Study area and period
This study was conducted at Gurage zone hospitals which is located in Southern Nations Nationalities and Peoples’ Region state (SNNPRs) of Ethiopia. The “Gurage”zone has three primary Hospitals, one general hospital and 72 health centers. All hospitals have chronic follow up clinic especially for diabetes mellitus and hypertension. Those four hospitals were“Attat” (private hospital), “Gunchire”, and “Bui” are primary hospitals and Butajira is the only General hospital in the zone. The study was conducted from April 1- 30, 2019.
Study design
Were Institutional based cross sectional study.
Source population
Were all DM patients on follow up at Gurage Zone Hospitals.
Study population
All sampled diabetic patients attending “Butajira” general hospital, “Attat” and “Gunchire” primary hospitals follow up clinics during the study period.
Inclusion criteria
All diabetic patients who had follow up in sampled hospitals of Gurage zone having follow up during the study period.
Exclusion criteria
Were patients with less than three months durations and also who were unconscious and had mental illness during data collections were excluded.
Sample size and sampling technique
(See Sample size and sampling technique in the Supplementary Files)
Sampling techniques
Stratified sampling method was used to select the study sample from selected hospitals. First one general hospital was purposively selected and two primary hospitals were selected by simple random sampling using lottery method from three primary hospitals. Then stratified sampling and proportional allocation was done for one general hospital (Butajira general hospital) and two primary hospital (Gunchire and Attat primary hospital) from the total diabetic patients of each hospitals by n = n/N * Nj equation. Number of study subjects in each stratum determined by proportion to population size from each hospital. This sampling procedure is presented schematically as follows. (Figure1).
Patients of each hospitals further selected by systematic sampling from follow-up registration books (sampling frame) after calculation of the sampling interval =N/n, 1540/338=5. The patient`s card were used to get other medical condition and laboratory results for additional information.
Study variables
Independent variables
- Socio-demographic characteristics (age, sex, weight, educational status, place of residence, income)
- Medical conditions (type of DM, hyperlipidemia, duration of disease, BMI, infection, other comorbidities(hypertension, heart diseases))
- Type of medication (treatment adherence, insulin, oral hypoglycemic agent, and life style medication (diet, exercise), smoking)
Dependent variables
Data collection procedure
Data collection instruments
The data were collected using structured questionnaire and by reviewing patients cards for laboratory results and other medical findings (hypertension, kidney failure, heart failure and infection). The questionnaire had three parts. These includes socio-demographic data, medical related factors and management related factors
Data collection process
Three diploma nurses were selected for data collection for each hospital with two BSc nurses for supervisors. Training were given for both data collectors and supervisors for two days before the actual data collections about the study procedure and data collection techniques go through the questionnaires questions by questions, ways of data collection, supervision and finally clarification was given for each doubt.
Operational definition and definition of terms
DM complications: DM patients having both acute and chronic complications of type 1 and type 2 DM.
Diabetes ketoacidosis: ketonuria positive
Hyperglycemic hyperosmolar state – it is mental change confusion, lethargy or coma associated with diabetes especially with recent history of dehydration of poor oral intake of fluid associated with increased osmolality and blood glucose level.
Retinopathy- It is complication of diabetes which damages blood vessels in the retina due to leaking of blood and other fluid as a result of long standing diabetes mellitus.
Nephropathy- It is the complication of diabetes in people who have had diabetes for 20 years or more present with albumin in the urine.
Neuropathy- It is diabetic effect of the nerve damage due to high blood glucose which mostly affects nerves of legs and feet.
Diabetic control:Good 130 or RBS200 and Poor >130 of FBS/RBS>200[(12)].
Diabetic complication:
No: if the diabetic patients have neither acute nor chronic complication.
Yes: if the patients has one complication either acute(hypoglycemia, DKA and HHNS) or chronic complication (Macro vascular, micro vascular, neuropathy, nephropathy or diabetic foot ulcer) that rule out by laboratory investigation and physical examination during follow up.
Data quality management
To assure the quality of data, properly designed data collection tool (structured questionnaire) was prepared in English and translated to Amharic language and then back to English to check the consistency. The questionnaire was pre tested. Training was also given for both data collectors and supervisors before actual data collection on the data collection process.
Data processing and analysis
After data collection, responses were entered into EPI data Version 3.1 and exported to SPSS version 23 for clearing, coding and analysis. In descriptive statics both frequency and proportion were calculated and in analytic logistic regression were made by considering diabetic complication as binary outcome variable (yes/no). Those explanatory variable with p- value 0.2 at 95% CI in bivariate were eligible for multivariate and those variables with p value0.05 were found to be significant
Ethical consideration
Before data collection, Ethical clearance letter was obtained from Wolkite University College of medicine and health science department of nursing and dispatch to each selected hospitals and Gurage zonal health office. The respondents were informed and their oral consent was obtained. The respondents had the right to refuse or with draw from participating were also maintained in addition to keep their response confidentially
Dissemination of finding
The result of the study was communicated to Wolkite University College of medicine and health science, department of nursing, “Butajira” general hospital, “Attat” primary hospital and “Gunchire” primary hospitals.