subjects with history of diabetes and whose glucose level in the blood was below 160mg/dl, three went for follow up care when there was problem and 2 (33.3%) monitored their blood sugar level once in three months.
Table 3 : Follow up care among subjects with history of diabetes.
to take a view of burden of diabetes mellitus among adult population in a rural setting, the present study was undertaken with the objective to find out the prevalence of diabetes mellitus and the treatment seeking behaviour of diabetic client among adult population (35- 65 years of age) in a rural setting.
Prevalence of diabetes mellitus in the present study based on presence of sugar in urine was 8.7%, based on increased level of blood glucose was 9.1%. Comparison of the
|
|||||||
findings of the study is difficult as a critical
literature search showed that no two studies had similar criteria for diagnosis. The prevalence of diabetes mellitus found in the present study is more than what has been reported by many authors from other states
Follow up care intervals
Once a month 6 (20.0) 1
Once in three months 3 (10.0) 1
Once in six months 1 (03.3) 1
Once a year 1 (03.3) –
Whenever there was problem 19 (63.4) 3
Monitor blood glucose level
in India9 who used urine test as criteria for diagnosis, this may be due to the time gap of twenty years between these studies.
|
The present study reveals that 7.3% of the subjects had history of diabetes and duration of illness in the subjects with history of diabetes and glucose level in the blood above 160mg/dl was less than three years in 40%. About 60% were diagnosed at private health agencies, this is just the opposite to what Srinivas and Suresh et al (2002)14 found
in their study in rural areas of south India12.
Discussion
According to current estimates about 150 million people worldwide have diabetes, of which two- third live in developing countries. The total number of people with diabetes in the world is predicted to rise to 300 million by 2025, with one-third of affected individuals living in India and China alone. So,
About 93.3% took treatment for their disease, similar findings were revealed by Srinivas and Suresh et al in their study in rural areas of south India. The present study indicates that, 63.4% went for follow up care only when there was problem, and 53.3% monitored their blood sugar level once in three months. Of those with history of diabetes and whose glucose level in blood was below 160mg/dl,
the duration of illness was less than three years in three of them, all six were on allopathic treatment. Four of them took treatment from government health agencies, three went for follow up care only when there was problem, two of them monitored their blood sugar once in three months.
Conclusion
From the result of this study, it was found that the prevalence of diabetes mellitus among adult population in a rural village from
U.T. Chandigarh comparatively high based on urine analysis for sugar and also based on level of glucose in the blood.
glucose tolerance in adult rural Kashmiri population. JAPI 1997; 45 (10): 771-773.
- Park Text book of Social and Preventive Medicine 17th ed. Jabalpur; M/S Banarsidas Bhanot, 2002: 45, 294-298.
- Ahuja Recent contributions to the epidemiology of diabetes in India. Intnl.J.Diab.Dev.Countries 1991; 11:5-8.
- Dulal R Noninsulin dependant diabetes mellitus in World Health Organization SEARO Countries: development and implementation of integrated care model is eminent to combat diabetes in Nepal global threat.www.usatoday. com/ news/health /front.htm/review04.
- Assal JP, Bonnici F, Boulton AJM et Increasing trend in prevalence of diabetes in rural South Asian Countries undergoing social transition.www.servier.com/pro/diabetologic/
References
- No author. www.who.int/ review2004.
- No Second national health and
12.
home-diabeto.asp/review2005.
Sayeed MA, Mahtab H, Khanam PA et al. Diabetes and impaired fasting glycemia in a rural population of Bangladesh.Diabetes care 2003; 26
(4): 1034-1039.
morbidity survey- diabetes. www.diabetes.org.my/index.html/review2004.
- No Diabetes mellitus. www.who.int/review2004.
- Edgren A R, Odle TG.Diabetes www.health hotoz.com/health hatoz/a to z/ default.html/review 2004.
- Gala DR, Gala D, Gala Diabetes, high blood pressure without any fear. Ahmedabad, Navneet publications India limited, 2003:5
- Ramachandran A. Epidemiology of type 2 diabetes in www.jima on line. Org/ 2002/toc.html/ review2004.
- Bhat N A, Kamili M A, Ali G et Prevalence of diabetes mellitus and impaired
- p J C, Williams G. Text book of Diabetes 1, 3rdrev ed. Italy: Blackwell science limited, 2003:6.1-6.11.
- Srinivas G, Suresh E, Jagadeesan M et al. Treatment seeking behaviour and compliance of diabetes patients in a rural area of south Annals of New York Academy of Science 2002; 958 l: 420-424.
- Kapur A, Shishoo S,Ahuja MMS et al. Diabetes care in India-patient’s perception, attitudes and Int.J.Diab.Dev.Countries 1997; 17; 5-17.
- Hospital professional blood glucose management system: test strip for glucose testing in whole blood. USA: Johnson & Johnson company 2000.