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. DiabetesInsipidus 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.
