Knowledge, Attitude, and Practice Towards Diabetes Mellitus Tmong Chiro Town Population, Eastern Ethiopia

doi:10.21203/rs.3.rs-4810001/v1

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Knowledge, Attitude, and Practice Towards Diabetes Mellitus Tmong Chiro Town Population, Eastern Ethiopia

https://doi.org/10.21203/rs.3.rs-4810001/v1

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Background: Diabetes mellitus is a metabolic disorder of multiple etiological factors characterized by chronic hyperglycemia with disturbance of carbohydrate metabolism. It can play the vital role in the cause of morbidity and mortality through continued clinical consequence and mortality. Therefore good knowledge of diabetes mellitus prevention and management is necessary in promoting care and enhancing good therapeutic outcomes.

Objective:To assess the knowledge, attitude, practice and associated factors among general population regarding diabetes mellitus in Chiro town, Estern Ethiopia, august 01 to October 30, 2023.

Methods: Cross-sectional study design was conducted on 764 subjects from Augeust 01 to December 30, 2023. A pre-tested structured questionnaire was used to collect the socio-demographic information of the study participants. Data was enterd into Statstical Package for social science , checked for completeness and analyzed. The characteristics of the study population were summarized using descriptive statistics, frequency and percentage.

Result: The study revealed that 98% of respondents had heard of diabetes, with 80% correctly identifying it as a condition of high blood sugar and 25% recognizing inadequate insulin action as a characteristic. Additionally, 65.57% demonstrated good knowledge of diabetes, 60% had a positive attitude towards diabetes management, and 35.4% reported good practices. Despite these insights, misconceptions persisted, such as 25% believing diabetes is caused by a curse. Regular exercise and non-smoking were common positive practices, but only 10.4% regularly checked their blood sugar levels.

Conclusion and recommendation: This study highlights high diabetes awareness (98%) but incomplete understanding, with only 25% recognizing inadequate insulin action. Mixed perceptions about diabetes management and significant gaps in prevention practices underscore the need for targeted educational programs, emphasizing the treatability of diabetes, regular monitoring, and healthier lifestyle choices. Enhanced awareness of comprehensive diabetes care, including proper medication use and physical activity, is crucial.

Knowledge

Attitude

Practice

Diabetes mellitus

Diabetes mellitus (DM) is a metabolic disorder of multiple etiological factors characterized by chronic hyperglycemia with disturbance of carbohydrate metabolism which resulted from either insufficient insulin secretion, resistance to the action of Insulin or both (Balaji et al., 2019).The two major types of DM are Type 1 (insulin dependent) DM and Type 2 (non-insulin dependent) DM, responsible for 90% of the disease prevalence (Ibrahim and Mohamedahmed, 2022).Type 1 DM (T1DM) is characterized by an autoimmune destruction of beta cells, which leads to absolute insulin deficiency and dependence on insulin injections for survival (Huang et al., 2023). Type 2 Diabetes Mellitus (T2DM) is the furthermost common form of DM which is identified via hyperglycemia, insulin resistance, and relative insulin deficiency (Abbas et al., 2020). It can be controlled through healthy diet, physical activity, losing excess weight, and oral medication (Magkos et al., 2020).

Gestational DM occurs only during pregnancy and is a risk factor for T2DM after pregnancy (Kjos and Buchanan, 1999). The above types are by far the most frequent forms, but other specific types exist that are much less common (Tuomi et al., 2014).

Most persons with diabetes in developing countries are between 45 to 64 years of age, which is a significant segment of the productive age range. In addition to this reduced productivity and declining economic growth, the disease leads to high economic burden in terms of healthcare expenditure (da Rocha Fernandes et al., 2016).

Globally, 537 million adults (20–79 years) are living with diabetes in 2021. This number is predicted to rise to 643 million by 2030 and 783 million by 2045 that is almost double of the 7 diabetic population today. Over 3 in 4 adults with diabetes live in low- and middle-income countries(Sun et al., 2022, Asif and Batool, 2020). This indicates diabetes mellitus is a major and growing public health problem.

The African region is expected to experience the highest increase in coming years with estimated increase in prevalence rates of 98% for Sub-Saharan Africa. According to International Diabetes Federation (IDF), 2017 report in Ethiopia 2.6 million DM cases in the country.

Ethiopia as one of the developing countries has been showing changes that shift the lifestyle of the people towards urbanization, dietary changes, and reduced physical activity, particularly in recent decades. These rapid changes have led to the emergence of noncommunicable diseases (NCDs) such as diabetes mellitus (Cho et al., 2005).Which can play the vital role in the cause of morbidity and mortality through continued clinical consequence. People living with diabetes may have to deal with short-term or long-term complications as a result of their condition (Saravanan et al., 2020).

Effective approaches are available to prevent these complications and premature death that can result from all types of diabetes (Guariguata et al., 2014). knowledge and practice across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure (Reza et al., 2014, WHO, 2016). In addition, information against diabetes mellitus can help people assess their risk of diabetes, motivate them to seek proper treatment and care, and inspire them to take charge of their disease for their lifetime (Moodley and Rambiritch, 2007).

The 80% of all diabetes cases will occur in the low and middle socioeconomic classes where knowledge about diabetes is poor (Guariguata et al., 2014). Studies regarding the knowledge, attitude and practice towards DM has been conducted in some parts of Ethiopia. KAP regarding diabetes are the principal markers of awareness, that vary greatly depending on socio economic conditions, cultural beliefs and habits which need to be studied in various population groups in specific racial and cultural contexts (Fatema et al., 2017). As a result, to the knowledge of the researchers no study was conducted in estern Ethiopia in general and chiro town in particular. Therefore this study aim to assess the KAP towards diabetes mellitus in Chiro town population, eastern Ethiopia.

Study Area and Period

The study was conducted in Chiro town of West Hararghe Zone of Eastern Etiopia. Chiro town is located in Oromia region, Eastern Ethiopia, 314 km away from Addis Ababa. Its elevation is 1,825 meter above sea level. According to 2022 Ethiopian census report, there are about 69,793 populations in the town, among these populations, 37,204 male and 32,589 female (CSA, 2022) and average temperature of 27°C. currently, the town has one Zonal hospital and two health centers.The study was conducted from august 01 to October 30, 2023.

Study Design

Cross sectional study was conducted.

Source Population

All people who live in chiro town.

Study Population

Those who fulfill the inclusion criteria.

Eligibility criteria

Inclusion Criteria

All people who are voluntary to participate and those who are 18 years and above.

Exclusion criteria

Those who are involuntary, seriously ill diuring the study period and those who are unable to speak and hear.

Variables

Dependent variables

Knowledge, attitude, and practice towards DM.

Independent Variable

Age, sex, religion, place of residence, marital status, educational status, occupational status, family income, and family history of DM.

Operational Definition

Good knowledge:-Answering above the mean of Knowledge Questions.

Poor Knowledge:-Answering below the mean of Knowledge Questions.

Good Attitude:- Answering above the mean of attitude Questions.

Poor attitude:- Answering below the mean of attitude Questions

Good practice:- Answering above the mean of practice Questions.

Poor practice

- Answering below the mean of practice Questions

Sample Size determination and Sampling technique

Sample Size determination

sample size was determined using single population proportion formula. By considering p value, 65.41% prevalence of knowledge about DM, which is obtained from previous study, conducted in Debre Maricos population (Simachew and Temesgen, 2022), with 95% CI and margin of error (d) = 5%. After adding of 10% none response rate and multiplying by design effect the final sample size was 382 * 2 = 764

Data Collection procedure

An official letter of support was written from Oda Bultum University Research and Community Service Vice President office. Permission to conduct the study was sought from Chiro town Adminstrartion. After written informed consent has been signed, data was collected using structured questionnaire. The questionnaire contains three parts: Socio demographic information, general questions on knowledge, attitude and practice about Diabetes Mellitus and the respondent’s response on knowledge, attitude and practice on Diabetes Mellitus, which were developed from different literatures (Belsti et al., ,2020, Kassahun and Mekonen, 2017, Shiferaw et al., 2020, Simachew and Temesgen, 2022). The face to face interview was the technique of data collection.

Data Analysis and Interpretion

Data was checked for completeness and entered to SPSS version 20 for analysis. Data was enterd into EPI Info version 7 checked for completeness and transferred to SPSS (23) for analysis. The characteristics of the study population were summarized using descriptive statistics, frequency and percentage.

Data quality control

The questionnaire was pre-tested on 5% of the sample size on Hirna town population before the actual study begins to make sure that whether the questionnaire is appropriate and understandable. The collected data was checked daily for consistency and accuracy. The questionnaires was randomly selected for quality control purpose and rechecked. Data collectors were trained and the investigators were also followed up the data collection process. Participants were participated only once and also double data entry was done using Epi-Data.

Sociodemographic Characterstics

The study revealed that a greater portion of the participants were male, comprising 53% of the total sample. The majority of participants fell within the age range of 18 to 78 years (mean 34.26 years, Standard deviation (SD) ± 9.35 years). Most of the participants, 267 (35.4%) were between the age of 25 to 34 years. A significant portion of the respondents reported a monthly income of less than 5000 Birr, accounting for 62.8% of the sample population. Furthermore, the predominant ethnicity among the participants was Oromo, with 54.3% of respondents identifying as such. In terms of education, the majority of participants had completed either elementary or high school, constituting 64% of the sample. Additionally, a notable portion of the respondents were single (18.1%) and identified as Muslim (51.7%). Regarding occupation, self-employment was the most common, with 12.2% of respondents engaged in this type of work. Other prevalent occupations included farming (4.5%) and unemployment (24%) (Table 1).

Table 1

socio-demographic characteristics of participants
Variables	Category	Frequency	Percent (%)
Sex	Male	443	53%
Sex	Female	359	47%
Age	18–24 years	112	14.6
	25–34 years	267	35.4
	35–44 years	171	22.4
	45–54 years	122	16
	> 55 years	66	8.6
Monthly income	< 5000	478	62.8
Monthly income	5000	286	37.2
Ethnicity	Oromo	415	54.3
	Amhara	301	39.5
	Others	48	6.2
Educational status	Unable to read and write	66	8.6
	Elementary/High school	488	64
	College/university	210	27.4
Marital status	Single	138	18.1
	Married	484	57.7
	Divorced /Widowed	142	18.5
Religion	Orthodox	297	39
	Muslim	395	51.7
	Protestant	65	8.5
	Others	7	0.9
Occupation	Self employed	93	12.2
	Farmer	34	4.5
	Unemployed	183	24
	Employed (gov’t/privet)	454	59.4

Knowledge towards DM

In this study, the vast majority of respondents (98%) were heared of diabetes. When it comes to understanding diabetes, 80% of respondents correctly identified it as a condition of high blood sugar and 25% of respondents accurately recognized inadequate insulin action as a characteristic of diabetes. Similarly, 71% of respondents associated diabetes with being a non-communicable disease. 92%, 83%, 46%, 42.3%, of respondents identified that DM as being related to one's lifestyle, DM as a chronic disease, insulin is required for diabetic patients and there are several types of diabetes respectively. Surprisingly, 25% of respondents believed that DM was caused by a "curse." On a more positive note, 37.5% of respondents recognized excessive eating as the symptom of having DM and Gangrene in limbs that require surgical removal (43.5%) as major complication of diabetes while 40% recognized obesity as a contributing factor (Table 2).

Table 2

Knowledge of the participants towards DM
knowledge towards DM		Frequency (%)
Heard of diabetes	Yes	749(98)
Heard of diabetes	No	15 (2)
DM is a condition of high blood sugar	Yes	611(80)
	No	153 (14)
	I am not sure	31(4)
DM is a condition of inadequate insulin action	Yes	191 (25)
	No	153(14)
	I am not sure	466(61)
DM is non-communicable disease	1. Yes	542 (71)
	2. No	155(20.3)
	3. I am not sure	67(8.7)
Insulin is required for diabetic patients	1 Yes	351 (46)
	2 No	260(34)
	3 I am not sure	153 (20)
There are several types of diabetes	Yes	323(42.3)
	1. No	306(40)
	2. I am not sure	135 (17.7)
DM is a long term (chronic) disease	1 Yes	634 (83)
	2 No	53(7)
	3 I am not sure	77(10)
DM is related to life style	1. Yes	703(92)
	2. No	61(8)
	3. I am not sure
Risk factor for DM	1 Family History	222(29)
	Obesity	305(40)
	2 Decreased physical activity	46 (6)
	curse	191(25)
The Symptoms of diabetes	1. Excessive feeling of thirst	134 (17.5)
	2. Excessive urination	3. 107(14)
	Excessive eating	283(37.5)
	1. Unexplained Weight loss	78(10.2)
	2. Slow healing of cuts and wounds	116(15.3)
	3. Tiredness and weakness	42(5.5)
know complications of diabetes	4. Eye problems	145(19)
	5. Kidney problems	122(16)
	6. Oral and dental complication	31(4)
	1. Loss of sensation in arm and leg	84 (11)
	2. Cardiovascular disease	42(5.5)
	1. Gangrene in limbs that require surgical removal	332 (43.5)
	2. Erectile dysfunction / loss of libido	8(1)

The total mean score for correctly answered knowledge questions were 38.52 ± 0.5. Those participants who scored below the mean score were 264 (34.4% which was considered as poor knowledge) and above the mean score were 500 (65.57% which was considered as good knowledge).

Attitude towards DM

The study explored attitudes toward diabetes mellitus (DM) among participants, revealing diverse opinions. A significant portion (43%) strongly disagreed that DM is treatable, while 22% agreed and 13.5% strongly agreed. Regarding DM's impact on life expectancy, 74% strongly disagreed that it reduces life expectancy, while 8% agreed and 1.5% strongly agreed.For blood pressure control in DM, 32% strongly disagreed, 18% agreed, and 29.5% strongly agreed. Regular exercise was deemed crucial by 60% who strongly agreed, while 20% agreed. Smoking complications were acknowledged by 55% who strongly agreed, and 19.5% agreed.

Medication discontinuation was strongly disagreed by 62%, while 14.5% agreed. Initiating insulin worsening DM was strongly disagreed by 67.3%, and 4.2% agreed. Proper diabetes treatment reducing complications was strongly disagreed by 43%, while 21% agreed.

Herbal medications were seen as less complicated by 65% who strongly agreed, while 20% agreed. Lipid and blood pressure control necessity was strongly agreed by 55%, and 19.5% agreed (Table 3).

Table 3

Attitude level of participants towards DM
Attitude towards DM	Strongy disagree	Disagree	Neutral		Agree	Strongly agree
DM Is treatable	329(43)	160(21)	4(0.5)		168(22)	103(13.5)
DM reduces life expectancy	565(74)	119(15.5)	8(1)	61(8)		12(1.5)
blood pressure controlling is necessary in DM	244(32)	96(12.5)	61(8)	138(18)		225(29.5)
regular exercise controls DM	30(3.9)	54(7.1)	69(9)		153(20)	458(60)
smoking increase complication of DM	19(2.5)	92(12)	84(11)	149(19.5)		420(55)
Medication can be discontinued	65(8.5)	84(11)	30(4)	111(14.5)		474(62)
Initiating insulin exacerbates diabetes and its complications.	514(67.3)	158(20.7)	16(2)	32(4.2)		44(5.8)
Proper diabetes treatment could reduce the risk of other complications	329(43)	78(10.2)	131(17.1)	160(21)		66(8.7)
Herbal medications have less complication than modern medications	38(5)	19(2.5)	57(7.5)	153(20)		497(65)
Lipid and blood pressure control is necessary in diabetic patients.	420(55)	149(19.5)	42(5.5)	99(13)		54(7)

The mean score of the participant’s practice level was 36 ± 2.3. Those participants who scored below the mean score were 306 (40% which was considered as negative attitude) and above the mean score were 393 (60% which was considered as positive attitude).

Practice twards DM

The study also examined the practices related to diabetes mellitus (DM) among participants. In this study, the overall mean for the practice related data was 3.5 wih the percentage of good practices was 35.4% and the percentage of bad practices was 64.6%.

A significant majority (78.8%) reported not smoking cigarettes. Regarding exercise, 19.3% practiced it regularly, with frequencies of every day (5.5%), once a week (2.6%), twice a week (9.4%), and sometimes (1.8%). Additionally, 27% of respondents actively tried to reduce or maintain their weight, with efforts being made every day (30%), usually (49%), or sometimes (21%).

Only 10.4% of participants regularly checked their blood sugar levels. A substantial portion (81%) included vegetables in their diet; however Fruit consumption was lower, with only 30.4%. On the other hand, Alcohol consumption was reported by 36% of respondents, with drinking frequencies of frequently (10.2%), weekly (13.5%), monthly (6.7%), and for holidays only (5.6%). 8.6% of the participants also commonly included meat and fat in their diet (Table 4).

Table 4

Practice level of respondents towards DM.
Practice towards DM		Frequency (%)
Smoke cigarettes	Yes	161(21.2)
Smoke cigarettes	No	602(78.8)
practice exercise	Yes	148(19.3)
practice exercise	No	616(80.7)
If yes on question, how often	Every day	42(5.5)
	Once a week	20(2.6)
	Twice a week	72(9.4)
	Sometimes	14(1.8)
trying to reduce or maintain weight	1. Yes	206(27)
trying to reduce or maintain weight	2. No	558(73)
If yes on question 404,	Every day	62(30)
	Usually	101(49)
	Sometimes	43(21)
Check blood sugar regularly	Yes	80(10.4)
Check blood sugar regularly	No	684(84.6)
includes vegetables in their diet	1 Yes	619(81)
includes vegetables in their diet	2 No	145(19)
includes fruits in their diet	1 Yes	232(30.4)
includes fruits in their diet	2 No	532(69.6)
drink alcohol	Yes	275(36)
drink alcohol	No	489(64)
If yes	Frequently	78(10.2)
	Weekly	103(13.5)
	Monthly	51(6.7)
	For holidays only	43(5.6)
commonly include meat and fat in their diet	Yes	66(8.6)
commonly include meat and fat in their diet	No	698(91.4)

The mean score of the participant’s practice level was 35.21 ± 2.9. Those participants who scored below the mean score were 306 (40% which was considered as negative attitude) and above the mean score were 393 (60% which was considered as positive attitude).

In the present study, approximately 62.7% of study participants knew the definition of DM, with 24.3% having good knowledge about risk factors of DM, 16.58% of participants correctly identifying the symptoms of DM, and 83.7% participants correctly identifying the complications of DM.In contrast, our results were higher than those of a study conducted in Kenya 29% and omani 57%, on DM sign/symptom. Similarly, our results were higher than a study conducted at Nigeria (19%) on risk factors (Ndibuagu Edmund et al., 2016), the higher levels of knowledge about DM in our study compared to Kenya, Oman, and Nigeria can be attributed to a combination of factors including better healthcare and education systems, effective public health campaigns, greater access to information, and cultural and socioeconomic differences. Understanding these factors can help inform future public health strategies and interventions to improve DM awareness and knowledge in other regions.

Regarding the knowledge about the complication of DM, results in this study were also higher than a study conducted at (57.8%) (Ndibuagu Edmund et al., 2016). The higher knowledge about DM complications in our study area compared to the 57.8% study can be attributed to factors such as better healthcare infrastructure, effective public health campaigns, greater access to information, and cultural and socioeconomic differences. These insights can help inform targeted public health strategies and interventions to improve awareness and management of DM complications in other regions.

The present study, found that 27.8% and 35.4% of the participants had good diabetes-related attitude and practice respectively. This findings were higher than a study carried out in Vadodara, india, that revealed had 23.54% in the attitude questions and 12.80% in practice questions (Rathod et al., 2018). The higher levels of good attitude and practice in your study suggest that existing educational and health programs are effective and should be continued and potentially replicated in areas with lower levels. Tailoring educational content to address specific gaps in attitudes and practices can further improve outcomes. Policymakers should use these findings to support the development of initiatives aimed at improving attitudes and practices towards diabetes management in areas with lower levels. Strengthening healthcare infrastructure and provider training can help improve patient attitudes and practices. Future research should explore the specific factors contributing to higher levels of good attitudes and practices in your study area, such as the role of healthcare providers, public health initiatives, and community engagement. Identifying successful strategies from your region and adapting them for use in other areas with lower levels of good attitudes and practices can enhance diabetes management efforts.

Whereas this findings were lower than studies from Ethiopia and india which scores 55.07% had a favorable attitude towards diabetes mellitus (Alemayehu and Sisay, 2021) attitude towards diabetes is 71.6%. The study conducted at india showed that the diabetic patient’s practice is 69.6% (Chrisolite, 2024). The differences in findings could be due to variations in healthcare infrastructure and accessibility. Ethiopia and India have more comprehensive diabetes education programs and better healthcare support systems, leading to higher levels of favorable attitudes and practices. Robust public health campaigns in these regions effectively promote positive attitudes towards diabetes through community-based education and media. Cultural emphasis on proactive health management and community support, along with higher literacy rates and better access to healthcare resources, also contribute to the higher scores observed in these countries. Your study area may lack such extensive campaigns and support systems, resulting in lower levels of favorable attitudes and practices.

This study shows that while awareness of diabetes is high (98%), understanding is incomplete. Although 80% identified diabetes as high blood sugar, only 25% understood inadequate insulin action. Knowledge about diabetes as a non-communicable disease (71%) and its types (42.3%) varied. A significant majority recognized diabetes as chronic (83%) and lifestyle-related (92%), yet misconceptions remain, with 25% attributing it to a "curse."Perceptions of diabetes management and treatment are mixed. A notable 43% strongly disagree that diabetes is treatable, with only 22% affirming its treatability. There is broad consensus that diabetes does not significantly impact life expectancy. Most participants (60%) strongly agree that regular physical activity is effective, and 55% agree that smoking increases diabetes complications. However, 62% believe medication should not be discontinued, and 67.3% strongly disagree that initiating insulin worsens diabetes. Conversely, 65% think herbal medications have fewer complications than modern treatments, though 55% disagree on the necessity of controlling lipid and blood pressure, suggesting a need for improved education on comprehensive diabetes care.

Regarding practices, the overall mean score of 3.5 indicates moderate practices, with 35.4% showing good practices and 64.6% poor ones. Smoking is less common (78.8% abstain), but exercise is infrequent (80.7% do not exercise regularly). Efforts in weight management and blood sugar monitoring are also limited. Dietary habits show that 81% include vegetables, but only 30.4% include fruits. Alcohol consumption varies, with 36% drinking and 64% abstaining. Overall, significant gaps in diabetes prevention practices highlight the need for enhanced awareness and intervention to promote healthier lifestyle choices.

Recommendation

Based on the findings, targeted educational programs should be developed to improve understanding of diabetes management, particularly regarding insulin action and the disease's impact on life expectancy. Increased emphasis on the treatability of diabetes and the importance of controlling blood sugar levels through consistent monitoring should be prioritized. Public health campaigns should focus on promoting regular physical activity and weight management while addressing misconceptions about diabetes causes, such as the erroneous belief in curses. Enhanced awareness about the role of medication and comprehensive diabetes care, including the management of lipid and blood pressure, is crucial. Additionally, interventions should encourage healthier dietary choices and regular exercise to improve overall diabetes prevention practices.

Ethical approval and consent

The study was conducted after obtaining institutional ethical clearance from Oda Bultum University. The participants recruited to the study were informed about the objectives of the study.A written informed consent was obtained from all study participants involved in the study.Data collected during the study period was used only for the study objectives. Information obtained at any course of the study was kept confidential. Confidentiality was maintained by numeric coding of the questioners.

Consent for publication

Not applicable.

Availability of data and materials

The data sets generated during and/or analyzed during the current study are available from the corresponding authors on reasonable request.

Conflict of interest

The author declares no conflict of interest.

Funding statement

Not applicable

Authors’ contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Acknowledgements

We are thankful to Chiro town adminstrations and the community for their unreserved support and corporation.

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TUOMI, T., SANTORO, N., CAPRIO, S., CAI, M., WENG, J. & GROOP, L. 2014. The many faces of diabetes: a disease with increasing heterogeneity. The Lancet, 383, 1084-1094.
WHO 2016. Global report on diabetes: executive summary. World Health Organization.

Table 1. socio-demographic characteristics of participants

Variables	Category	Frequency	Percent (%)
Sex	Male	443	53%
Sex	Female	359	47%
Age	18-24 years	112	14.6
	25- 34 years	267	35.4
	35-44 years	171	22.4
	45-54 years	122	16
	> 55 years	66	8.6
Monthly income	< 5000	478	62.8
Monthly income	5000	286	37.2
Ethnicity	Oromo	415	54.3
	Amhara	301	39.5
	Others	48	6.2
Educational status	Unable to read and write	66	8.6
	Elementary/High school	488	64
	College/university	210	27.4
Marital status	Single	138	18.1
	Married	484	57.7
	Divorced /Widowed	142	18.5
Religion	Orthodox	297	39
	Muslim	395	51.7
	Protestant	65	8.5
	Others	7	0.9
Occupation	Self employed	93	12.2
	Farmer	34	4.5
	Unemployed	183	24
	Employed (gov’t/privet)	454	59.4

Table 2: Knowledge of the participants towards DM

knowledge towards DM		Frequency (%)
Heard of diabetes	Yes	749(98)
Heard of diabetes	No	15 (2)
DM is a condition of high blood sugar	Yes	611(80)
	No	153 (14)
	I am not sure	31(4)
DM is a condition of inadequate insulin action	Yes	191 (25)
	No	153(14)
	I am not sure	466(61)
DM is non-communicable disease	Yes	542 (71)
	No	155(20.3)
	I am not sure	67(8.7)
Insulin is required for diabetic patients	Yes	351 (46)
	No	260(34)
	I am not sure	153 (20)
There are several types of diabetes	Yes	323(42.3)
	No	306(40)
	I am not sure	135 (17.7)
DM is a long term (chronic) disease	Yes	634 (83)
	No	53(7)
	I am not sure	77(10)
DM is related to life style	Yes	703(92)
	No	61(8)
	I am not sure
Risk factor for DM	Family History	222(29)
	Obesity	305(40)
	Decreased physical activity	46 (6)
	curse	191(25)
The Symptoms of diabetes	Excessive feeling of thirst	134 (17.5)
	Excessive urination	107(14)
	Excessive eating	283(37.5)
	Unexplained Weight loss	78(10.2)
	Slow healing of cuts and wounds	116(15.3)
	Tiredness and weakness	42(5.5)
know complications of diabetes	Eye problems	145(19)
	Kidney problems	122(16)
	Oral and dental complication	31(4)
	Loss of sensation in arm and leg	84 (11)
	Cardiovascular disease	42(5.5)
	Gangrene in limbs that require surgical removal	332 (43.5)
	Erectile dysfunction / loss of libido	8(1)

Table 3. Attitude level of participants towards DM

Attitude towards DM	Strongy disagree	Disagree	Neutral		Agree	Strongly agree
DM Is treatable	329(43)	160(21)	4(0.5)		168(22)	103(13.5)
DM reduces life expectancy	565(74)	119(15.5)	8(1)	61(8)		12(1.5)
blood pressure controlling is necessary in DM	244(32)	96(12.5)	61(8)	138(18)		225(29.5)
regular exercise controls DM	30(3.9)	54(7.1)	69(9)		153(20)	458(60)
smoking increase complication of DM	19(2.5)	92(12)	84(11)	149(19.5)		420(55)
Medication can be discontinued	65(8.5)	84(11)	30(4)	111(14.5)		474(62)
Initiating insulin exacerbates diabetes and its complications.	514(67.3)	158(20.7)	16(2)	32(4.2)		44(5.8)
Proper diabetes treatment could reduce the risk of other complications	329(43)	78(10.2)	131(17.1)	160(21)		66(8.7)
Herbal medications have less complication than modern medications	38(5)	19(2.5)	57(7.5)	153(20)		497(65)
Lipid and blood pressure control is necessary in diabetic patients.	420(55)	149(19.5)	42(5.5)	99(13)		54(7)

Table 4. Practice level of respondents towards DM.

Practice towards DM		Frequency (%)
Smoke cigarettes	Yes	161(21.2)
Smoke cigarettes	No	602(78.8)
practice exercise	Yes	148(19.3)
practice exercise	No	616(80.7)
If yes on question , how often	Every day	42(5.5)
	Once a week	20(2.6)
	Twice a week	72(9.4)
	Sometimes	14(1.8)
trying to reduce or maintain weight	Yes	206(27)
trying to reduce or maintain weight	No	558(73)
If yes on question 404,	Every day	62(30)
	Usually	101(49)
	Sometimes	43(21)
Check blood sugar regularly	Yes	80(10.4)
Check blood sugar regularly	No	684(84.6)
includes vegetables in their diet	Yes	619(81)
includes vegetables in their diet	No	145(19)
includes fruits in their diet	Yes	232(30.4)
includes fruits in their diet	No	532(69.6)
drink alcohol	Yes	275(36)
drink alcohol	No	489(64)
If yes	Frequently	78(10.2)
	Weekly	103(13.5)
	Monthly	51(6.7)
	For holidays only	43(5.6)
commonly include meat and fat in their diet	Yes	66(8.6)
commonly include meat and fat in their diet	No	698(91.4)

No competing interests reported.

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Editorial decision: Revision requested
08 Aug, 2024
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Knowledge, Attitude, and Practice Towards Diabetes Mellitus Tmong Chiro Town Population, Eastern Ethiopia

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Version 1

Abstract

Introduction

Methodology

Study Area and Period

Study Design

Source Population

Study Population

Eligibility criteria

Inclusion Criteria

Exclusion criteria

Variables

Dependent variables

Independent Variable

Operational Definition

Sample Size determination and Sampling technique

Sample Size determination

Data Collection procedure

Data Analysis and Interpretion

Data quality control

Results

Sociodemographic Characterstics

Knowledge towards DM

Attitude towards DM

Practice twards DM

Discussion

Conclusion

Recommendation

Declarations

References

Table

Additional Declarations

Status:

Version 1