Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 26  |  Issue : 2  |  Page : 99-103

Knowledge, beliefs, and practices regarding diabetic eye disease among patients with diabetes at the lions diabetic centre, university of calabar teaching hospital, Nigeria


1 Department of Ophthalmology, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
2 Department of Internal Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria
3 Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria

Date of Web Publication13-Feb-2019

Correspondence Address:
Dr. Bassey A Etim
Department of Ophthalmology, University of Calabar and University of Calabar Teaching Hospital, Calabar
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njo.njo_12_18

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  Abstract 


Objective: To assess the knowledge, beliefs, and practices among participants with diabetes mellitus (DM) receiving care at a tertiary government hospital in Calabar, Nigeria, on DM and diabetic eye disease. Materials and Methods: A hospital-based, cross-sectional study where serial recruitment of consenting participants was performed. Ethical approval was obtained from the hospitals’ ethics committee. Data were obtained using a structured interviewer-administered questionnaire. Data were collated and analyzed using the SPSS for Windows (version 20; SPSS Inc., Chicago, Illinois, USA). Categorical variables were presented as frequencies and continuous variables as means. Results: Of the 123 study participants, majority 87 (70.7%) were females and 36 (29.3%) were males. Forty-three (35%) had a duration of DM greater than 10 years. A total of 54 (44%) had good knowledge of DM. One hundred and six (86.2%) had the knowledge that regular eye checkups for a diabetic person was important, and 92 (69.9%) knew that DM could affect vision, whereas 84 (68.3%) believed that DM frequently affects vision. Eye-health-seeking behavior was good in 83 (67.5%) of participants, and an ophthalmologist was the medical personnel sought for by most participants. Conclusion: The knowledge of diabetic eye disease as a potential cause of vision loss among study participants was good. However, the knowledge on DM was poor in majority of study participants. The beliefs and practice toward eye-health were also good. Sustained health education including eye health education will most likely improve the knowledge base of DM and encourage early presentation for eye evaluation in patients with DM.

Keywords: Beliefs, Calabar, diabetic eye disease, knowledge


How to cite this article:
Etim BA, Nkanga DG, Agweye CT, Enang OE, Ibanga AA, Udoh MME, Utam UA. Knowledge, beliefs, and practices regarding diabetic eye disease among patients with diabetes at the lions diabetic centre, university of calabar teaching hospital, Nigeria. Niger J Ophthalmol 2018;26:99-103

How to cite this URL:
Etim BA, Nkanga DG, Agweye CT, Enang OE, Ibanga AA, Udoh MME, Utam UA. Knowledge, beliefs, and practices regarding diabetic eye disease among patients with diabetes at the lions diabetic centre, university of calabar teaching hospital, Nigeria. Niger J Ophthalmol [serial online] 2018 [cited 2023 Feb 6];26:99-103. Available from: http://www.nigerianjournalofophthalmology.com/text.asp?2018/26/2/99/252181




  Introduction Top


Diabetes mellitus (DM) affects nearly all organs of the body. The principal risk factor for the development and progression of DM complications is the duration of diabetes.[1] Consequently, the complications of diabetes associated with longer duration of the disease will become a major challenge facing the healthcare sector.[1] Diabetic eye disease refers to a group of eye conditions people with DM may develop as a complication of this disease, potentially leading to visual impairment and blindness.[2] Cataract and diabetic retinopathy, a microvascular complication, are well-known causes of visual impairment and blindness among working-age adults with DM.[3],[4]

Other ocular complications of DM include recurrent styes, xanthelasma, extra ocular muscle palsies, diplopia due to diabetic neuropathy, blepharoconjunctivitis, impaired corneal sensitivity which predisposes the diabetic patient to bacterial corneal ulcers, neurotropic ulcers, difficulties with contact lenses,[3] and variation of ocular refraction.[4]

Knowledge plays a vital role in any future disease development and its early prevention and detection. Positive knowledge, beliefs, and practice (KBP) are important for diabetic patients.[5] Elements of KBP are interrelated and dependent on each other. If the level of one element is higher, the other two factors would be affected positively. Knowledge, attitude, and practices regarding diabetes vary greatly depending on socioeconomic conditions, cultural beliefs, and habits.[5] A need has been demonstrated for the diabetic population to be aware of the annual eye screening from the time of diagnosis in type 2 and after 5 years of diagnosis in type 1.[6] It is noticed that in spite of the availability of technology and protocol which aids early detection of diabetic retinopathy in the developed countries, prevention and management are still emphasized.[7] On the other hand, in poor resource countries such as Nigeria, prevention and management are imperative, but this will depend largely on the knowledge the patients possess the effect of this knowledge on their psyche and their attitude toward eye care.[8]

Aim of study

The aim of the study is to assess the knowledge about diabetic eye disease, the belief, and practice among patients with DM undergoing treatment for DM in a tertiary care government hospital in Calabar, Nigeria.


  Materials and Methods Top


The study was conducted among patients with DM attending University of Calabar Teaching Hospital (UCTH)/LIONS diabetic clinic (on Wednesdays) at the University of Teaching Hospital located in Calabar Municipality. Serial recruitment of consecutive patients attending the clinic was performed. A structured interviewer-administered questionnaire capturing information on the demographic data of the patients, their medical history, knowledge of diabetes and its effect on the eye, their beliefs, and practice regarding diabetic eye care was obtained by the authors and research assistant.

Study population

The study population comprised both the old and newly diagnosed patients with diabetes attending the diabetic clinic of UCTH.

Study period

This study spanned for a period of 2 months.

Study design

It was a cross-sectional study.

Data analysis

Data were collated and analyzed using the SPSS for Windows (version 20; SPSS Inc., Chicago, Illinois, USA). Categorical variables were presented as frequencies and continuous variables as means. The Chi-square statistical tool was used in the analysis of the result. The level of significance will be set at P < 0.05.

Ethical considerations

Ethical approval for the study was obtained from the Health Research Ethics Committee of the UCTH.

Permission was also sought from the Head of Department of Internal Medicine of UCTH, as well as the Consultant In-Charge of the diabetic clinic of UCTH.

Verbal informed consent was obtained from the patients before enrollment into the study. Prior to this, detailed information and explanation of the study was made to each patient. Opportunity for asking questions was provided and appropriate clarifications were given to each patient before administering the questionnaire. Patients were informed that they had a right to refuse to participate in the study, and they were reassured that their withdrawal would not affect their treatment in the hospital in any way.


  Results Top


There were a total of 123 participants, with 36 males and 87 females. About a third of the participants 43 (35%) have had DM for greater than 10 years [Table 1].
Table 1 Sociodemographic characteristic of participants

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Knowledge

When the DM knowledge scores of participants were calculated, 69 (56%) of participants were noted to have poor knowledge scores, whereas 54 (44%) participants had good knowledge [Table 2].
Table 2 Responses to questions related to knowledge of diabetes mellitus

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Majority of participants 106 (86.2%) knew that patients living with DM should have regular eye examinations, as more than half knew that DM could affect vision [92 (74.8%)], and vision loss from DM could be prevented [86 (69.9%)] [Table 3].
Table 3 Ophthalmic knowledge among participants with diabetes mellitus

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Beliefs

It was observed that more than half of the participants 84 (68.3%) believed that DM affected vision frequently [Table 4].
Table 4 Beliefs about DM and the eye among participants with diabetes mellitus

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Practice

The eye-health-seeking behavior among participants was good, as more than half [83 (67.5%)] have had their eyes checked after their diagnosis of DM [Table 5].
Table 5 Eye-health-seeking behavior of participants with diabetes mellitus

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About half of those who had their eyes checked [40 (48.2%)] had their screening about a year ago. Majority of participants [25 (62.5%)] who had not had their eyes screened revealed that they were not informed about the necessity of having their eyes checked. An ophthalmologist was the medical personnel prefer first by most participants [91 (74%)] [Table 6]. Only 14 (11.4%) of the participants had ever used traditional herbal medication for their eyes.
Table 6 Practice of participants

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  Discussion Top


DM is a significant cause of visual impairment among patients with the chronic condition. Therefore, sufficient knowledge concerning diabetes and its ocular involvement as well as good practices with regards to controlling their diabetes and availing themselves for the recommended eye examination are crucial. In addition, awareness is an important step in the creation of a successful screening program to tackle the sight-threatening eye complications among people living with DM. This study showed that more than half of the participants (56%) were unable to explain DM. This is in contrast to other studies conducted in Nigeria (56.4%) and Jamaica (57%) where a little over half of the respondents had good knowledge of DM.[8],[9] There was a good knowledge among the participants regarding DM affecting the eyes (74.8%), which was comparable to studies performed in Saudi Arabia (75.62%) and Oman (72%),[10],[11] but higher than those performed in Ghana (19%) and India (50%).[12],[13] The observation made in this study may be due to the fact that it was conducted in a hospital setting where health education sessions on the subject are constantly conducted by ophthalmologists in charge of the diabetic retinopathy eye screening in the endocrinology clinic.

In the present study, majority of participants (69.9% and 86.2%, respectively) were aware that vision loss from DM could be prevented, and people with DM should have regular eye examination; the latter is in variance with that in Bangladesh (49%).[14] Participants had a fair knowledge of DM causing cataract (51.2%). Result of similar studies in Nigeria and Bangladesh revealed the opposite, where 11.65% and 40% of respondents, respectively, had poor knowledge of DM causing cataract.[8],[14] A poor knowledge of diabetic retinopathy (46.3%) as a complication of DM was observed in this study, and this is comparable to a study in Nepal (37%)[15] but is in contrast to that conducted in Bangladesh (55%) and Pakistan (73.5%), where a good knowledge of diabetic retinopathy as an ocular complication was observed among participants.[14],[16] Majority of the study participants (87%) believed regular eye examination could prevent one from losing vision from DM; Mian et al.[16] observed otherwise in their study. The knowledge about diabetes and its ocular manifestation as well as the need for regular eye examination in this work translated to good practice. It was observed that around 67.5% of the participants had their eyes examined after their diagnosis of DM, with 40% of them having the examination about a year ago. This result was comparable with a study performed in Saudi Arabia.[10] This observation was not in accordance with the results of Mwangi et al.,[17] who reported that only 50% of the participants had eye examinations and 27% of them went once a year. Likewise, Ovenseri-Ogbomo et al.[12] reported only 19.5% of participants had undergone eye checkup within 1 year. Reason proffered by most of the study participants (62.5%) who had not had their eyes examined was that they were not told it was necessary to check their eyes. This was higher compared to a study in Owerri, Nigeria, which showed that 32.4% of respondents gave the same reason.[8] This buttresses the need for medical personnel to consistently educate diabetic patients they see on the importance of having their eyes examined and screened by an ophthalmologist,[18] as sight-threatening and asymptomatic ocular manifestations of DM may be identified for early intervention.


  Conclusion Top


The results of this study have shown that, although more participants were aware that diabetes affects the eye and had a fair eye care practice, the knowledge on DM as a disease was poor in majority of study participants. Furthermore, they had poor knowledge of the fact that they do not have to wait for eye symptoms to manifest before seeing the eye physician. Some were yet to have an eye examination because they were not aware of its importance. The results suggest the need for intensified general health education and eye health education to increase awareness regarding DM and ocular manifestations of DM, especially diabetic retinopathy and its sequalae. Health personnel must implement effective methods of counseling patients living with diabetes on the need to have an eye examination on diagnosis of DM.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alasiri RA, Bafaraj AG. Awareness of diabetic retinopathy among diabetic patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Ann Int Med Den Res 2016;2:42-5.  Back to cited text no. 1
    
2.
Diabetic eye disease https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-eye-disease. Updated May, 2017. [Accessed on 2018 Mar 15].  Back to cited text no. 2
    
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Muecke J, Newland H, Ryan P, Ramsey E, Aung M, Myint S et al. Awareness of diabetic eye disease among general practitioners and diabetic patients in Yangon, Myanmar. Clin Exp Ophthalmol 2008;36:265-73.  Back to cited text no. 3
    
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Rowe NG, Mitchell PG, Cumming RG, Wans JJ. Diabetes, fasting blood glucose and age-related cataract: The Blue Mountain Eye Study. Ophthalmic Epidemiol 2000;7:103-14.  Back to cited text no. 4
    
5.
Fatema K, Hossain S, Natasha K, Chowdhury AH, Akter J, Khan T et al. Knowledge attitude and practice regarding diabetes mellitus among nondiabetic and diabetic study participants in Bangladesh. BMC Public Health 2017;17:364.  Back to cited text no. 5
    
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Al-Mulla AH, Al-Thafar AK, Hussain MAA, Ali SI, Al-Dossary SK. Knowledge, attitude and practice toward diabetic retinopathy and retinal examination among diabetic population in Al-Hasa Region, Saudi Arabia: A cross-sectional study. Int J Sci Stud 2017;5:165-9.  Back to cited text no. 6
    
7.
Resnikoff S, Kocur I. Non-communicable eye diseases: Facing the future. Commun Eye Health J 2014;27:41-3.  Back to cited text no. 7
    
8.
Achigbu EO, Oputa RN, Achigbu KI, Ahuche IU. Knowledge, attitude and practice of patients with diabetes regarding eye care: A cross sectional study. Open J Ophthalmol 2016;6:94-102.  Back to cited text no. 8
    
9.
Foster T, Mowatt L, Mullings J. Knowledge, beliefs and practices of patients with diabetic retinopathy at the University Hospital of the West Indies, Jamaica. J Commun Health 2016;41:584-92.  Back to cited text no. 9
    
10.
Al Zarea BK. Knowledge, attitude and practice of diabetic retinopathy amongst the diabetic patients of Saudi Arabia. J Clin Diagn Res 2016;10:1-8.  Back to cited text no. 10
    
11.
Khandekar R, Harby SA, Harthy HA, Lawatti JA. Knowledge, attitude and practice regarding eye complications and care among Omani persons with diabetes—A cross sectional study. Oman J Ophthalmol 2010;3:60-5.  Back to cited text no. 11
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12.
Ovenseri-Ogbomo GO, Abokyi S, Koffuor GA, Abokyi E. Knowledge of diabetes and its associated ocular manifestations by diabetic patients: A study at Korle-Bu Teaching Hospital, Ghana. Niger Med J 2013;54:217-23.  Back to cited text no. 12
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13.
Namperumalsamy P, Kim R, Kaliaperumal K, Sekar A, Karthika A, Nirmalan PK. A pilot study on awareness of diabetic retinopathy among non-medical persons in South India. The challenge for eye care programmes in the region. Indian J Ophthalmol 2004;52:247-51.  Back to cited text no. 13
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14.
Ahmed KR, Jebunessa F, Hossain S, Chowdhury HA. Ocular knowledge and practice among type 2 diabetic patients in a tertiary care hospital in Bangladesh. BMC Ophthalmol 2017;17:1-6.  Back to cited text no. 14
    
15.
Thapa R, Paudyal G, Maharjan N, Bernstein PS. Demographics and awareness of diabetic retinopathy among diabetic patients attending the vitreo-retinal service at a tertiary eye care center in Nepal. Nepal J Ophthalmol 2012;4:10-6.  Back to cited text no. 15
    
16.
Mian LS, Moin M, Khan IH, Manzoor A, Bajwa JA. Awareness of diabetic retinopathy among diabetic patients. Pak J Ophthalmol 2017;33:149-55.  Back to cited text no. 16
    
17.
Mwangi MW, Githinji GG, Githinji FW. Knowledge and awareness of diabetic retinopathy amongst diabetic patients in Kenyatta National Hospital, Kenya. Int J Humanit Soc Sci 2011;1:140-6.  Back to cited text no. 17
    
18.
Momoh ZD, Agweye CT, Oguntolu V, Nkanga D. Diabetic retinopathy screening in Calabar, Nigeria: Factors influencing referrals and uptake of screening service. Niger J Ophthalmol 2017;25:118-22.  Back to cited text no. 18
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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