Microvascular Complications among Diabetic Patients; A Case Study Carried out In Kiryandongo General Hospital, Kiryandongo District

ABSTRACT

Background: Micro-vascular complications among diabetes patients; a case study carried out in Kiryandongo General Hospital(KGH) diabetes clinic, was done with the aim of determining the prevalence of micro-vascular complications and their associated risk factors with a goal of establishing the baseline data for the clinic.

Methods: It was a cross-sectional study conducted among diabetes patients attending Kiryandongo general hospital diabetes clinic by interviewing, physical examination, investigation done on patients aimed to identify retinopathy, nephropathy and neuropathy and observation of healthcare providers service delivery aimed at meeting the NEEDS strategy for DM management. Selection of participants was by stratified random sampling and sampling size of 100 participants was used in the study.

Results: 56% of patients were male and the rest were female.84% of patients were over 40 years and only 8% were less than 20 years. The study revealed that 76% of the patients had micro-vascular complications. Neuropathy, retinopathy, and nephropathy were at a prevalence of 72%,56% and 28% respectively. The 3 leading factors associated with micro-vascular complications were Poor glycemic control at 94.7%, followed by lack of knowledge of diabetes management at 88% thenT2DM at 82.6%. The others which were important were age, duration of DM , HIV infection hypertension, sex and socio-economic status. Male sex had a greater risk for nephropathy but female sex had a predilection for retinopathy.

Conclusion: There is very high prevalence of micro-vascular complications among patients attending KGH diabetes clinic and vigorous health education and restructuring of the clinic to address the needs of these patients is key to off-setting them.

TABLE OF CONTENTS

DECLARATION ............................................................................................................................. i

APPROVAL ................................................................................................................................... ii

DEDICATION ............................................................................................................................... iii

ACKNOWLEDGEMENT ............................................................................................................. iv

LIST OF ACRONYMS .................................................................................................................. v

OPERATIONAL DEFINITIONS .................................................................................................. vi

LIST OF FIGURES AND TABLES............................................................................................... x

1.0 CHAPTER ONE: INTRODUCTION ....................................................................................... 1

1.1 Introduction ........................................................................................................................... 1

1.2 Background information ....................................................................................................... 1

1.3 Problem statement ................................................................................................................. 2

1.4 Study Objectives ................................................................................................................... 3

1.4.1 Broad Objective .............................................................................................................. 3

1.4.2 Specific Objectives ......................................................................................................... 3

1.5. Research Questions .............................................................................................................. 3

1.6 Justification /significance of the study .................................................................................. 4

1.7 Scope of the study ................................................................................................................. 4

1.8. Conceptual framework ......................................................................................................... 5

2.0 CHAPTER TWO: LITERATURE REVIEW ........................................................................... 6

2.1 Introduction ........................................................................................................................... 6

2.2 Prevalence of Microvascular complications among Diabetes Patients. ................................ 6

2.3 Risk factors for Diabetes Microvascular Complications. ..................................................... 7

2.3.1 Diabetes risk factors associated with microvascular Complications. ............................. 7

2.3.2 HIV/AIDS and Hypertension comorbidities with Diabetes mellitus. ............................ 7

2.3.3: Prevention, management and Provider associated risk factors of diabetic microvascular complications. .................................................................................................. 8

viii

3.0 CHAPTER THREE: METHODOLOGY ............................................................................... 10

3.1 Introduction ......................................................................................................................... 10

3.2 Study design ........................................................................................................................ 10

3.3 Study area ............................................................................................................................ 10

3.4 Study population ................................................................................................................. 10

3.5 Eligibility criteria ................................................................................................................ 10

3.5.1 Inclusion criteria ........................................................................................................... 10

3.5.2 Exclusion criteria .......................................................................................................... 11

3.6 Sampling.............................................................................................................................. 11

3.6.1 Sample size determination ............................................................................................ 11

3.6.2 Sampling technique ...................................................................................................... 11

3.7 Study variables .................................................................................................................... 11

3.7.1 Dependent Variable ...................................................................................................... 11

3.7.2 Independent variables ................................................................................................... 11

3.8 Data collection tool ............................................................................................................. 12

3.9 Quality control /Assurance ................................................................................................ 12

3.10 Data collection procedure.................................................................................................. 12

3.11 Data processing and analysis............................................................................................. 12

3.12 Ethical considerations ....................................................................................................... 13

3.13 Study limitations ............................................................................................................... 13

3.14 Dissemination of results .................................................................................................... 13

4.0 CHAPTER FOUR: RESULTS ............................................................................................... 14

4.1 Demographic characteristics ............................................................................................... 14

4.1.1 Sex of participants. ....................................................................................................... 14

4.1.2 Age distribution of participants .................................................................................... 14

4.1.3 Education level of participants. .................................................................................... 15

4.1.4 Average monthly income.............................................................................................. 15

4.2 Knowledge and Self management of Diabetes .................................................................. 16

4.2.1 What Diabetes is. .......................................................................................................... 16

4.2.2 Duration of diabetes from time of diagnosis. .............................................................. 18

ix

4.2.3 Type of diabetes. ........................................................................................................... 18

4.2.4 Knowledge of possible complications of Diabetes. .................................................... 19

4.2.5 Knowledge of risk factors for diabetes complications ............................................... 19

4.2.6 Management of diabetes. ............................................................................................ 20

4.2.7 HIV/AIDS and Hypertension comorbidity. ................................................................ 21

4.3 Healthcare providers’ implementation of the NEEDS strategy to prevent/control DM microvascular complication. ..................................................................................................... 22

4.3.1 Presence of clinic day health education program on nutrition, complications and diabetes management. ............................................................................................................ 22

4.3.2 Individual health education directed to the need. ....................................................... 22

4.3.3 Clerking (history taking and examination) and investigation for microvascular complications. ........................................................................................................................ 23

4.4 Microvascular complications of Diabetes. ......................................................................... 24

4.4.1 Symptoms associated with micro-vascular complications of DM. .............................. 24

4.4.2 Examinations (visual acuity and fundoscopy, peripheral neuropathy physical examination and urinalysis) for Micro-vascular complications. ........................................... 25

5.0 CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS. .......... 37

5.1 Discussion of results............................................................................................................ 37

5.1.1. Prevalence of Micro-vascular complications among diabetes patients. ...................... 37

5.1.2 Risk factors for diabetic Micro-vascular complications. .............................................. 37

5.2 Conclusions. ........................................................................................................................ 42

5.3 Recommendations. .............................................................................................................. 42

REFERENCES ............................................................................................................................. 44

APPENDICES .............................................................................................................................. 46

Appendix I: Questionnaire and checklist to determine the knowledge, prevalence of microvascular complications and their risk factors among diabetic patients. ........................... 46

Appendix II: Recommendation Letter To Carry Out The Research ........................................ 51

Appendix III : Map of Uganda showing Kiryandongo District. ............................................... 52

Appendix IV: Map Of Kiryandongo District Showing Location Of Study Area ..................... 53

Appendix V: Research Work Plan ............................................................................................ 54

Appendix VI: Research Budget And Budget Justification ........................................................ 55