ABSTRACT
This study assessed Health belief determinants of obesity and diabetes mellitus among the elderly in Ikwuano and Umuahia north local government area Abia state. The study was a descriptive cross-sectional study. Multi-stage sampling technique was used to select the study sample of 66 respondents. A structured and validated questionnaire was used for the data collection and analyzed using descriptive statistics and Pearson correlation and significance was at p<0.05. IBM Statistical Package (SPSS), version 22.0 was used to analyze the data. The result showed that 56.1% were males and 43.9% were females and the age categories of the respondents were between 60 to 90 years, more than half (51.5%) were within their 60 to 65 years of age. The result revealed that majority of (83.3%) adults perceived that they were not too fat (obese), while very few (16.7%) of the adult perceived that they were too fat. Majority (89.4%) were not found to be diabetic while 10.6% of the population already knows they were diabetic. Result further showed that the respondents positively agree that they had perceived susceptibility of obesity, perceived severity of obesity, perceived benefits of engaging in preventive behaviour, perceived barriers for engaging in preventive behaviour and self-efficacy in performing preventive behaviour with a mean value of 0.01±0.63, 0.27±0.55, 0.59±0.52, 0.14±0.61, and 0.24±0.63 respectively. Result also revealed perceived benefits of engaging in preventive behaviour was 0.59±0.52, perceived barriers for engaging in preventive behaviour, -0.14±0.61 and self-efficacy in performing preventive behaviour was 0.24±0.63. The study revealed that the perceived severity of being obese, the perceived benefits of engaging in preventive behaviour and the perceived self-efficacy in performing preventive behaviour were the determinants (P<0.01) of the perceived susceptibility to obesity of the respondents. It showed that the respondents’ self-perception of being obese was being influenced (P<0.01) by body mass index and their belief of the benefits derived from engaging in preventive behaviours. The findings of this study also showed a correlation between having high educational status, perceived barriers and perceived benefits. Result revealed that being retired predicted perceived benefits and perceived severity of obesity. It showed a significance (P<0.05) association between having high education and perceived benefits. Also being retired predicted perceived severity and perceived benefits of engaging in preventive behaviours against diabetes mellitus. The result also there was no correlation between age and the health belief determinants of diabetes mellitus. The result conclude that the elderly adults were discovered to be diabetic using the random blood glucose classification and they were aware of their current health status. The study also concludes many of the respondents percieved themselves to have a poor body size. Many perceived themselves to be obese even when they were not. Prevalence of obesity and overweight found in the respondents were higher than the prevalence of overweight and obesity in Nigeria. They were also at high risk of non-communicable diseases. The study therefore recommends that families and caregivers of the elderly should be educated by nutritionist and the government on health belief models which will key component in care of the elderly.
TABLE OF CONTENT
TITLE PAGE i
CERTIFICATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
TABLE OF CONTENT v
LIST OF TABLES vii
ABSTRACT viii
CHAPTER 1
INTRODUCTION
1.1 Statement
of problem 3
1.2 Objectives of the study 4
1.3 Significance of the study 5
CHAPTER 2
LITERATURE REVIEW
2.1 EPIDEMIOLOGY
AND PATHOGENESIS OF DIABETES IN 6
ELDERLY
PEOPLE 6
2.2 PATHOPHYSIOLOGY OF TYPE 2 DIABETES
MELLITUS 7
2.3 LIPID PROFILE AND
DIABETES MELLITUS 8
2.4 RISKS FACTORS OF TYPE 2 DIABETES MELLITUS (T2DM) 9
2.4.1 Family history 10
2.4.2 Ethnicity Type2 Diabetes Mellitus 10
2.4.3 Advancing age 10
2.4.4
Obesity 10
2.4.5
Unhealthy dietary or eating pattern 11
2.4.6
Westernized diet 12
2.4.7 Fast-foods 12
2.4.8 Physical inactivity 13
2.4.9
High sugar intake 14
2.5 MEDICAL
CONDITIONS ASSOCIATED WITH DIABETES 14
MELLITUS IN THE ELDERLY 16
2.5.1 Cognitive
Dysfunction 15
2.5.2 Functional
impairment 15
2.5.3 Polypharmacy 16
2.5.4 Depression
16
2.5.5 Vision
and hearing impairment 16
2.6 OVERWEIGHT
AND OBESITY IN ELDERLY PEOPLE 16
2.6.1 Risk Factors of Overweight and Obesity in
Elderly People 17
2.6.1.1
Eating Habits 18
2.6.1.2
Physical Activity 18
2.6.1.3
Sedentary Behaviors 19
2.7 HEALTH
BELIEF MODEL 19
2.7.1 The
major concepts and definitions of the health promotion model 20
2.8 ANTHROPOMETRIC ASSESSMENT 21
2.8.1 Weight 21
2.8.2 Height 22
2.8.3 Body Mass Index (BMI) 22
2.8.4 Waist Circumference 23
2.8.5 Hip Circumference 23
2.8.6 Waist-Hip-Ratio 24
CHAPTER 3
MATERIALS AND METHODS
3.1 Study Design 25
3.2 Area of Study 25
3.3 Population of the
Study 26
3.4 Sample and Sampling
Technique 26
3.4.1 Sample size determination 26
3.4.2 Sampling procedure 27
3.5 PRELIMINARY
ACTIVITIES 27
3.5.1 Preliminary visits 27
3.5.2 Training
of research assistants 27
3.5.3 Informed
Consent 28
3.5.4 Ethical Approval 28
3.6 DATA
COLLECTION 28
3.6.1 Questionnaire
Design 28
3.6.2 Questionnaire
administration 28
3.6.3 Anthropometric measurement 29
3.6.3.1 Weight Measurement 29
3.6.3.2 Height measurement 29
3.6.3.3 Hip Circumference
Measurement 29
3.6.3.4 Waist circumference
measurement 29
3.6.3.5 Waist hip ratio (WHR) 30
3.6.4
Blood glucose assessment 30
3.7 Data analysis 30
3.7.1 Body mass index (BMI) 30
3.7.2 Waist circumference and waist hip ratio 31
3.7.3 Plasma glucose test 31
3.8 Statistical
analysis 31
CHAPTER 4
RESULTS AND DISCUSSION
4.1
Socioeconomic and Demographic Characteristics of the Respondents 32
4.2
Background Information of the Adults Studied on Obesity 34
4.3 Health
Belief Determinants of Obesity (Being Too Fat) 36
4.4
Background Information of the Adults Studied on Diabetes Mellitus 37
4.5 Health
Belief Determinants of Diabetes Mellitus 39
4.6
Anthropometric and Random Blood Glucose Status of the Adults 41
4.7
Relationship between Health Belief Determinants and body
Mass Index of the Adults 43
4.8
Relationship between Health Belief Determinants and Random Blood Sugar of
the Elderly 45
4.9
Comparison of Mean Response between the Health Belief Determinants of
Obesity and Diabetes Mellitus 47
4.10
Relationship between Mean Response of the Adults on Obesity and
Diabetes Mellitus 48
4.11
Relationship between Health Belief Determinants of Diabetes Mellitus and
Socio-Economic Characteristics 50
4.12
Relationship between Health Belief Determinants of Diabetes Mellitus and
Socio-Economic Characteristics 51
CHAPTER 5
CONCLUSION AND RECOMMENDATION
5.1 Conclusion 53
5.2 Recommendations 53
REFERENCES
LIST OF
TABLES
Table Page
4.1: Demographic
and socio-economic characteristics of the students 33
4.2 Background Information of the Adults
Studied On Obesity 35
4.3 Health
Belief Determinants of Obesity 36
4.4 Background
Information of the Adults Studied On Diabetes Mellitus 38
4.5 Health
Belief Determinants of Diabetes Mellitus 40
4.6 Anthropometric and Random Blood Glucose
Status of the Adults 42
4.7 Relationship
between Health Belief Determinants and Body Mass 44
Index of the Adults
4.8 Relationship
between Health Belief Determinants and Random 46
Blood Sugar of the Adults
4.9 Comparison
of Mean Response between the Health Belief Determinants 47
of Obesity and Diabetes Mellitus
4.10 Relationship
between Mean Responses of the Adults On 49
Obesity and Diabetes Mellitus
CHAPTER
1
INTRODUCTION
1.1 BACKGROUND OF
THE STUDY-
Non-communicable
diseases have overtaken communicable diseases as the leading causes of
morbidity and mortality in Nigeria (Sani et al., 2010). The
changing disease pattern has been traditionally attributed to changes in diet,
cigarette smoking, alcohol consumption, and inadequate exercise. The World Health Organization (WHO) (2013) has identified the main
categories of NCDs which includes cardiovascular diseases such as heart attacks
and strokes; chronic respiratory diseases like chronic obstructive pulmonary
disease and asthma; cancers; diabetes; kidney diseases. These diseases share
key risk factors which are tobacco use, harmful use of alcohol, physical
inactivity and unhealthy diet (WHO, 2013). Among these non-communicable diseases are obesity and
diabetes mellitus (Oladapo et al.,
2015).
The
nutritional and epidemiological transitions driven by demographic changes,
rising income, unhealthy lifestyles, and consumption of highly processed diets
are among the leading contributors to obesity and diabetes (Steyn and Mchiza,
2014). Rapid industrialization,
urbanization, economic development and market globalization over the past decades
have contributed to rapid changes in diet and lifestyles. This is having a
significant impact on the health and nutritional status of populations,
particularly in developing countries and in countries in epidemiological and
nutrition transition phases (Opara and Ekanem, 2016). Recent evidence on the
high burden of cardiovascular disease, diabetes mellitus and hypertension in
Nigeria mirrors the classic population pyramid that depicts a greater
proportion of adult population with increased vulnerability (Chinedu and Emiloju ,
2014; Adeloye et al., 2015;
Adeloye et al., 2017).
These chronic conditions have also been linked to the clustering of major risk
factors with obesity being the common denominator (Dada,
2017). Obesity and diabetes have greatly impacted
on individuals’ health, self-esteem, educational attainment, quality of life
and overall productivity (WHO, 2010).The World Health Organization (2015)
defines obesity as a body mass index (BMI) of 30 kg/m2 or more.
Obesity generally results from a chronic
imbalance between energy intake and expenditure (Baron et al., 2017). In 2008, more than 1.4 billion Elderly
(20 years and above) were overweight, and of these over 200 million men and
nearly 300 million women were obese (WHO, 2011).
Aging is associated with significant
changes in the physiological, physical, psychological and immune function,
particularly cell-mediated immunity, resulting in progressive generalized
impairment that increases susceptibility to communicable and non-communicable.
The elderly vulnerable to rapid degenerative processes, reduced efficiency of
the gastrointestinal tract, loss of appetite due to a decline in sensory
perception and a decline in health (Memon et
al., 2014; Wei and Ya-Wen, 2015). Also, diabetes, eye problems, tooth
loss/decay, rheumatism and hypertension are on the rise among the aged (Slavin,
2014). Diabetes is the most common important metabolic disease among the
elderly. Due to its high prevalence, diabetes is considered as a health problem
worldwide (Shaw et al., 2010).
Diabetes type 2 constitutes about 90 to 95 percent of diabetic patients and
occurs most often in older than 40 years (National Center for Chronic Disease
Prevention and Health Promotion, 2015). This disease imposes great direct and
indirect costs to health care systems (Fattahi et al., 2014). Major part of these costs is related to long-term
complications of the disease, such as coronary heart diseases, stroke,
blindness, lower limb amputation and kidney diseases (Health Quality Ontario,
2009). In 2010, about 285 million people worldwide were suffering from diabetes
(Shaw et al., 2010). Considering the
multiple chronic complications of diabetes, such as visual, renal,
cardiovascular and nervous impairments, by appropriate and immediate
prevention, control and treatment of this disease, numerous limitations and
problems will be solved for diabetic patients (Sharifirad et al., 2007). The diabetes care, treatment and complication costs,
change of behaviour and improving metabolic control is a major goal in the
treatment of diabetes which is dependent on the patient's self-care behavior
(Agha et al., 2015).
To combat the menacing effects of
obesity and diabetes mellitus among the elderly, there is a need adequate
knowledge and proper health seeking behaviours. Thus, the aim of this study is
to determine the health belief determinants of obesity and diabetes mellitus
among the elderly in Umuahia North and Ikwuano Local Government areas, Abia
State.
1.2
STATEMENT OF PROBLEM
Statistics
from 2018 showed that Non-communicable Diseases (NCDs) are responsible for the
deaths of 41 million people annually, of which 15 million affected people are
in the 30- and 69-year age group. It is reported that 50% of these premature
deaths occurred in low- and middle-income countries (WHO, 2018). Global Health
Observatory data in 2018 predicted that deaths from NCDs would rise to about 52
million worldwide in the year 2030 (WHO, 2020). The WHO (2018) reported that
the probability of dying prematurely from NCDs in Nigeria is 20%. The projected
prevalence estimate of diabetes in Nigeria is 4.04%.
In
addition to these, WHO (2008) estimates that more than 180 million people
worldwide have diabetes in 2008 and in 2009, the prevalence rose to 246million.
A diabetes prevalence of 20.8million (7% of population) for Nigeria is
considered high and Nigeria having the largest prevalence of Diabetes Mellitus
in African region in 2011 is a concern (International Diabetes Federation
(IDF), 2012). The global prevalence of diabetes among Elderly over 18 years of
age has risen from 4.7% in 1980 to 8.5% in 2014. In 2015, an estimated 1.6
million deaths were directly caused by diabetes. Another 2.2 million deaths
were attributed to high glucose in 2012. Almost half of all the death
attributable to high blood glucose occurs before the age of 70 years. WHO
projects that diabetes will be the seventh leading cause of death in 2030 (WHO,
2017). Risk factors for the pooled prevalence of Diabetes Mellitus were a
family history of Diabetes Mellitus, urban dwelling, unhealthy dietary habits,
cigarette smoking, older age, physical inactivity and obesity (Uloko et al., 2018).
Diabetes in elderly is linked to higher mortality, reduced functional
status, and increased risk of institutionalization (Brown et al., 2013). Older
Elderly with diabetes are at substantial risk for both acute and chronic
microvascular and cardiovascular complications of the disease. Diabetes is associated with increased risk of multiple
coexisting medical conditions in older Elderly. In addition to the classic
cardiovascular and microvascular diseases, a group of conditions such asgeriatric
syndromes cognitive dysfunction falls, slow rehabilitation,
depression and anxiety, decreased socialization, sleep and appetite
disturbances, and higher health care costs and utilization also occur at higher
frequency in the elderly with diabetes and may affect self-care abilities and
health outcomes including quality of life (Laiteeraponget al., 2011).
1.3
OBJECTIVES OF THE STUDY
1.3.1
General objective of the study
The general objective of this study
is to determine the health belief determinants of obesity and diabetes mellitus
among the elderly in Umuahia North and Ikwuano Local Government areas, Abia
State.
1.3.2
Specific objectives of the study
The specific objectives
are to:
- determine
the socio-demographic/economic characteristics of the elderly.
- determine the health belief determinants
of obesity and diabetes mellitus among the elderly in the study areas
using the Health belief model.
- assess the blood glucose status of the elderly
in the study areas.
- determine the anthropometric status of the
elderly in the study areas using Body Mass Index and Waist - Hip ratio
Indicators.
- identify the relationship between the
socio-demographic/economic characteristics, blood glucose and
anthropometric status of the elderly and their health belief determinants.
1.4 SIGNIFICANCE OF THE
STUDY
Findings from this study will help Elderly know the
necessity of regular monitoring exercise and also provide a good knowledge and better
perception about obesity and diabetes among the elderly. The
knowledge gained from this study will also help the target population and
healthcare providers in understanding how early prevention and detection
measures could reduce obesity and diabetes prevalence and the financial and
economic burden in Nigeria. The study would also be useful to nutritionists,
corporate bodies and professional bodies by providing sufficient information
which would serve as a medium or basis for further researches to be carried out
in the near future.
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