Self-care practice and associated factors among Diabetes Mellitus patients on follow up in Benishangul Gumuz Regional State Public Hospitals, Western Ethiopia: a cross-sectional study

Diabetes mellitus (DM) is a metabolic disorder of multiple etiologies characterized by increased level of glucose in the blood with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both [1]. It is a complex, chronic illness demanding continuous medical and self-care [2].

Diabetes is a global health problem targeted for action and currently increasing both in the number of cases and the prevalence [3, 4]. According to the International Diabetes Federation (IDF) 2017 reports, more than 425 million people worldwide are reported as diabetic patients and nearly 80% of them are living in low and middle-income countries including Ethiopia. Globally, more than 212 million people with diabetes are not aware of their disease and there are above 352 million people with impaired glucose tolerance (IGT) [5], which puts them at high risk of developing diabetes and its complications like cardiovascular diseases, stroke, kidney failure, foot ulcer, visual impairment and nerve damage [3, 5, 6].

Diabetes self-care is important to keep the disease under control, It includes performing activities such as healthful eating, regular physical activity, foot care, medication adherence, and self-monitoring of blood glucose (SMBG) [6]. However, it is highly challenging since many people with diabetes may have contact with a healthcare professional for a total of a few hours per year and factors such as diabetes knowledge, physical activities, social support and self-efficacy can affect the self-care practice [7, 8].

In Ethiopia, diabetes becomes a fast-growing and more common chronic illness, in which > 2.135 million people are expected to be diabetic patients and it becomes the most common cause of admission which fasten the development of complications like heart attack and strokes; as a result it shortens an individual lifespan by 10–15 years. Despite this, the feature of self-care practices towards diabetes was not adequate [9–11]. Diabetes has a great burden on the quality of life and socioeconomic structures of the affected individuals, their families, and the country’s economic status. Countries like Ethiopia, where the resources are limited, and treatment costs of the disease are constantly increasing, good adherence to diabetic self-care practice may result in better economic and therapeutic outcomes [6, 12, 13]. Although such studies are important in such resource-limited areas, to realizing the various complex nature of the problem and to individualize, integrate the clinical approach that will enhance the diabetic self-care practice utilization [6, 7, 14], there is no study conducted in Benishangul Gumuz public hospitals regarding self-care practice on diabetic patients; few studies conducted in developing countries have discrepancy on self-care practice among diabetes patients and all of the available literatures in Ethiopia were limited in addressing factors that influence self-care practice. Therefore, this study aimed to assess self-care practice and associated factors among diabetic patients in Benishangul Gumuz public hospitals, Western Ethiopia.

In this study, the magnitude of overall poor self-care practice was 45.7% (95% Cl 40.9–51%); which is consistent with studies conducted in Dilla University Hospital [19], Nekemte referral Hospital [10], Mekele and Ayder Referral Hospital, Ethiopia [20], and India [21] which were (44%, 45%, 49% and 50.5%) respectively. However, it is higher than a study conducted in Addis Ababa (39.7%) [21]. In the contrary, the finding is lower than the study conducted in Kenya, Felege Hiwot and Harar Hospital, Ethiopia (59%, 63.2% and 60.8%) respectively [9, 22, 23]. The possible reasons for this difference could be the difference in the sources of information, socio-cultural variation, inadequate access of the glucometer, inadequate health education towards self-care practice and educational level of the study participants.

In the present study, those who were unable to read and write were 3.6 times more likely to have poor self-care practice than those who were Grade 12 and above. Similar findings were observed in a study conducted in Harrari [9], Jimma [25] and FelegeHiwot hospital, Northwest Ethiopia [24]. Moreover, diabetes health education had a preventive effect against poor self-care practice and this finding was supported by findings from Addis Ababa and Bahir Dar hospitals [21, 23]. The possible reason behind this finding might be the diabetes education given by health professionals increased the interest of patients on their own health and created awareness that enhances the self-care practice.

Not having glucometer was also significantly associated with poor self-care practice; this finding is comparable with a study conducted in Anand District of Gujarat [13]. The possible reason could be having a glucometer at home may reinforce to monitor their blood glucose level regularly. Respondents who had poor diabetes knowledge were also 5 times more likely to have poor self-care practice than those who had good diabetes knowledge. This finding was supported with the study conducted in Nekemte, Indian and Bangladesh [9, 10, 19].

Additionally, respondents who had no diabetes self-efficacy were more likely to have poor diabetes self-care and which was similar with studies conducted in Malaysia and Omani [25, 26]. This study finding also showed that social support was one factor that affects self-care practice in diabetes patient; in which participants who had no social support were more likely to have poor self-care practice than those who had social support. This finding was supported by the study done in Jimma [25], Anand District of Gujarat and India [13, 21]. The possible reason for this might be due to having social support may be considered as a guiding force that reinforce individuals for the better self-care practice.

Generally, the finding of this study revealed that a significant number of diabetes patients had a low level of self-care practice. These findings request for the need of integrated interventional management on diabetes, which will increases health and wellbeing of the patients. Therefore, in order to improve diabetes self-care practice; different stakeholders including Hospitals, health professionals, health programmers, and different non-governmental organizations should give emphasis on linking diabetic patients to different supporting social groups, improving knowledge through health education and providing self-monitoring glucometer for those individuals who are unable to buy by themselves.

Since the study was a cross-sectional study, which was poor in establishing a temporal relationship and the data collection method was self-report rather than direct observation of patient’s self-care practices.