KNOWLEDGE & ATTITUDE OF TYPE 2 DIABETIS MELLITUS - Dept of SPM

In Rural Population Of Alor GajahMalacca

KNOWLEDGE & ATTITUDE KNOWLEDGE & ATTITUDE OF TYPE 2 DIABETIS OF TYPE 2 DIABETIS

MELLITUS MELLITUS

Community Residency Programme (CRP)

MBBS PHASE 3A, SESSION 2004/05, CLASS 2002/07

• WHO: > 15 mil people worldwide. Doubled in 20251

• M’sia: 1986 (6.3%) 1996 (8.2%)2

2000 (942, 000 cases) 2030 (2479, 000)3

• Alor Gajah: 2000 (3546 cases) 2003 (4012 cases)4

• Indian > Chinese > Malay > aborigines

• Affected by level of social development5

INTRODUCTIONINTRODUCTION

To assess knowledge and attitude of Diabetes Mellitus among the rural population in Alor Gajah, Malacca.

To determine the association between 1. level of education2. diabetic status

with knowledge and attitude on Diabetes Mellitus.

OBJECTIVESOBJECTIVES

• Cross-sectional survey of households in four villages in Alor Gajah: 7th - 9th June, 2005

• Kampung Kuala Sungai Baru• Kampung Air Limau• Kampung Pinang• Kampung Solok Air Batu

• Analysis: 10th – 17th June, 2005.

• Pre-tested 23-questions questionnaire with 3 main sections:-- knowledge -- sources of information-- attitude

• Random sampling of houses in 4 villages

• Head of the household or any other adult representative who is greater than 18 years old

• 198 subjects were interviewed • Data processing by SPSS version

11.0• Data transformation into reports,

power point & posters.

• Limitations: • Four villages were not randomly

selected • Relatively small sample size in

relation to the actual population of Alor Gajah

• Only Malay population was included

MATERIALS & METHODSMATERIALS & METHODS

Do you have Diabetes Mellitus?

1.5%

25.8%

72.7%

NoYesDon't know

FINDINGS & DISCUSSIONFINDINGS & DISCUSSION

KNOWLEDGE OF DIABETES MELLITUSKNOWLEDGE OF DIABETES MELLITUSWhat is Diabetes Mellitus?

120

44 2 5 270

20

40

60

80

100

120

140

No.

of R

espo

nden

ts

High sugar contentin blood

High sugar contentin urine

Low sugar contentin blood

High cholesterollevel in blood

Don't know

What Is Diabetes Mellitus?

Don't know13.6%

Right answer60.6%

Wrong answer25.7%

Right Answer Wrong Answer Don't Know

Common misconception: high sugar in urine (22.2 %) or “kencing manis”

Diabetic status(Diabetic vs non-diabetic)

p = 0.762, df=1

Educational level(Upper 2° & above vs

lower 2° & below)

p = 0.001, df=1;OR = 3.106, 95% CI: (1.600, 6.061)

KNOWLEDGE OF DIABETES MELLITUSKNOWLEDGE OF DIABETES MELLITUSRisk Factors of Diabetes Mellitus

020406080

100120140160180200

Sex

Hig

h su

gar

Hig

h fa

t

Hig

h sa

lt

Inad

equa

teex

erci

se

Cha

rm

Inhe

ritan

ce

Obe

sity

Infe

ctiv

edi

seas

e

No.

of R

espo

nden

ts

Yes No Don't know

• Well recognized risk factors: 1. high sugar content food – 90.4%2. genetic inheritance – 81.8%3. inadequate exercise – 81.3%4. obesity – 71.1%

• 56.1% scored correctly for “high fat intake”

n=198

Percentage of Respondents Answered Risk Factors Correctly

3.5

32.3

64.2

010203040506070

≤2 3-6 ≥7No. of Answers Correct

Percen

tage

(%)

• Generally: good understanding. • Diabetic status

Independent T-Test: p=0.662, df=196• Level of education

Independent T-Test: p=0.001, df=163.710• Understanding RF enhances primary prevention

n=198

KNOWLEDGE OF DIABETES MELLITUSKNOWLEDGE OF DIABETES MELLITUS

• 84.5% - nocturia • 81.0% - lethargy• 80.5% - polydipsia

Early Symptoms of Diabetes Mellitus

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Freq

uent

sor

eth

roat

Hae

mat

emes

is

Noc

turia

Wei

ght l

oss

Leth

argy

Alo

peci

a

Poly

dips

ia

Poly

phag

ia

Hae

mor

rhoi

d

No.

of R

espo

nden

ts

Yes No Don't know n=198


• 50.0% - LOW despite polyphagia• 29.5% - LOW not associated with DM • 32.3% - polyphagia• 47.5% - polyphagia not associated with DM• 57.5% - no alopecia• 22.5% - alopecia associated with DM

Complications of Diabetes Mellitus

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Feet

num

bnes

s

Blu

rred

visi

on

Poor

heal

ing

wou

nd

Ren

al

dise

ase

Stro

ke

Hea

rt

dise

ase

Can

cer

Ast

hma

Cat

arac

t

No.

of R

espo

nden

ts

Yes No Don't know

• > 70% : loss of sensation in legs blurred visonpoor wound healing renal diseases

• 60.6% : cataracts ** elderly people developed cataract w/o DM

• 51.5% & 56.1% know CVA and CVD complicate DM** co-morbidities eg HPT & hypercholesterolaemia

• 57.1% & 55.6% : no relationship between CA & asthma with DM

n=198


Number of Respondents Answered Complications Correctly

9491

130

102030405060708090

100

≤2 3-6 ≥7

No. of Answers correct

No.

of R

espo

nden

ts

• Generally, adequate knowledge of complications

• Mean for correct answers is 6.02 out of 9-- 66.9% comparable to score obtained in S’pore study (66.7%)

n=198

Diabetic status p=0.003, df=196

Education level p=0.049, df=160.510


How Can Diabetes Mellitus Be Diagnosed?

82

102

5 2 3 40

20

40

60

80

100

120

No.

of R

espo

nden

ts

Urine test

Blood test

Examine by doctor (withoutany test done)Eye check-up

Blood pressure check-up

Don't know

Diabetic status p<0.001, df=1OR = 3.334 95% CI: (1.663, 6.686)

Education level p=0.763, df=1

51.1% - blood test (RBS / FBS)41.0% - urine test (not sensitive)

knowledge on diagnostic test is not satisfactory as only ~ half scored correctly.

n=198


Most effective Moderately effective

Less effective Frequency

Medication Exercise Diet control 13Medication Diet control Exercise 34

Exercise Medication Diet control 5Exercise Diet control Medication 11

Diet control Medication Exercise 55Diet control Exercise Medication 80

• Correct knowledge on DM controldiet control – 68.1%exercise – 8.1%medication – 23.8%

• Unclear if know the proper method of diet control • Important education & role of dietitian


The sources of information for diabetes

143 148

88

115102

76

158

23

113

020406080

100120140160180

1types of sources

num

ber o

f res

pond

relatives/friends/surrounding peoplegovernmentmedical officerprivate medicalofficernewspaper

pamphlets

books

television

radio

internet

• 79.8% -- TV• 74.7% -- governmental health personnel• 72.2 % -- relatives / friends/ people around

n=198

SOUCES OF INFORMATIONSOUCES OF INFORMATION

The Most Effective Source of Information

28

104

113

83

38

1 20

20

40

60

80

100

120

Type of sources

No. of R

espo

nden

ts

Relatives/friends/surrounding peopleGovernment medical officer

Private medical officer

Newspaper

Pamphlets

Books

Television

Radio

Internet

• 52.5% -- govt. health personnelsReasons: 50% - trustability of the professional advice

38.5% - easy to understand• Modern medicine has increased influence & its credibility is not in doubt • Villagers are comfortable with government doctors.

n=198

SOUCES OF INFORMATIONSOUCES OF INFORMATION

Source of Awareness of Diabetes Mellitus

3.5%8.6% 1.5%

5.1%

37.9% 43.4%

Self

Others

Advertisement

Health campaign

No awareness

Relatives/friends withdiabetes mellitus

• 43.4% - own initiative• 37.9% - real experience of seeing diabetic complications • 3.50% - health campaigns• 5.10% - advertisements• 8.60% - not aware of DM

n=198

ATTITUDE OF DIABETES MELLITUSATTITUDE OF DIABETES MELLITUS

Have You Ever Done Any Blood Test For Diabetes Mellitus?

83.8%

16.2%

YesNo

n=198

Diabetic status

•p < 0.001, •df =1•OR=1.278•95% CI =

(1.174, 1.392)Education level

•p=0.003 •df =1 •OR = 3.161

(lower vs. upper)•95% CI=

(1.456, 6.860)


Reason For Doing A Blood Test

37.3%

18.1%

5.4%

39.2%

Curiosity / own initiative

During government healthcampaignsAdvised by doctor duringillnessHealth check up upon goingfor a job / study / antenatal


Reason For Not Doing A Blood Test For Diabetes

3.6%10.7%

32.1%

14.3%21.4%

17.9%

Not interested

Afraid of getting diabetes

Afraid of going to the hospital

Afraid of needles during bloodtestNo time

No knowledge on diabetesmellitus


n=198

Diabetic status

p= 0.301df = 1

Education level

p=0.026, df=1OR = 1.96895% CI = (1.081, 3.581)

56.6% - yes- up to individuals to exploit the various

available sources 43.4% - no

- information does not reach them

Government's Moves To Increase People's Knowledge On Diabetes Mellitus Are Adequate

Yes56.6%

No43.4%


• generally well informed • Upper secondary & higher educated vs.. lower secondary &

below:better knowledge in risk factorsbetter attitude in diet control awarenessmore likely to feel inadequacy in government’s move

• Diabetics vs.. non-diabetics:better knowledge in symptoms, complications, diagnosisbetter attitude in diet control awareness

• Most effective source of information: government healthcare personnel

• An improved educational program on Diabetes Mellitus in future is anticipated.

• Private sectors (TV, doctors, pharmacists) are encouraged to participate.

CONCLUSIONCONCLUSION

1. World Health Organization http://www.who.int/mediacentre/factsheets/fs138/en/index html(Accessed on June 2005)

2. Rugayah B. Diabetes Mellitus among adults 30 years and above. Report ofthe Second National Health and Morbidity Survey, Vol 9; 1996-1997. Public Health Institute, Ministry of Health, Malaysia.

3. World Health Organization. http://www.who.int/diabetes/facts/world_figures/en/index html(Accessed on June 2005)

4. Kes Diabetes di Alor Gajah, 2000-2003. Jabatan Kesihatan, Alor Gajah, Malacca.

5. O Ali, TT Tan, O Sakinah, BA Khalid, LL Wu and ML Ng. Prevalence of NIDDM and Impaired Glucose Tolerance in Aborigines and Malays inMalaysia and Their Relationship to Socio Demographic, Health andNutritional Factors. 1993. Diabetes Care. 1993; 16: 68-75.

6. Mustafa BE, Wan Mohamad WB, Chan SP, Rokiah P, Mafuazy M, Kumari S, Chandran AA, Ong GKC, Jogensen LN and Yeoh JP. For The Diabetes Data Collection Project (Diabcare-Malaysia) Study Group. The Current Status of Diabetes Management in Malaysia. J Asean Fed Endo Soc.1998; 16(2): 1-13

7. Diabetes Facts and Figures. American Diabetes Association.8. H L Wee, H K Ho, S C Li; Public Awareness of Diabetes Mellitus in

Singapore. Singapore Med J 2002 Vol 43 (3): 128-134.

REFERENCESREFERENCES

http://www.who.int/mediacentre/factsheets/fs138/en/index

http://www.who.int/diabetes/facts/world_figures/en/index

KNOWLEDGE & ATTITUDE OF TYPE 2 DIABETIS MELLITUS - Dept of SPM

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