PREVALENCE AND PREVENTIVE MEASURES FOR GESTATIONAL DIABETES AMONG CHILDBEARING MOTHERS IN OWERRI NORTH LOCAL GOVERNMENT AREA OF IMO STATE

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Abstract

The study was designed to determine the prevalence and preventive measures of diabetes among child bearing mothers (CBM) in Owerri North LGA of Imo state from 2004-2013. To achieve these purpose seven specific objectives with corresponding research questions were posed and three null hypotheses  were formulated.  Ex-post facto research design  using the retrospective survey was used for the study. The population for the study was 3560 childbearing mothers and

356  were selected  as sample  size through  simple  random  sampling  technique,  also  20,  280 folders from the selected health facilities were used. Inventory proforma and questionnaire forms were  used  as  instruments  for  the  data  collection,  research  formula   for  prevalence  rate, percentage, frequency, counts, mean and chi-square  statistics  (X2) used for data analysis. The major findings of the study were that; the  number of diabetic childbearing mothers in Owerri North LGA from 2004 – 2013 was 46, prevalence rate of Diabetes mellitus among Childbearing

mothers in Owerri North LGA was at 2.3 per thousand, the trend of prevalence is fluctuating, the highest prevalence (41.3%) based on age was recorded between age of 40years and above, the highest prevalence (54.3%) according to parity occurred among Childbearing mothers of 4 and above. The highest prevalence of Diabetes mellitus based on level of education (37.0%) occurred among non-formal educated Childbearing mother.. The three null-hypotheses which stated that there were no significant difference in the prevalence of diabetes among Childbearing mothers according to age,parity and level of education respectively was tested using Chi-square at .05

level of significance and all were accepted [ (X2=26.595, P value =.873, df = 36, p=.05),  (X2

value  =14.810,  P value  =.675, df =18, p =.05),(X2   value =13.691,  P value =.984,df  =27,  p

=.05)].This  study  found  low  prevalence  rate  with  fluctuating  trend,  which  prompted   the researcher to make some relevant recommendations such as establishing International Diabetes Federation  in  LGAs,  making  diabetic  laboratory  test  free,  creating  awareness  on  diabetes prevention  among  childbearing  mothers  and  establishing  both  secondary  and  tertiary  health facilities with adequate specialists to manage the diagnosed diabetics childbearing mothers and their babies.

Background to the study

CHAPTER ONE Introduction

 1  

Diabetes  is  one  of  the  leading  causes  of  death  in  the  world  over.  World  Health Organization (WHO) observed that in 2011, it resulted to 1.4 million deaths globally making it the 8th leading  cause of death. Also  International  Diabetes  Federation  (2007)  observed  that between 8 and 14 million deaths are caused by diabetes every year in developing countries.In

2013, World Health Organization estimated that about 382 million people have diabetes world wide with Type 2 diabetes making up 90 percent of the cases, this is equal to 3.3 percent of global population. WHOfurther predicted that the number of people with diabetes is expected to rise up to 592 million by 2035.In United States, about 23.7 per cent adult population are diabetic. (American Public Health Association, 2008),and in Nigeria, not fewer than 6 million people have diabetes,  especially Type2  diabetes.  The above  assertions  indicated  that  there  is increase  in prevalence of diabetes globally and nationally.

Diabetes is described as an excessive discharge of urine due to disorder of the endocrine (hormone)   system.   It  has  two   types,   namely  diabetes   mellitus  and   diabetes   insipidus. DiabetesInsipidus is defined as a disorder associated with malfunction of the pituitary gland that leads to pituitary imbalance. This study will concentrate mainly on diabetes mellitus which is often referred to as diabetes by medical doctors. Mullen (2000) defined diabetes mellitus as a condition where the body has difficulty in absorbing glucose from the blood and delivers it to the rest of body for its energy needs because of lack of insulin. Weller (2005) opined that diabetes is a metabolic  disease  characterized  by  excessive  urination  (polyuria),  hyperglycemia  resulting from defect in insulin secretion, insulin action or both. Also Onuzulike (2006) described it as a disorder  in which the body  cannot  convert  foods properly into  the energy needed  for daily activity. The author further described it as a medical condition characterized by chronic increase in blood sugar level and it is due to impaired production of insulin or impaired action of insulin. Gupta and  Ghai (2007)  asserted  that diabetes  is a chronic  systemic  disease  characterized  by hyperglycemia    and   glucosuria,    resulting    from   defective    B-cell   function,    diminished responsiveness  to  insulin  or both.  Furthermore  Walsh and  Crumble  (2007)  defined  diabetes mellitus as a heterogeneous  group of disorders  of carbohydrate,  fat and  protein metabolism. According to them it is characterized by chronic hyperglycemia, degenerative vascular changes and neuropathy.

Diabetes  is  seen  as  a  heterogeneous  group  of  disease,Park  (2009)  opined  thatit  is characterized  by a  state  of  chronic  hyperglycemia,  resulting  from  a diversity  of  etiologies,

environmental and genetic factors, acting jointly the underlying cause of disease is the defective production or action of insulin. Insulin is a hormone that controls glucose, fat and amino acid metabolism. Adebayo (2014) defined DM as a condition in which the amount of glucose in the blood is too high because there is not enough of the hormone insulin. Similarly, Medical News (2014)  described  diabetes mellitus as metabolic  disease  in which  the person has high blood glucose either because insulin production is inadequate or because the body cells do not respond properly to insulin or both. The author further explained that patients with high blood sugar will typically experience  polyuria  (frequent  urination),  increasingly  thirst (polydipsia)  and excess hunger (polyphagia). Lastly, World Health Organization WHO (2014) defined diabetes mellitus as a chronic disease that  occurs when the pancreas does not produce enough insulin or when thebody cannot effectively use the insulin it produces. This study will adopt WHO’s definition as the operational definition and types ofDiabetes mellitus were discussed below.

Diabetes  mellitus is of two major types and the third is seen only during  pregnancy. WHO (2007) classified  diabetes into Type 1 or insulin dependent diabetes  mellitus (IDDM), Type 2 or non-insulin dependent diabetes mellitus (NIDDM) and  gestational diabetes. Type 1 diabetes is also referred to as juvenile or childhood onset diabetes. It is characterized by deficient insulin production, acute onsets and occurs before  30 years of age often before adulthood or during teenage  years. Walsh and Crumbie  (2007) asserted that Type 1 diabetes is caused by destruction  of  B-cell  in the  islets  of  langerhans  of  the  pancreas.  The  destruction  is  due  to autoimmune  response  associated   with  environmental  and  genetic  factors.  It  accounts  for approximately 10 percent of all cases. Treatment is often with administration of insulin injection. Another type of diabetes mellitus is Type2.

Type  2  is  also  known  as  non-insulin   dependent   diabetes  mellitus  (NIDDM)   is

characterized  by insulin  resistance,  which may  be combined  with relatively  reduced  insulin secretion. Medical News (2014) revealed that approximately 90per cent of all cases of diabetes worldwide are of this type. It is typically a progressive disease, it gradually gets worse and the patient  may  probably  end  up  having  to  take  some  medications  that  will  improve  insulin sensitivity or reduce glucose production by the liver. Often Type 2diabetes occurs after the age of 40years but can develop  anytime  in the adulthood.  It  develops  as a result of genetic  and environmental factors also obese people have much higher risk of developing Type 2 diabetes compared to those with a healthy body weight. Being physically inactive, taking the wrong foods and sugar sweetened drinks also contribute to risk of developing this type of diabetes. The risk is also greater as one gets older and having a close relatives who have suffered diabetes.

Gestational   diabetes   mellitus   (GDM)   is   another   type   of   diabetes   that   is   first recognizedduring  pregnancy  especially  during  the  third  trimester  of  pregnancy.  Walsh  and Crumbie   (2007)   asserted  that  among  pregnant   women  who  suffer   diabetes  about  87.5 percentwere  first recognized  during pregnancy and the cause is  pregnancy-related,  while 7.5 percent are due to Type 1 and Type2diabetes is responsible for 5 percent. Park (2009) revealed that gestational diabetes is more among women whose country of birth were China, India and Asian than European and Northern African. Park (2009) further observed that in India GDM has been found to be common in women living  in urban areas than in rural areas. Unfortunately Adebayo (2014) observed that Nigeria  lacks an aggregate data of child- bearing mothers with diabetes.

Gestational diabetes affects females during pregnancy and disappears within 6 weeks of delivery, but many sometimes develop into Type2 diabetes in later life(Nordiquist, 2013). Thisis the key issue of this study, because it is only suffered by childbearing mothers.Wikipedia (2014) opined that recent data shows that GDM prevalence has increased by 16-27per cent in several race/ethnicity  groups  during  the  past  20years.Deboer,  Baner,  Georgieft  and  Nelson  (2005) observed  that during normal  pregnancy many physiological  changes occur, such as increased hormonal secretion that influence blood glucose levels, which can lead to increased excretion of glucose by the kidney and resistance of cells to insulin.Freinkel (2007) opined that gestational diabetes  mellitus  (GDM)  results  from    women’s  inability  to  secrete  sufficient  insulin  to compensate  for the increased  nutritional  needs of gestationand  the production of  anti-insulin hormones such as human placental lactogen, prolactin, cortisol and  progesterone.  The author further explained thatunder listedpeople may be at risk of GDM: small- for- date, large- for date at birth, very short or very tall women, children born by diabetic mothers, pregnant women with past history of gestational diabetes or type 2 diabetes, women of high cholesterol and high degree of obesity. Finally he asserted that GDM is thus a metabolic disorder similar to Type 2 diabetes mellitus.GDM is a form glucose intolerance diagnosed during pregnancy, according to National Institute of Health (2011) it is common among obese women and women with family history of diabetes mellitus. Also it was observed that immediately after pregnancy, 5-10 per cent of the women  develop  Type2diabetes  mellitus.  And  between  35-60  per  cent  have  the  chance  of developing DM in 10-20 years.

Childbearing mothers are women who are pregnant or have given birth and still in their reproductive age from 15-49years. They are most vulnerable in the society because of the life threatening  challenges  and  death  associated  with  pregnancy  and  childbirth.  World  Health Organization WHO (2009) stated that childbearing mothers should be the important target group

in any government  policy formation  and implementation  because  of their  vulnerability.  The author further opined that the maintenance of adequate health of the childbearing mothers and infants is crucial to attainment of optimal maternal health and national development.Childbearing mothers here refer to mothers who are still pregnant up till 6weeks of post natal in Owerri North LGA. In the context of this study, some childbearing mothers develop diabetes due to alteration in production and secretion of pregnancies  related hormones which are known as anti-insulin hormones. This can lead to difference in prevalence of DM among CBM and the prevalence of this disease varies depending on the environmental or genetic factors.

Prevalence,  according  to  Weller  (2005),  means  the  number  of persons  who  have  a specific disease or condition that present in a defined population at one specific point in time. Lucas and Giles (2003) defined prevalence as the total number of casesexisting in a population at a specific period of time. Park (2009) described disease prevalence as all cases of a disease (old and new) existing  at a given point  in time or over  a period of  time in a given population. Onwasigwe (2010) defined prevalence of disease as number of people in population that have a disease at a given time,(old and new cases). This study will adopt Onwasigwe’s definition as its operational definition.This isbecause the research seeks to find out the number of childbearing mothers who are diabetic from 2004-2013 in Owerri North LGA.

Prevalence is of two types namely point and period prevalence. Point prevalence is the prevalence  at a specific  point in time, the specific point may be hour or week. And  period prevalence is the prevalence during a given interval, the time interval is usually in months or years.Prevalence can be determined using rate and rate issaid to be measurement of the speed atwhich something happens or number of events within a certain period. In relation to disease condition,  it means  the  number  of times  a particular  disease  occurs  in a  given population. According to Gupta and Ghai (2007) prevalence rate is measured by the number of people in population, who have a disease at a given time, and this includes both old and new cases and is obtained  by a cross sectional studies.  He further  explained  prevalence  rate is determined  by comparing number of existing cases (old and new) of a specified disease during a given period of time interval, over the estimate population at risk per 1000 population.

Prevalence rates are specifically important in chronic diseases. Park (2009) opined that it

determines the total workload and is useful tool for health planning. Also it helps in expressing the magnitude of the problem in a community. Lastly periodic estimation of prevalence is useful in studying changes in pattern of disease. He noted that diseases with an acute onset and short duration have low prevalence rate than diseases with sub-acute onset and longer duration, such as diabetes, hypertension and other chronic diseases. This means that the prevalence rate depends

upon the incidence and duration of illness, in other words, the longer the duration of the disease, the  greater  the  prevalence.Direction  of  prevalence  rate  of  diabetes  for  many  years  can  be reviewed to know whether it is increasing or decreasing using trend.

Trend is defined by Weller (2005)as method of time series data (information in sequence over time). It involves the collection of data from multiple time periods and plotting the data on a chart. Trend shows a general direction in which something is developing or changing, it could be upwards, downwards or fluctuating. Upward trend means that there is steady increase in disease development. Downward trend indicated that there is continuous reduction in number of people affected by the condition. Also trend can be said to be fluctuating, when there is neither steady increase  nor  decreased  condition.  Trend  when  analyzed,  will  help  in  prediction  of  future conditions  or  outcomes.  Trend  in  this  study  adopted  Weller’s  definition  as  its  operational definition  because  the  study  intended  to  review  prevalenceof  gestational  diabetes  among childbearing mothers in Owerri North from 2004 to 2013. Trend on prevalence can be influenced by some variables, such as age,  level of education, parity,location,  marital status, income and many others. But the study will concentrate on age, parity and level of education.

Age according to Park (2009) is a strong contributory factor related to diseases because persons of both extremes of age tend to be most severely affected. The author further stated that chronic and degenerative diseases such as DM show a progressive  increase in incidence with advancing age. Diabetes Care (2006) asserted that maternal age is an established risk factor for GDM. American Diabetes Association (2013) recommended that the lowest cutoff age at risk should be 25years and above, based on the research conducted by them.The report observed that the risk increases as maternal age rises in this order, 20-24 years, 25-29 years, 30-34 years, 35-

39years, and 40years upward. This indicated that as childbearing mothers are advancing in age, there are at risk of developing gestational diabetes.

Level  of  education  is  another  important  variable  that  determines  the  prevalence  of gestational diabetes among childbearing mothers.Zimmerman,  Steven and Haley (2015) stated that there is a large gap in health statues between high and low education. The authors estimated that by 2011, the prevalence of diabetes mellitus had reached 15 per cent for adults without a high school education compared  with 7 per cent for University  graduates.Studyconducted  by Kang and Park (2008) on influence of education on childbearing mothers’ knowledge revealed that the higher educated one is, the higher the level of knowledge.Therefore if the child bearing mothers are educated up to secondary level, they will have enough knowledge on health issues. This willenable them to adhere to medical instruction on their health and know the importance of regular  antenatal care,  laboratory investigation  and good healthy habit.Since  the above study

indicated that level of education is related to level of knowledge, this iswhy this study seeks to know  if  level  of  education  will  have  effect  on  prevalence  of  gestational  diabetes  among childbearing mothers. Therefore level of education in this studyrefers to academic attainment of the  childbearing  mothers,  whether  they  attained  primary,  secondary,  tertiary  or  non-formal education.

Parity is a way of classifying women with regard to the number of children that they have

given birth to(Weller,2005). Various authors like Onuzulike (2006), Fraser and Cooper (2003) have opined that women with high parity of over four children are at greater risk in all pregnancy related  sickness  and problems  such as Anaemia,  hypertension,  diabetes.  Egeland  (2002) also observed  from his study that women with grand  multiparity had  greater  gestational  diabetes mellitus. This study seeks to find out if increase in parity increases the prevalence of gestational diabetes mellitus. However the influences of these  variables on prevalence of diabetes can be reduced or managed through some preventive measures.

Prevention according to Weller (2005) is defined as serving to avert the occurrence of, it is also called  prophylactic  measure.  Hornby (2006) also defined  it as intention to,  trying to, means or the act of stopping something bad from happening such as accident, crime, disease and fire.Also American Heritage (2011) defined preventive measures as intended or used to prevent or  hinder,  acting  as  obstacle.  Preventing  or  slowing  the  course  of  an  illness  is  known  as prophylactic.  In other words preventive means  hindering  or acting as an obstacle to slow the development of a condition like disease.

Park (2009) classified the preventive measures of diabetes into primary, secondary and tertiary. He explained that primary preventive measure is plans intended to hinder the occurrence of disease. This action is taken prior to the onset of a disease or occurrence of something bad to the individual. In case of diabetes mellitus, the plans commence before one is diagnosed diabetic. It  is  made  up  of  population  and  high-risk  measures.  Population  preventive  measureis  not applicable to type 1 diabetes mellitus because based on current knowledge there is no known preventive measures, though emphasis is on need to prevent emergence of risk factors.

On the other hand, high-risk preventive measure refers to removal of risk factors that can lead to diabetes by the target population. Park (2009) explained that since NIDDM appears to be linked with sedentary life-style, over-nutrition and obesity, correction of these may reduce the risk of diabetes among childbearing mothers and its complication. Again, since alcohol is a risk factor,  it  should  be  avoided,  also  people  at  risk  should  avoid  diabetogenic  drugs  like  oral contraceptive,   reduce  factors  that  promote   atherosclerosis   example  smoking,   high  blood pressure, elevated cholesterol and high triglyceride level.

Secondary  Preventivemeasures  refer  to  the  action  which  slows  the  progression  of a disease  or occurrence  of something  bad, it ensues when diabetes  is detected.It  is  adequately managed,  by maintaining  blood  glucose  levels  close  to  normal  limits,  maintain  ideal  body weight,  eat  adequate  diet  and  take  insulin  drugs.    Tertiary  preventive  measures  focuses  on prevention of disabilitiesand helping people to manage complications which is easily caused by diabetes  such  as  blindness,   kidney  failure,   coronary  thrombosis,  gangrene  of  the  lower extremities. The main objective of the tertiary level is to prevent further physical deterioration and  maximizing  quality  life  by  organizing  specialized  clinics/units  capable  of  providing diagnostic and management skills of a high order.In addition, other authorsoutlined the following preventive measures.

According to Freinkel (2007) gestational diabetes mellitus (GDM) is a form of  Type2 diabetes  therefore,  all the  preventive  measures  are same  including  the  following:  Inprimary preventive  measures,  timely  and  appropriate  screening  of  all  childbearing  mothers  for  DM especially those at risk must be ensured. Also CBM who have preexisting DM should be advised to get pregnant only when there is glycaemic control in other to reduce risk. Children of diabetic parent should be encouraged  to maintain  healthy  life-styles  to avoid excess weight gain and reduce their risk for type 2 diabetes, also regular blood and urine test. In secondary preventive measures, blood glucose level must be under control, appropriate screening and management of complication  from  diabetes  and  fetal  surveillance  must  be  ensured.  After  delivering  of the babies,  mothers  should  be  advised  on exclusive  breast-feeding,  because  it  enhances  weight reduction and reduces  insulin resistance.In the context of this study, preventive  measures are plans intended to avert the occurrence of diabetes or early diagnosis of diabetes mellitus and its management,  in other to reduce or manage  its complications  among childbearing  mothers in Owerri North LGA of Imo State.

This  study  is  anchored  on  three  theories;  Health  belief  model  (HBM),  Protection motivation  theory (PMT)  and  Precede  model.  HMB  was developed  by social  psychologists Rosenstock and Becker (1974). The model attempts to explain and predict health behavior by focusing on the attitude and beliefs of individual. Protection motivation  theory was originally founded by Rogers (1975) and it explains how one can take some measures to combat the risk of developing a health problem.The Precede model was  proposed  by Green(1974),  it provides a comprehensive   structure   for   assessing   health   and   quality   of   life   needs   for   designing, implementing and evaluating health programmes and other public health programmes to meet those needs. Health Belief Model and Protection Motivation Theory in this study are based on the belief that if  childbearing  mothers can successfully observe the recommended  preventive

measures,  the outcome of pregnancy were satisfactory while precede model will help  health planners and policy makers to analyze the health needs of childbearing mothers in Owerri North LGA of Imo State in other to make adequate provisions.

Owerri North LGA is one of twenty-seven LGA in Imo State, with its’ headquarter  at Orie Uratta. It has population of 175,397 people and land mass of 165,83 sqkm  (Ministry of land/survey 2006). It is of Ibo-speaking tribe, the peoples’ occupations are mainly farming, petty trading and there are few civil servants with poor economic status. There is no secondary health facility like general hospital.However there are few health centres, one mission hospital, private hospitals  and  maternity  homes.  Most  of  these  health  facilities  have  no  standard  medical laboratory and trained  personnel,  there are  under staffed with few medical doctors, qualified nurses and midwives. These inadequacies may hinder prompt and adequate management of these childbearing  mothers  with  diabetes.  International  Diabetes  Federation  (2007)  asserted  that shortage of health facilities and  medical personnel may attest to high prevalence  of diabetes. Their low socio-economic status prevents them from accessing the private hospitals because their bills are unaffordable. The distance of Owerri North to secondary and tertiary health facilities in the state is quite far and this may contribute to the poor attainment of hospital by child- bearing mothers. Their staple food is mainly carbohydrate such as yam, rice, garri, cassava to mention but a few and these types of food may contribute to weight gain which may lead to obesity, their culture   also   encourages   high  parity  rate,   merry-making   and  alcoholism.   All  these   are predisposing factors of diabetes.

These gross inadequacies of under staff of available health centres, absence of secondary and tertiary health institutions,  including  poor socio-economic  status, intake of  high calories foods as staple food and culture of the people of Owerri North LGA, are what motivated the researcher on this study, to find out the prevalence of diabetes among childbearing mothers in Owerri North LGA of Imo State.

Statement of the Problem

Motherhood is a joyous and emotional moment for both couple and entire family. They are happy that very soon a new baby will be added to the family. It involves antenatal, natal and postnatal stages.During  the antenatal stage, there are a lot of physiological  changes that take place in the lives of both the mother and baby.These changes result chiefly from alterations in hormones  production,  circulation  and  metabolism.  At  this  stage  of  pregnancy,  mothers  are supposed to be attending hospitals for regular antenatal cares by the medical professionals like

obstetricians,  midwives,  laboratory scientist  and others. This is to ensure good health of  the mother  by detection  and  treatment  of  any ailment,in  other  to  have  a hitch-free  labour  and successful delivery of a healthy baby at last.

However,  in some women with certain predisposing  factors like family history of  diabetes, unhealthy  lifestyle,  obesity,  physical  in-activities,  ageing,  grand  multi-parity,  past  medical history of diabetes, these physiological changes can result to some adverse medical conditions like diabetes known as gestational diabetes mellitus.This can pose some health challenges to both mother  and baby during pregnancy if high blood sugar level is  not detected  on time or not controlled. This can lead to some complications like spontaneous abortion, premature delivery, fetal distress, obstructed labour due to macrosomic (above 4kg) baby, birth injury like shoulder dystocia  due  to  difficult  vagina  delivery,  intra  uterine  death/stillbirth,  maternal  death  and caesarean section as last resort. These are worrisome complications among child bearing mothers that have diabetes.

However,  these possible  complications  are preventable  and manageable  through  early booking,  regular  and  early  laboratory  investigations,  adequate  management  by the  medical experts, administration of prescribed drugs, eating of balanced meals and  adherence to health education on preventive measures of diabetes.

Regrettably,  Owerri North LGA being a rural area has neither  secondary nor  tertiary health facilities where these medical specialists and cares can be found. Rather  there are few health centres which are short-staffed  and underequipped.  These account for  inadequate cares and poor management  of few CBM that attend the facilities,  while a  good number of them prefers  self-management  and  patronizing  of  quacks,traditional  birth  attendants  and  private maternity homes. Again,considering  their low socio-economic status, high carbohydrate staple foods and cultural background  that encourages  high parity rate for their women,therefore  the researcher wants to find out what is the prevalence rate of gestational diabetes mellitus among CBM  based  on  age,parity  and  level  of  education.  And  what  are  the  necessary  preventive measures that can assist the CBM in Owerri North LGA, since there is no known literature which showed that such study has been carried out in Owerri North LGA.

Purpose of the study

The purpose  of this  study is to  find  out  the prevalence  and  preventive  measures  of diabetes among the childbearing mothers in Owerri North LGA of Imo State. Specifically the study seeks to find out:

1.   The prevalence of diabetes among childbearing mothers of Owerri North LGA of Imo State

(2004-2013);

2.   the prevalence rate of diabetes among childbearing mothers of Owerri North LGA of Imo

State (2004-2013);

3.   the trend  of prevalence  of diabetes  among-child  bearing  mothers  of Owerri North  LGA (2004-2013);

4.   the prevalence of diabetes among childbearing mothers based on age;

5.   the prevalence of diabetes among childbearing based on level of education;

6.   the prevalence of diabetes among CBM of Owerri North LGA based on parity;

7.   the preventive measures of DM among child bearing mothers.

Research questions

To guide this study, the following research questions are posed:-

1.   What is the prevalence of diabetes among childbearing mothers in Owerri North LGA of Imo

State (2004-2013)?

2.   What is the prevalence rate of diabetes among childbearing mothers in Owerri North LGA of

Imo State (2004-2013)?

3.   What is the trend on prevalence of diabetes among childbearing mothers in Owerri North

LGA of Imo State?

4.   What is the prevalence of diabetes among of childbearing mothers in Owerri North  LGA

basedon age?

5.   What is the prevalence of diabetes among CBM in Owerri North LGA based on level of education?

6.   What is the prevalence of diabetes among child bearing mothers in OwerriNorthbased  on parity?

7.   What are the preventive measures for DM among CBM?

Hypotheses

The following hypotheses are formulated to guide the study and they were tested at .05 level of significance.

1. There is no significant difference in the prevalence of diabetes amongchildbearing mothers according to age.

2. There is no significant difference in the prevalence of diabetes among childbearing mothers according to level of education.

3.  There is no significant difference in the prevalence of diabetes among childbearing mothers accordingto parity.

Significance of the Study

The  findings  from  this  study  Prevalence  and  Preventive  Measures  for  Gestational Diabetes among Childbearing Mothers may be of great benefit to doctors,  nurses, midwives, community health practitioners, public health educators, childbearing mothers, health planners, epidemiologists,  the  pharmacists,  the  government  and  general  public.  Data  generated  from prevalence  rate  of  diabetes  among  CBM  will  benefit  the  preexisting  diabetic  women,  their husbands  and  medical  personnel,  the  information  will  guide  them  while  planning  for  next pregnancy, also the data will help CBM to realize that DM is a chronic disease so that they can learn to cope with it, by adhering to the preventive measures, such as regular laboratory test of blood  and urine  sugar  level,  avoiding  injuries,  engage  in regular  exercise,  taking medically prescribed drugs, eat appropriately and uphold good lifestyle.

The findings  from this study on trend of prevalence of diabetes among  Childbearing motherswill  benefit  the  State  Ministry  of  Health  and  epidemiologist  since  it  will  provide statistics  for evaluating the lifestyle of the people,  disease progression,  the impact of health programmes and activities in this LGA. Again it will enable the  pharmacists  to evaluate the efficacy and potency of drugs in use.

Information  generation from prevalence  of Gestational Diabetes Mellitus according  to age may be useful to the CBM and their husbands because they will learn to avoid pregnancy at old age, since some literature stated that pregnancy during older age is associated with greater risk. Also the knowledge will help medical personnel to realize that older mothers are at greater risk and need prompt attention.

Data generated on prevalence of GDM according to level of education will beuseful to government  especially Ministry of   Education by giving them  insight on academic  status of childbearing mothers, since some study ascertained this,therefore plans were  made on how to make education compulsory, affordable and accessible for all.Also the general public and family members shall see the need to encourage all to complete at least secondary level of education because  it  will  enhance  their  total  knowledgeon  health  issues  and  adherence  to  medical instruction.

Data generated  on prevalence of GDM according to parity mayl benefit all women of childbearing age because they will learn the risk associated  with bearing too many children, since this endangers their lives and predispose them to many risks like diabetes. Also the study

will benefit health educators by learning the importance of teaching and encouraging mothers on importance of family planning since it is a good measure to control grand multi-parity and its consequences.  Again  government  will  know  from  the  study  the  need  to  establish  a  well- equipped family planning centre in Owerri North LGA which should be affordable.

Datagenerated  from  preventive  measures  of  diabetes  mellitus  among  child  bearing mothers will benefit the general public both men and women, to check if they are  at risk of developing  DM and adopt the necessary measures to avert the occurrence  of the disease  or enhance  its  early  detection  and  management.  Also  the  information  is  relevant  to  health professionals, who will appreciate the importance of early laboratory investigations for all child bearing mothers and need to emphasize on these issues during health talks.

Finally, the study is anchored on health belief model and protection motivation theory and precede model. The information generated from this study may be beneficial to readers and other researchers, because the theories expounded in the study will guide those who may wish to conduct further studies on this topic prevalence and preventive measures of DM among child bearing mothers of Owerri North LGA, to apply it where necessary.  It would also  serve as resource materials for others on further research.

Scope of the Study:

This study was delimited to childbearing mothers assessing public health facilities and one mission hospital  in Owerri North Local government  Area of Imo State.This  study were concerned with the prevalence and preventive measures of diabetes among childbearing mothers in Owerri North from 2004-2013, some socio-demographic variables of age, parity and level of education were studied. Theories such as health belief model, protection motivation theory and precede model which are relevant to the study are also discussed. .



This material content is developed to serve as a GUIDE for students to conduct academic research


PREVALENCE AND PREVENTIVE MEASURES FOR GESTATIONAL DIABETES AMONG CHILDBEARING MOTHERS IN OWERRI NORTH LOCAL GOVERNMENT AREA OF IMO STATE

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