PREVALENCE AND CONTRIBUTING FACTORS TO DIABETES AMONG MEN IN NIGERIA (A CASE STUDY OF ELEME LOCAL GOVERNMENT AREA OF RIVERS STATE)
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Abstract
Globally, the prevalence of diabetes mellitus across various occupational groups and its relationship with an occupational factor is a topic of recent interest. Business men as an occupational group are exposed to unhealthy life style, excessive alcohol consumption and smoking which leads to diabetes mellitus and other cardiovascular diseases than the general population. Due to this reason the present study were conducted among men in Rivers state. The objective of this study was to assess the prevalence of diabetes mellitus and impaired fasting glucose level and identify their contributing factors among business men at Ebubu local government area of Rivers state, Nigeria. A cross-sectional study was employed using multi-stage sampling technique. The study populations were all business men living in Ebubu. The total sample size for the study was 1003. The data were collected using structured questionnaire, physical examinations and blood samples, by using the WHO stepwise approach. Data were entered into SPSS version 20.0. The entered data were cleaned and analyzed Frequency distributions, percentage, tables and charts were used to show result of univariate analysis. Cross tabulation, chi-square tests, and 95% confidence interval used to present results of bivariate analysis. Multivariate logistic regression analyses were done to control potential confounding variables. Out of 1003 eligible subjects 936 (93.3) business men were participated in this study. Of the total subjects tested for blood glucose level the prevalence of impaired glucose homeostasis (IGH) were 13%, out of which 47 (5.0 %) were diabetes and 73 (8.0%) impaired fasting glucose. Age ≥45 years (p=0.044, AOR= 4.9 (1.04, 23.1)), having history of first degree relative who suffered from diabetes (P=0.008, AOR= 3.2 (1.4, 7.5)), and Hypertension (P=0.000, AOR= 4.5 (2.6, 7.8)), Body Mass Index (P=0.000, AOR= 6.0 (1.2, 30.2)) were found to have stastical significance with the prevalence of Impaired Glucose Homeostasis among the study participants. The study identified a high prevalence of diabetes mellitus and impaired fasting glucose level among business men. Finally, the study recommend awareness and prevention of diabetes mellitus program should be given priority as that of communicable diseases by health practice directorate, Federal Minster Health and Non Governmental Organizations.
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Diabetes mellitus is characterized by chronic hyperglycemia which becomes an emerging public health problem due to its high prevalence, association with cardiovascular diseases, and overall morbidity and mortality (1). A recent estimate indicates that more than 387 million (8.5%) of people worldwide have diabetes. Among these Africa account a 22 million (5.1%) people with diabetes which is likely to increase by 70% in 2035 (2).
Approximately 5.1 million people whose age is between 20-79 years died from diabetes in 2013, accounting for 8.4% of all global mortality among people in this age group. This estimated number of death is similar in magnitude to the combined deaths from several infectious diseases and is equivalent to one death in every six seconds. Almost half of deaths due to diabetes are in people under the age of 60 years (3).
Among people with diabetes mellitus in developing countries the majority were with age group of 45 to 64 years while those in developed countries are aged 65 years and above. This indicates that developing countries are losing productive age groups than developed once. This in turn brings double burden in the region; that already affected with communicable diseases such as ʻ HIV AIDS ʼ, tuberculosis and other infectious diseases (4).
The impact of diabetes mellitus is bound to continue globally if nothing is done to curb the rising Prevalence of Impaired Glucose Tolerance (IGT) which is now affecting 316 million people (6.9%). The vast majority (70%) of these people live in low and middle income countries. By
2035, the number of people with IGT will increase to 471 million, or 8.0% of the adult population unless something is done to reduce the contributing factors associated with the development of the disease (5).
Before the 1990s, diabetes mellitus was considered as a rare medical condition in Sub-Saharan Africa (6). However, currently many studies revealed that the prevalence and incidence of type 2 diabetes is rising in the region, mostly it is due to lifestyle changes (westernization), lack of physical activities, increased rural urban migration (urbanization), high calorie intake and increased life expectancy (ageing) of the population (7, 8).
According to World Health Organizations global estimation of diabetes mellitus in Sub- Saharan Africa the number of diabetes cases in 2013 ranges from 4.5-5.0% (8). This could increase by 98% which is from 12.1 million in 2010 to about 23.1 millions in 2030. The impaired glucose tolerance that was reported in 2010 (26.9 million) is also expected to rise to 47.3 million in 2030 (9).
In Nigeria, it is difficult to find population based data on the exact prevalence of diabetes. However, there are some studies done on selected population groups that showed an increase prevalence of 4.6 % and 5.1% diabetes (10, 11). It is also the second causes for patients to attend health care practices in most hospital of the countries (12-15). According to the 2014 report of the International Diabetes Federation (IDF), the number of people aged 20-79 years living with diabetes in Nigeria was estimated to be 4.9 million and more than 2.9 million (6.9%) people live with impaired glucose tolerance (2). Among these more than 1.4 million people were undiagnosed for diabetes mellitus and its prevalence is higher in urban than rural population (2).
Globally, the prevalence of diabetes across various occupational groups and its relationship with an occupational factor is a topic of recent interest. Businessmen as occupational group exposed to unhealthy life style, excessive alcohol consumption and smoking which in turn leads to diabetes mellitus and other cardiovascular diseases than other population. For instance, the study conducted among business men in India showed that this occupational group had higher prevalence of metabolic syndrome and other cardiometabolic abnormalities compared to the general population (16-17). In US, a cohort study conducted among business men force also showed that these groups are at risk of developing non communicable diseases and cardiovascular diseases at earlier age and that they dies much earlier compared to other groups (18). But the situation of Nigerian business men is unknown, even though the groups are predisposed to those factors responsible for developing diabetes mellitus due to nature of the work.
Evidence from many studies indicates that business men with well managed diabetes mellitus are capable of safe and effective job performance (16-19). However, those who are undiagnosed may be at risk of sudden in capitation and death, thus it will affect their ability to perform well. So, knowing the prevalence of diabetes mellitus and impaired fasting glucose level and its contributing factors among business men will give us a clue for appropriate intervention. Therefore the present study was conducted to estimate the prevalence of diabetes mellitus and impaired fasting glucose level and to identify possible contributory factors among men in Rivers state, Nigeria.
1.2 STATEMENT OF THE PROBLEM
According to global estimation of diabetes in 2014, 387 million people worldwide had diabetes and there were 5.1 million deaths associated with it (2). By 2035 this figure could rise to 592 million unless some preventive measures are taken (5). In United State of America (USA) reports of National Diabetes Statistics of 2014 indicated that 29.1 million people or 9.3% of the US population had diabetes, among those 8.1 million people were undiagnosed for diabetes (20).
In Africa the prevalence of diabetes is increasing with ageing of the population and life style change which is associated with rapid urbanization and westernization (21). Traditional rural communities still have low prevalence, at most 1-2%, except in some high risk group where it could reach as 1-20% of prevalence of diabetes among adult populations of urban community (22).
According to 2009 International Diabetes Federation (IDF) estimation the number of adults with diabetes in Sub Saharan Africa was projected to increase by 98%, from 12.1 million in 2010 to
23.1 million in 2030 and impaired glucose tolerance in the region will expected to rise by 75.8% from 26.9 million in 2010 to 47.3 million in 2030 (23).
In Nigeria, national data on prevalence and incidence of diabetes are not sufficient. Even though, diabetes mellitus among other chronic non-communicable diseases is the second leading cause of hospital admission and medical care of most hospital in Nigeria (12-15). It is also a cause of death, disability and hospital stays and absentees from duty among men. However, there was no study done on the prevalence of diabetes in this group of populations in Nigeria.
Therefore; the purpose of this study was to assess the prevalence of diabetes mellitus and impaired fasting glucose level and identify their contributing factors among business men at Ebubu residing in Rivers state, Nigeria
1.3 OBJECTIVES
General objectives
To assess the prevalence of diabetes mellitus and impaired fasting glucose level and their contributing factors among business men at ebubu
Specific objectives:
To assess the prevalence of diabetes mellitus among men
To assess the prevalence of impaired fasting glucose level among business men
To identify contributing factors associated with diabetes mellitus among business men
To identify contributing factors associated with impaired glucose homeostasis among business men
1.4 RESEARCH QUESTIONS
- What is the prevalence of diabetes mellitus among men?
- What is the prevalence of impaired fasting glucose level among business men?
- What are the contributing factors associated with diabetes mellitus among business men?
- What are the contributing factors associated with impaired glucose homeostasis among business men?
1.5 SIGNIFICANCE AND RATIONAL OF THE STUDY
In Nigeria, hospital registration data indicate that the prevalence of chronic non-communicable diseases is ever increasing. Diabetes is one of the chronic non-communicable diseases which is becoming the major cause for hospital admission in Rivers state (13, 14).
Literatures indicates that lack of physical activities, excessive alcohol consumption, unhealthy eating behavior, smoking and ageing of the population deriving this epidemic in worldwide (30- 47). Few studies (10,12) done in Rivers state in selective group of population indicate that increasing number of diabetes was found but the situation in Men is unknown even though the group is predisposed to those factors that lead to diabetes mellitus. So the finding of this study is the initial for the commission of business men in the country and can be also useful at the national level for policy makers. Finally, through identifying business men at greatest risk of developing the diseases, the finding will help to develop prevention and intervention strategies.
- SCOPE OF THE STUDY
This study which is focused on assessing the prevalence of prevalence and contributing factors to diabetes among men in eleme local government area of rivers state is limited to the people of rivers state.
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