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1. THESIS PRESENTATION COLLEGE OF MEDICINE AND HEALTH SCIENCE DEPARTMENT OF PUBLIC HEALTH ASSESSMENT OF KNOWLEDGE,ATTITUDE AND PRACTICE ON COMPLICATIONS OF DIABETES MELLITUS AMONG DIABETIC PATIENTS IN AGENA PRIMARY HOSPITAL, 2023. BY: NAME ID NO. 1. MUSTEFA BEDASO.............NSR/1112/12 2. DEJENE ASEFA……..............NSR/0447/12 3. TSEHAYENA BIRHANU……NSR/1472/12 4. TIZAZU FIKADU…………….NSR/1756/12

2. OUTLINES Introduction Statement of problem Significance of study Objective Methods and materials Result & Discussion Strength and limitation of the study Conclusion and Recommendation Acknowledgement References 2 23/12/2015

3. INTRODUCTION Background Diabetes mellitus is a complex chronic metabolic disease characterized by an elevation of blood glucose . It is occurred when the body cannot produce any or enough of the hormone insulin or cannot effectively use the insulin it produces . DM is classified on the basis of the pathogenic process leading to hyperglycemia. Accordingly, t here are two broad categories of DM, designated as either type 1 or type 2 DM. There are other s everal distinct types of DM and all of them share hyperglycemia as common and they are caused by a complex interaction of genetics and environmental factors. 3 22/12/2015

4. Continue… According to WHO estimates, there are currently 422 million diabetics globally and by 2030, there will be 438 million . According to recent estimates, diabetes mellitus causes 1.5 million fatalities yearly and is the seventh biggest cause of mortality in the world. DM is Africa’s most prevalent non-communicable disease and 14.7 million individuals in Africa have diabetes, a ccording to WHO estimates from 2011 . According to Ethiopian Diabetes Association report, there were approximately 1.33 million instances of diabetes mellitus in Ethiopia in 2015 . P rojections made by the WHO showed that, cas es of DM in Ethiopia expected to be about 1.8 million by 2030. 4 22/12/2015

5. Continue… DM has acute and chronic complications. DKA, HHS and hypoglycemia are examples of acute complications. While Nephropathy, neuropathy, retinopathy, ischemic heart disease, myocardial infarction, stroke, impotence are among examples chronic complications of DM. All major complications of diabetes are preventable by good control of blood glucose levels, blood pressure, and cholesterol levels. Concerning this, There is an increasing amount of evidence that patient education is the most effective way to lessen the complications of diabetes and its management by improving their attitude and practice. 22/12/2015 5

6. STATEMENT OF THE PROBLEM Diabetes mellitus (DM) is one of the most common non-communicable diseases. Globally, 347 million peoples have diabetes in 2011; by 2030 this will have risen to 552 million. It is the fourth or fifth biggest cause of death in the majority of high-income countries and worldwide studies shows that, People with diabetes are at least twice as likely to pass away as people without the disease. Eight percent or more of diabetic are in low- and middle-income nations, deaths do happen. Even in the continent with the lowest prevalence (Africa), an estimated 280,000 fatalities in 2011 were linked to diabetes. 6 22/12/2015

7. Continue… An estimated 1.5 million people in Ethiopia have diabetes. The number of DM deaths in Ethiopia reached 21,550, or 2.62% of all deaths, according to 2011 data from the WHO. Ethiopia is ranked number 28 in the world with a 61.96 per 100,000 people death rate. In Ethiopia, it is the 7th greatest cause of mortality. Diabetic retinopathy is an important cause of blindness. DM is also the leading cause of amputation and renal failure . Diabetes accounted for 11% of all adult healthcare costs (20-79 years old) in 2011 and cost the healthcare system at least USD 465 billion. 7 22/12/2015

8. SIGNIFICANCE OF STUDY The finding of this study will contribute in improving knowledge, attitude and practices regarding acute and chronic complications of DM among diabetic patients coming for follow up Agena Primary Hospital. The results of this study will inform design of acute and chronic complication of DM education intervention strategies targeting known DM patient due to their importance in productive roles in the society. Besides the health providers, who are interested in patients with DM in general will benefit from this research. 8 22/12/2015

9. OBJECTIVES General objective To assess Knowledge, Attitude and Practice of prevention regarding to acute and chronic complications among known diabetic patients in Agena Primary Hospital, Ezha Woreda, Gurage Zone, SNNPR, Ethiopia , in 2023 Specific objectives To assess knowledge of known diabetic patients regarding acute and chronic complications of DM in Agena Primary Hospital. To assess attitude of known diabetic patients regarding acute and chronic complications of DM in Agena Primary Hospital. To assess preventive practices among known diabetic patients in Agena Primary Hospital 9 22/12/2015

10. METHOD AND MATERIALS Study d esign , a rea & period An institutional-based cross-sectional study was conducted from July 1 to 30 , 2023 at Agena Primary Hospital , Gurage Zone, SNNPR, Ethiopia, it`s 192km from Addis Ababa. In 2019, the Woreda had a population of 10 5,048 with 5 0,423 males and 54,625 females. 10 22/12/2015

11. Continue… Source population Target population of this study was all diabetic patients in Agena primary hospital who registered on patient registration book Study population Selected Sampled population for institutional diagnosis was our study population . Study Subject Selected individuals who come to Agena Primary Hospital for follow up 11 22/12/2015

12. Continue… Inclusion and exclusion criteria Inclusion criteria All randomly selected diabetic patients in Agena Primary Hospital. Those whose have willingness to participate Exclusion criteria Those patients who are seriously sick and unable to communicate during data collection period Those who are under 15 years old. 12 22/12/2015

13. Continue … Sample size and sampling procedures Sample size was determined by using a formula for estimating a single population proportion formula by assuming confidence level of 95%,5% marginal error with of diabetic patients with good knowledge, have good attitude and practices regarding prevention of acute and chronic complication of DM which is 59%,53% and 41% respectively [33] and 5% allowance for non-respondent rate. Since only one of the p-value could be taken, the one close to 50% (which is 53%) is used to calculate the sample size Sample size calculation formula: n= z 2 pq/d 2s 13 22/12/2015

14. Continue… where n= sample size z= confidence interval [1.96] p= proportion of diabetic patients who have good knowledge, attitude and practices d= marginal of error [0.05] n= z 2 pq/d 2 n= [1.96] 2 x 0.53 x 0.47/ [0.05] 2 n= 382 14 22/12/2015

15. , since population is less than 10,000 [0000] we use correction formula nf= n/(1+n/N) where N=total number of DM patients in Agena Primary Hospital which is 351 n= initial sample size nf= final sample size nf= 382/ (1+382/351) =182.9 For the possible non-respondents 10% is added and the total sample size is nf+(nf*10%):182.9+(182.9*10%) =201 22/12/2015 15

16. Continue… Sampling procedures A simple random sampling was used to select the study subject and participants was selected by using lottery method who registered orderly on the patient registration book.so sample size is 201. 16 22/12/2015

17. Continue… Study variables Age Sex Residence Monthly Income Educational level Occupation Marital status Husband or wife educational level 17 22/12/2015 Frequency of visit of health facility Family history Duration of DM Type of medication they use Knowledge of diabetes patients toward of complications of DM Attitude towards complications of DM Practice towards prevention of DM complications

18. Continue… Data collection instruments Structured questionnaires written in English was used to collect the data. The questionnaire was designed with both open-ended and closed-ended questions that cover all pertinent factors in relation to the study's goal. Data collection procedures Data was collected by face to face interview on DM patient who came for follow up to the OPD. The data was collected by 4 Public health students. 18 22/12/2015

19. Continue … Data quality control To ensure quality, questionnaire was initially prepared in English language and then translated in to Amharic orally and to local language. Common understanding was reached among group members to avoid mis understanding. The data was checked for completeness before entry. 19 22/12/2015

20. Continue… Data processing and analysis The data was entered and analyzed using SPSS version 25. Descriptive statistics such as frequencies , ratio and proportions summary statistics were used to describe the study population in relation to relevant variables. Texts, tables and graphs were used to present the data that had been analyzed. 20 22/12/2015

21. Continue… Ethical considerations All the ethical issues was considered & requested by using a legal letter written by the health science college before the beginning of process of data collection. The purpose of study was briefly explained for the respondents and verbal informed consent was also obtained from the respondents. Participation was voluntary and every DM patient could participated without penalty or loss of benefit at any time. Confidentiality was assured and no personal detail was recorded on any documentation related to the study. Verbally informed consent was obtained from all participants. 22/12/2015 21

22. Dissemination of the results After writing the report, the result will submitted to public health department of Wolkite University and Agena health institutions bureau. Also, the result will be presented to disseminate to the public through internet in collaboration with college of Medicine and health sciences and Wolkite university administration . 22/12/2015 22

23. RESULT AND DISCUSSION Socio-demographic Characteristics of the Study Participants A total of 195 DM patients were participated in the study with a 97% response rate. Of the total study subjects, majority of them were male. Large proportion of respondents were aged between 46-60 years, which is 86(44.1%). Regarding educational status, 82(42.1%) of the respondents were completed primary school. In this study the majority of the respondents 137(70.3%) were married . 102(52.3 %) of respondents earn below 5000 average monthly income . 138 ( 70.8 %) live in urban. 45 (23.1%) were merchants. 23 22/12/2015

24. DM related characteristics of respondents Among study participants 129(66.1%) of the respondents were living with DM for 6 years and above.108(55.4%) used only oral medication. In addition, majority of the respondents which is 53(27.2 %) had family history of DM. 22/12/2015 24 Figure 1: Duration of DM of respondents at Agena Primary Hospital, Ezha woreda, Gurage zone, SNNPR, Ethiopia, 2023

25. Knowledge Status of Study Participants From total study respondents 108(55.4%) respondents have good knowledge toward complications of DM. Among the respondents, 121(62.1%) of them stated healthy diet practice help for management of DM and 142(72.8%) of them stated regular exercise help for the control of DM. 83(42.6%) knew that DM affect all parts of the body. 89(45.6%) of the participant knew acute complications symptoms of DM . More than half of the respondents,119(61%) knew that DM cause hypoglycemia. 137 (70.3%) and 79(40.5%) of the participant knew that drug discontinuance and infection precipitate DM complications, respectively. 25 22/12/2015

26. Continue… 26 22/12/2015 DM cause blindness 53(27.2)   DM cause kidney disease 18(9.2) DM cause heart disease 31(15.9) DM cause foot ulcers and amputations 179(91.8) DM cause stroke   15(7.7) DM cause HTN 30(15.4) DM cause impotence 9(4.6) DM cause loss of sensation 48(24.6) Table 1: Knowledge response of respondents at Agena Primary Hospital, Ezha woreda, Gurage zone, SNNPR, Ethiopia, 2023

27. Attitude of study participants Among study participants, 77(39.5%) believed that diabetic complications can be prevented by having good glycemic control. Below half of the participants, 85(43.6%) were agreed that regular exercise can prevent complications of diabetes. Dietary modification and weight reduction were considered important to prevent diabetic complications by 146(74.9%) and 101 (51.8%) respondents, respectively. More than half of the respondents 121(62.1) believed that DM complication prevented by controlling the precipitating factors. Among the respondent more than half of the participant, 108(55.4) believed that hypoglycemia is preventable. 27 22/12/2015

28. Continue… 28 22/12/2015 Figure 2: Attitude response of respondents at Agena Primary Hospital, Ezha woreda, Gurage zone, SNNPR, Ethiopia, 2023

29. Practice of diabetic patients towards complications of Diabetes Among respondents 97(49.7%) had a good practice toward diabetic complications. Among respondents 155(79.5%) of the participant had candy or table sugar or biscuit in their pocket. About 148 (75.9 %) reported that they never forgot to take their medication. 65 (33.3%) and 55(28.2%) respondents said that they stopped their medication when they felt better and felt worse, respectively. Only 32(16.4%) of the participant were careless about taking the medicine. More than half 103 (52.8%) of them change their diet according to the recommendations of their physician 22/12/2015 29

30. DISCUSSION Variable In this study Comparable study Reason Good knowledge level Participants who had good knowledge were, 55.4% Study done in UAE (33%) [42]; Malaysia (41.9%) [41] and Sudan (15%) [40], the finding was higher study participants were hospital-based and they have better health education access difference in health education, sample size Good attitude level 51.8% had good attitude Kenya (49%) India (17.6%) [46, 47]. studies done in Kenya and India were from rural communities. Good practice level 49.7% showed good practice Harar, Ethiopia(39.2%) had good practice [53] due to difference in socio demographic and access to health education programs 8/29/2023 30

31. STRENGTH AND LIMITATION OF THE STUDY Strength of the study The study provides valuable insights into Knowledge, Attitude and Practice regarding DM complications . Limitations of the study cross sectional nature of the study does not allow the study to establish causal relationship between the different independent variables and the outcome variable. 31 22/12/2015

32. CONCLUSION AND RECOMMENDATION Almost half of the participants had good knowledge, attitude, and practice towards complications of DM. Less than half of the participants believed that regular exercise prevent DM complications. Among study participants more than half of them didn’t assumed good glycemic control as way of preventing diabetic complications. Only a few of participants have checked up their kidney and eye regularly . Therefore, health worker should work together on identified problems to improve patient follow up and health education. 32 22/12/2015

33. Recommendation For Agena primary hospital in Agena town, Gurage zone A hospital-based intervention program should be implemented To consider developing educational programs Measures should be put in place education for diabetes patients, emphasize more on self-care activities especially to patients with long duration of diabetes. For health care providers Encouraging patients' adherence to physical activity and regular follow up should be emphasized to diabetic patients at every appointment. Discussing barriers of treatment adherence when counseling patients and solutions should be tailored toward individual needs . 8/29/2023 33

34. REFERENCES Goodman, P., M.C. Mackey, and A.S. Tavakoli, Factors related to childbirth satisfaction. Journal of advanced nursing, 2004. 46 (2): p. 212-219. Cengiz, E., Measuring customer satisfaction: must or not. Journal of naval science and engineering, 2010. 6 (2): p. 76-88. Souza, J.P., et al., Obstetric transition: the pathway towards ending preventable maternal deaths. BJOG: An International Journal of Obstetrics & Gynecology, 2014. 121 : p. 1-4 Council, R.M.C.A., White Ribbon Alliance for Safe Motherhood.(2011). Respectful maternity care: the universal rights of childbearing women. Washington, DC: WRA. Retrieved [August 8th, 2013] p, 2013: p. 1-6. Organization, W.H., Strategies towards ending preventable maternal mortality (EPMM). 2015. 34 22/12/2015

35. ACKNOWLEDGEMENT First of all, we would like to thank and glorify enormously our Almighty God who has been and will be a source of strength throughout our life and thanks to Mr. Dereje M. and Mr. Abdurezak K. for their helpful remarks and suggestions made during the development of this study. We want to thank Wolkite University College of Medicine and Health Science, Department of Public Health , for giving us the chance to fulfil this research thesis and enrol in the B.Sc. program in Public Health . We would like to express our good gratitude to our family that stands with us for our success. Lastly, we would like to give our gratitude and deep respect to Agena Primary Hospital staffs for their support during the data collection. In advance we also would like to thanks all study participants who was helped us by responding to the prepared questioners. 35 22/12/2015

36. Thank You! 8/29/2023 36