DIABETES; A LEADING CAUSES OF DEATH IN NIGERIA, HOW HEALTH WORKER THROUGH EDUCATION AND HEALTH PROMOTION COULD INCREASE DIABETES AWARENESS AMONG NIGERIANS

1.1 Introduction

Diabetes is a metabolic disorder of multiple etiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both (WHO, 2011). The prevalence of diabetes and its complications are major public health issues globally, regionally and locally. Notable complications and consequences of diabetes are stroke, blindness, amputation, death etc. Inadequate knowledge of diabetes, negative attitude and perception about diabetes is usually the root causes of diabetes complications and consequences. Developments in diabetes care and management have greatly evolved over the last several decades. Diabetes care has shifted from a treatment-oriented plan of care, to a proactive, prevention-based plan of care. The American Diabetes Association sets forth standards of medical care in diabetes each year. The most recent guidelines emphasize a comprehensive treatment plan with individualized diabetes education for each patient (American Diabetes Association, 2018).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

1.2 Background of Study

Diabetes is a disease whereby a human (or any other animal) has high sugar in the blood due to either insufficient insulin or when the produced insulin cannot be used by the body effectively (World Health Organization, 2016). Diabetes is a group of metabolic chronic diseases characterized by high sugar in the blood. There are basically three types of diabetes namely, type 1, type 2 and gestational diabetes (GD). Type 1 diabetes used to be called an insulin dependent, juvenile or childhood-onset diabetes. It is genetic in nature and it is usually diagnosed at childhood and adolescence but then it's usually noted later in life. Current knowledge shows that type 1 diabetes is unpreventable (World Health Organization, 2016). Type 1 is usually uncommon as compared to type 2 (Chouhan & Shalini, 2006).

Type 2 diabetes occurs owing to the inability or unfitness of the body to effectively use the produced insulin. Type 2 is also be called non-insulin-dependent or adult- onset diabetes (World Health Organization, 2016). This type is usually caused by living a sedentary lifestyle. This is the commonest type of diabetes among adults worldwide and can be prevented or delayed (Sakane et al., 2011). Gestational diabetes occurs during pregnancy though a temporal condition; it can lead to type 2 diabetes in the long run and can also induce pregnancy and delivery complications (World Health Organization, 2016). In the US alone, gestational reported cases range from 2% to 10% in pregnancies. There is 35% to 60% probability of getting type 2 diabetes in women living with gestational diabetes (Facts & Diabetes, 2011).

Diabetes is a major and a serious public health issue not only in Nigeria but worldwide. Globally, in 2014,422 million had diabetes and the number rose to about 425 million people in 2017, it was projected that this will rise to about 629 million. In Africa an estimated number of over 16 million people suffer from diabetes, which is expected to increase up to around 41 million people by 2045 (International Diabetes Federation, 2017). This prevalence comes with some economic and health burden.

In 2017, 518,400 Nigerians were estimated to have the diabetes disease which is reported to be increasing daily and the prevalence rate was estimated to be 5%. Also diabetes related deaths in Nigeria (among ages 20-79 years) amounted to 9,778 (International Diabetes Federation, 2017).

Diabetes is one of the major causes of heart attacks, blindness, and lower limb amputation just to mention a few (Facts & Diabetes, 2011). Persistent high blood glucose, smoking, high cholesterol and excessive alcohol intake are some of the factors that can contribute to the risk of developing complications. Through adherence to medical treatment (taking medications as prescribed, to control their cholesterol and blood sugar) and diabetes care (regular checkup, regular exercise, healthy eating etc.), complications can be reduced drastically. Previous studies have shown that, socio-demographic and psychological factors are associated with diabetes education (Mogre et al., 2017).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Leading Causes of Death in Nigeria, How Health Worker through Education and Health Promotion Could Increase Diabetes Awareness Among Nigerians.

1.3 Statement of Problems

Investigation revealed that the prevalence of diabetes and its complications are major public health issues globally, regionally and locally. According to International Diabetes Federation (2017), in 2017, 518,400 Nigerians were estimated to have the diabetes disease and it is reported to be on the increase at 5% prevalence rate. According to the World Health Organization (2016), about 1.6 million people died due to diabetes globally in 2015 and in Nigeria diabetes related deaths (among ages 20-79 years) in 2017 was 9,778 (International Diabetes Federation, 2017). Most of the people who die are the adult group and usually, those with type 2 diabetes. The adult group is the active and working class who serve as the backbone for any country's development as they are the main source of production.

So, when the active group is being killed by the diabetes disease, there will be low productivity and can lead to underdevelopment (high indebted poor country). If effective measures are not put in place to reduce the complications (blindness, stroke, amputation etc.) and consequences (death, loss of job etc.), social selection can set in and its consequences may be costly. Previous studies have shown that, diabetes care providers give little support for diabetes patients' self-management and also, diabetes care are not provided close to the patients (Mwangome et al., 2017).

Much concentration is given to the biomedical (much reliance on drugs/medication) aspect of diabetes healthcare services than the education and awareness factors (knowledge, attitude and belief). However, existing evidence have shown that, knowledge, attitude and belief are related to diabetes care (Ahmed et al., 2015), (Services, 2014). Therefore, there is the need to ensure effective measures such as diabetes care education for both care providers and patients (self-care).

Hence, this research work seeks to determine the level of diabetes education through knowledge, attitudes and beliefs among persons with diabetes and to find out whether it is associated with their diabetes care.

1.4 Aim and Objectives of Study

The aim of the study is to study diabetes as Leading Causes of Death in Nigeria, How Health Worker through Education and Health Promotion Could Increase Diabetes Awareness among Nigerians. In achieving this aim, the following specific objectives were laid out as follows:

1. To investigate the causes of diabetes in Nigeria;
2. To ascertain the extent of diabetes awareness carryout by Nigeria Government;
3. To investigate the role of health practitioners in reducing the adverse effect of diabetes; and
4. To suggest possible solution to the identified problem.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• To what extent does Nigeria Government create diabetes awareness among people living in the area under study?
• What are the causes of diabetes in Nigeria?
• What is the role of health practitioners in reducing the adverse effect of diabetes?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: Health practitioners do not play any role in reducing the adverse effect of diabetes
• H1: Health practitioners plays a role in reducing the adverse effect of diabetes

Hypothesis Two

• H0: There are no diabetes awareness programs carried out by the government own medical centers in the rural communities
• H1: There are diabetes awareness programs carried out by the government own medical centers in the rural communities

1.7 Significance of Study

The study will be of benefit to ministry of health. The study educates nurses on how to educate, prevent and manage diabetes. The study will also be of great benefit to the researchers who intends to embark on research on similar topics as it will serve as a guide. Finally, the study will be of great importance to academia's, lecturers, teachers, students and the general public.

1.8 Scope of the Study

The scope of the research is focused on the study of diabetes as Leading Causes of Death in Nigeria, how nurses through education and health promotion could increase diabetes awareness among Nigeria.

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

1.10 Definition of Terms

Diabetes: Diabetes is a group of metabolic diseases or a chronic disease characterized by high sugar in the blood.

Knowledge: A factual information that a person knows or skills required to perform an act acquired through education, training or via experience.

Attitude: A settled way of thinking or feeling about something.

Belief: A mental acceptance or cognitive assertion or perceptions held by an individual.

Diabetes Care: The daily plans and practices that the individual performs in managing his/her diabetes.

Causes: A person or thing that acts, happens, or exists in such a way that some specific thing happens as a result; the producer of an effect

Nurses: Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life.

Educate: Give intellectual, moral, and social instruction to (someone), typically at a school or university.

Awareness: Awareness is the ability to directly know and perceive, to feel, or to be cognizant of events. More broadly, it is the state of being conscious of something.

1.11 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows:

Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study. Chapter two highlights theoretical framework on which the study is based, thus the review of related literature. Chapter three deals on the research design and methodology adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding. Chapter five gives summary, conclusion, and recommendations made of the study.