CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Diabetes Mellitus is a chronic and progressive metabolic disorder. Diabetes is of great

importance to all health systems and it has been characterized as a global epidemic. The global

prevalence of diabetes for those over 25 years of age, according to the World Health

Organisation is 10%, while in Africa the prevalence is 11% (Levitt, 2008). The costs of Diabetes

account for up to 15% of national health care budgets (WHO, 2011).

Diabetes, a crucial element of the non-communicable diseases, is undoubtedly a rising problem

globally. Sub-Saharan Africa is not immune to the process, and is experiencing a triple and in

many instances, quadruples burdens of disease, as the traditional infectious diseases such as

malaria and T.B. are joined by non-communicable diseases additionally to HIV. In certain

countries, high levels of trauma and violence contribute further to the burden of disease

(Jaremen, 2017).

Globally, the burden of diabetes is rapidly increasing. According to International Diabetes

Federation (IDF) Diabetes Atlas, by end of 2013, there were 382 million (or 8.3% of the adult

world population) people worldwide with diabetes of which 80% live in low‑and‑middle‑income

countries; this number is estimated to reach 592 million in <25 years (by 2035). Currently,

sub‑Saharan Africa is estimated to have 20 million people with diabetes, about 62% are not

diagnosed and the number is expected to reach 41.4 million by 2035 or an increase of 109.1%. In

sub‑Saharan Africa, Nigeria has the highest number of people with diabetes with an estimated
3.9 million people (or an extrapolated prevalence of 4.99%) of the adult population aged 20–

79‑year‑olds (World Health Assembly, 2013). Further, in terms of morbidity, diabetes

contributes to the development of heart disease, renal disease, pneumonia, bacteremia, and

tuberculosis (TB) (Kornum et al., 2008; Saydah, Eberhardt, Loria, & Brancati, 2002). It is known

that people with diabetes are 3 times more likely to develop tuberculosis and approximately 15%

of TB globally is thought to have background diabetes as a predisposing factor. This situation of

the double burden of disease particularly in developing countries put diabetes to compete for

resources as well as political commitment (Jeon & Murray, 2008).

Diabetes is a typical chronic medical condition that places serious constraints on patients'

activities. There is a need for extensive education and behaviour change to manage the

conditions. Lifestyle changes must incorporate careful dietary planning, use of medication, and

home blood glucose monitoring techniques for all diabetic patients (Al Hayek, Robert, Al Saeed,

Alzaid, & Al Sabaan, 2014).

The World Health Organization (WHO) and International Diabetes Federation (IDF)

have projected that the number of diabetes cases will increase to 366 million by 2030, an

increase of 214% compared to the year 2006 (Saumya Pal, Raman, Ganesan, Sahu, & Sharma,

2011). Diabetes mellitus (DM) is associated with multiple medical complications that decrease

the health-related quality of life and contribute to suboptimal physical and mental functioning

and earlier mortality (Yuying Zhang, 2014). Coronary heart disease, depression, and unhealthy

eating habits have significant negative effects on quality of life (QOL) of Diabetes mellitus

patients (Scollan-Koliopoulos et al., 2013; Yuying Zhang, 2014).

The World Health Organization (WHO) defines Quality of Life (QOL) as an individual’s

perception of their position in life in the context of the culture and value systems in which they
live and in relation to their goals, expectations, standards, and concerns (Lima et al., 2018) (. It is

a broad-ranging concept affected in a complex way by the person’s physical health,

psychological state, level of independence, social relationships, personal beliefs and their

relationship to salient features of their environment (Fleck et al., 2004). Although doctors and

competent professionals may evaluate the severity of the disease and degree of deterioration,

their opinion of the patients’ quality of life may not match with a personal view of the patients.

There is a great impact of psychosocial and cultural factors on the personal view of the patient

(Spasić, Radovanović, Dordević, Stefanović, & Cvetković, 2014).

The increasing prevalence may be due to population growth, aging, urbanization, and increasing

obesity and physical inactivity. Lifestyle changes/interventions are the current strategies that

exist to prevent or reduce the onset of Diabetes Mellitus (Wild S, Roglic G, Green A, Sicree R,

2004). DM is often associated with complications. These complications and the complexity of

the treatment regimens required to achieve strict glycemic control can significantly worsen the

health care burden and reduce the quality of life of patients in terms of their physical, social, and

psychological well‑being (Rani et al., 2014). Clinical management of the disease tends to focus

mainly on the patient's physical health, including glycemic control and complications. However,

these treatments are insufficient in managing the full burden of Diabetes Mellitus.

A coping strategy is defined as “the constantly changing cognitive and behavioural efforts to

manage the specific external or internal demands that are appraised as taxing or exceeding the

resources of the person” (Ma.E., J., & J., 2011). Coping is a psychological process developed at a

conscious level used when one tries to manage difficult and stressful situations in life. Coping

styles may be adaptive (meaning that the individual tries to reduce the stress) or maladaptive

(described by a situation in which the individual keeps or even amplifies the current
symptomatology). Coping has been demonstrated to be able to influence the individual’s

response at a biological level, leading to a normal or pathological reaction in humans, a

mechanism that depends on its efficiency in reducing the psychological distress (A. et al., 2017).

Different coping mechanisms have already been demonstrated to be associated with improved or

worse prognosis in other chronic diseases, such as chronic obstructive pulmonary disease.

The interest in quality of life is higher thanks to life span prolongation and the fact that
patients need to continue their lives with satisfying quality. It is necessary to take care about the
influence of the patients’ psychological structure while examining the results of self-estimation
of the examinees’ life quality. In essence, there is a strong link between quality of life and coping
strategies amount patients with DM. Despite the fact that care delivery is receiving increased
attention, in Nigeria there is an association between quality of life and coping strategies.

1.2 Statement of the problem

Quality of life measurement is increasingly being used to complement the clinical or

biological management of a disease because it provides data that helps evaluate the quality of

patient care, as well as the need for more health care and the efficacy of the interventions. Thus,

it improves the patient's feelings and treatment satisfaction, unlike traditional care, which is

focused on the evolution of the disease.

However, challenges to the quality of life of patients with diabetes mellitus in Lagos state

include factors affecting diabetic patients, monitoring and coping with diabetes mellitus, and to

what extent is their quality of life associated with coping strategies. Thus this study therefore

seeks to find out the quality of life and coping strategies among patients with diabetes mellitus in

Lagos State University Teaching Hospital, Lagos state.

1.3 Objectives of the study

The main objective of the study is quality of life and coping strategies among patients with

diabetes mellitus in Lagos State University Teaching Hospital, Lagos state. The specific

objectives include:

1. To know the level of quality of life of patients with DM in LASUTH

2. To find out the effect of coping strategies among patients with DM in LASUTH

3. to determine the benefit of quality of life and coping strategies among patients with diabetes

mellitus in Lagos State University Teaching Hospital, Lagos state

1.4 Research Questions

The following research questions were answered in the study:

1. What is the quality of life and coping strategies among patients with Diabetes Mellitus is

Lagos state?

2. What is the level quality of life of patients living with Diabetes Mellitus in Lagos state?

3. What are the coping Strategies employed among patients with DM in Lagos state?

4. What are the benefits of quality of life and coping strategies among patients with diabetes

mellitus in Lagos State University Teaching Hospital, Lagos state

1.5 Scope of the Study

This study is limited to diagnosed patients with type 1 diabetes mellitus registered with

Lagos State University Teaching hospital, Nigeria. Key variables of interest in the study include

Quality of Life of patients, factors and causes of Diabetes and coping strategies employed by

patients with diabetes mellitus.

1.6 Significance of the study

This study would investigate the result of quality of life and coping strategies among patients

with Diabetes Mellitus in Lagos state, Nigeria. The result from this analysis would facilitate diabetic

patients, policy manufacturers within the areas of delineating the responsibilities of the various

stakeholders within the health sector like health doctors, Nurses of teaching hospitals in Lagos state. This

study would counsel relevant strategies to be adopted combat deficiencies within the areas highlighted on

top; in order to put together the quality of life of patients living with the sickness may be improved.

1.7 Operational Definition of Terms

Diabetes Mellitus (DM): is a heterogeneous group of metabolic disorders characterized by

hyperglycemia.

Quality of life (QoL): is be defined as "The state of contentment in a conscious individual due to

his or her satisfaction in physiological, psychological, social and spiritual aspects of life"

Coping Strategy: this refers to the specific efforts, both behavioural and psychological, that

people employ to master, tolerate, reduce, or minimize stressful events.

 CHAPTER TWO

REVIEW OF LITERATURE

2.1 Overview of Diabetes Mellitus

 CHAPTER THREE

METHODOLOGY

Introduction

This chapter represent the procedure and methods adopted in the study. Sequentially, it consists

of introduction, research design, research setting, sample size, sampling technique, instrument

for data collection, validity and reliability of instrument, procedure for data collection, method of

data collection, data collection and ethical consideration.

3.1 RESEARCH DESIGN

This study employs a descriptive design and a quantitative approach as the researcher was

interested in determining the quality of life and coping strategies among patients with diabetes

mellitus visiting the Lagos State University Teaching Hospital LASUTH.

3.2 Research Setting

The study will takr place at the Lagos State University Teaching Hospital, Ikeja, a Tertiary

Healthcare Centre in Lagos, South‑Western Nigeria. The hospital is 740‑bedded facilities.

3.3 Target Population

The target population for this study comprises male and female adults, 18 years and above

attending the diabetic clinic of the hospital that give their consent would be recruited into the

study. Patients who were acutely ill and therefore not able or not willing to be a part of the study

will be excluded.
3.4 Sampling Size

The estimated minimum sample size for the study was calculated based on the highest

prevalence of diabetes in Nigeria which was reported to be 2.8% (Levitt, 2008), standard normal

deviation of 1.96, and precision level of 5%. Calculated minimum sample size was 42, however,

included 100 participants in the survey to increase the study power and to also increase its

representativeness.

In determining the sample size for patients with diabetes mellitus of LASUTH, using the leslie

kish sample size formula for finite population;.

𝑍 2 (𝑝𝑞)
𝑛=
𝑑2
𝑤ℎ𝑒𝑟𝑒,

𝑛 = 𝑚𝑖𝑛𝑖𝑚𝑢𝑚 𝑠𝑎𝑚𝑝𝑙𝑒 𝑠𝑖𝑧𝑒 𝑜𝑓 𝑟𝑒𝑠𝑝𝑜𝑛𝑑𝑒𝑛𝑡𝑠

𝑝 = 𝑝𝑟𝑒𝑣𝑒𝑙𝑒𝑛𝑐𝑒 𝑜𝑓 𝑑𝑖𝑎𝑏𝑒𝑡𝑒𝑠, 𝑝 = 2.8% (Levitt, 2008)

2.8
𝑞 =1−𝑝 = 1−( )
100

𝑞 = 1 − 0.028 = 0.972

Therefore, the probability of having diabetes mellitus is 97.2%

𝑧 = 𝑠𝑡𝑎𝑛𝑑𝑎𝑟𝑑 𝑑𝑒𝑣𝑖𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 95% 𝑐𝑜𝑛𝑓𝑖𝑑𝑒𝑛𝑐𝑒. (𝑆𝑒𝑡 𝑎𝑡 5% 𝑠𝑖𝑔𝑛𝑖𝑓𝑖𝑐𝑎𝑛𝑡 𝑙𝑒𝑣𝑒𝑙)

𝑑 = 𝑡ℎ𝑒 𝑙𝑒𝑣𝑒𝑙 𝑜𝑓 𝑠𝑡𝑎𝑡𝑖𝑠𝑡𝑖𝑐𝑎𝑙 𝑠𝑖𝑔𝑛𝑖𝑓𝑖𝑐𝑎𝑛𝑡 𝑠𝑒𝑡 𝑎𝑡 0.05

𝐶𝑎𝑙𝑐𝑢𝑙𝑎𝑡𝑒𝑑 𝑠𝑎𝑚𝑝𝑙𝑒 𝑠𝑖𝑧𝑒

 1.962 × 0.028 × 0.972 3.8416 × 0.028 × 0.972 0.1046
𝑛= = =
0.052 0.0025 0.0025

𝑛 = 42

3.5 Sample Technique

A simple random sampling method was used to select 100 respondents from the target

population.

3.6 Instrument for Data Collection

Questionnaire will be used to collect data from the respondents. The questionnaire will be

developed by the researcher and it comprises of five sections; A, B, C, D and E. Section A

covers the socio-demographic variables, sections B and C cover the effect of diabetes on quality

of life and the coping strategies employed by patients.

3.7 Validity and Reliability of Instrument

The validity of the questionnaire will be established through the use of face and content validity.

Ambiguous and inappropriate questions will be avoided. Few copies of the questionnaire will be

given to the supervisor and Institute of Public Health to assess the relevance to the subject matter

and its coverage. Reliability statistics will be done to check the reliability of the instrument that

will be used to determine the quality of life and coping strategies of patients with diabetes

mellitus.
3.8 Method of Data Collection

Data will be collected using a structured questionnaire which was administered using face to face

interviews. The questionnaires will be administered randomly to the calculated number of

diabetes patients in selected health centre. They will be given to those that are literate to fill.

Repeated visits will be made to selected health centre and questionnaires will be administered

after seeking the consent of the respondents. The data will be collected within six weeks.

3.9 Method of Data Analysis

The data for the study will be generated through collection, coding, and then subjected to

statistical analysis using IBM Statistical Package for Social Sciences (SPSS) version 20 using

both descriptive statistics (such as frequency, percentage, mean) and inferential statistics (such as

chi-square, correlation coefficient).

3.10 Ethical Consideration

A proposal for the study was presented to the Ethical Committee of the Institute of Public Health

for approval to conduct the study. Permission from the Head of Nursing Science Department to

conduct the study will be obtained. Informed consent will be obtained from the respondents.

Confidentiality and anonymity will be ensured by not including names of respondents in the

questionnaire. In addition, the respondents will be assured that the study will not pose any risk

to their health and voluntary filling of the questionnaires will be ensured.

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 Appendix 1

Questionnaire
DEPARTMENT OF NURSING,FACULTY OF HEALTH SCIENCES, OBAFEMI

AWOLOWO UNIVERSITY, ILE-IFE, OSUN STATE

Questionnaire on Quality Life and Coping Strategies of Patients with Diabetes Mellitus in
Lagos State University Teaching Hospital (LASUTH)
Dear Respondent(s),
I am a BSc student of the above-named institution. I am conducting a research on the above
research topic. Kindly assist in completing a copy of the questionnaire to enable me successfully
complete the study. All information volunteered would be kept in strict confidentiality and used
for research purposes only.
Signed
Veronica Ogar
BSc Research Student
07064578287
Instruction: please tick (√) where necessary.
Section A: Demographic characteristics
1. Age in years: < 20 [ ] 20-30 [ ] 31-40 [ ] 41-50 [ ] >50 [ ]
2. Sex: Male [ ] Female [ ]
3. Language: Yoruba [ ] Hausa [ Igbo [ ] Others [ ]
4. Marital status: single [ ] married [ ] Divorced [ ]
5. Educational qualification: No formal education [ ] Primary [ ]
Secondary [ ] postsecondary [ ]
6. Number of previous hospital visits…………………………………………………………….
7. Type of Diabetes: Type 1 [ ] Type 2 [ ]
8. How old were your when your diabetes was diagnosed?...................................................
9. In relation to your diabetes, how often do you visit Clinic/ Doctor?
Every month [ ] 3 months [ ] 6 months [ ] once a year [ ] every 2 years[ ]
10. The level of glycosylated Haemoglobin during the last year was about:
6.5-7.0[ ] 7.0-7.5[ ] 7.5-8.0 [ ] 8.0-8.5[ ] 8.5-9.0[ ] above 9.0[ ]