CHAPTER ONE
INTRODUCTION
Background to the Study
Diabetes mellitus is defined as a group of metabolic diseases characterized by increased level
of glucose in the blood resulting from defects in insulin secretion or insulin action or both [American Diabetic Association (ADA), (2004); Huang, Hwang, Wu, Lin, Leite & Wu, (2008)]. It is a devastating illness that has physical, social, emotional and economic implications. It impinges on the quality of life and overall health status of the individuals, as well as direct health care cost and indirect costs to the society when related to lost productivity. It is a chronic and distressing illness that makes demands on the individual by causing a lot of short-term and long-term complications that is life threatening. Diabetes mellitus is the leading cause of non-traumatic amputation and blindness in working age adults and the third leading cause of death from diseases primarily, because of the high rate of cardiovascular complications (myocardial infarction, stroke, and peripheral vascular disease) among people with diabetes (Smeltzer, Bare, Hinkle & Cheever, 2010).
Studies have shown that the incidence of diabetes is on the increase. The centre for Disease Control and Prevention (CDC) (2011), stated that in 2010, an estimated 79 million American adults aged 20years or older with pre-diabetes. In 2000, the world-wide estimate of the prevalence of diabetes was 171 million people, and by 2030, this is expected to increase to 366 million (Wild, Roglic, Green et al, 2004). The International Diabetes Federation (IDF) estimated that 194 million people had diabetes in the year 2003, and about two thirds of these people lived in developing countries of which Nigeria is one. The President of IDF (2006-2009), warned that if left unchecked, the number of people with diabetes will reach 380million in less than 20years. This will mean 1 out of 14 adults worldwide will have diabetes in the years 2025. The loss of earnings and life will be hard to bear.
Diabetes mellitus was once regarded as a disease of the affluent but is now vastly visible as a growing health problem in developing economies as almost 80% of diabetes deaths occur in low and middle income countries, of which Nigeria is one (Diabetes Atlas, 2006). Available data suggests that it is emerging as a major health problem in Africa, including Nigeria. In the African sub-region, diabetes is frequently undiagnosed. In most cases, it is diagnosed incidentally during routine check-up or when the patient presents with the complications (International Diabetes Federation, African Region, 2006). The World Health Organization (WHO) statistics indicates that Nigeria has the highest number of diabetics in Sub-Saharan Africa (Chinenye & Ogbera, 2013). The incidence and prevalence of diabetes mellitus in Nigeria continues to increase despite great deal of research and resources. With current trend of transition from communicable to non-communicable disease, it is projected that non-communicable diseases will equal or even exceed communicable diseases in developing nations, including Nigeria thus culminating in double burden of disease(Chinenye & Ogbera, 2013).The crude prevalence rate of diabetes mellitus in Port Harcourt, Nigeria is 6.8% ( Nyenwe, Odia, Ihekwaba, Ojule & Babatunde, 2003).With the alarming growth in the number of people suffering from diabetes, efficient and quality care become imperative. The numerous complications of the disease and its management poses challenges on the quality of life of the individuals suffering from the disease, therefore the need to assess the quality of life (QOL) of these individuals becomes necessary.
Quality of life (Q0L) is a descriptive term that refers to people’s emotional, social and physical well-being and their ability to function in the ordinary task of living (Donald, 2010). Health related quality of life (HRQ0L) is preferred by health researchers because it is used to narrow the scope to aspects of functioning directly related to diseases and or medical treatment (Odili, Ugboka & Oparah, 2010).
Studies of quality of life are performed for two reasons. First, they are conducted to evaluate the psychosocial functioning of patient group and to identify specific problems and needs of patients at different stages of the disease process. Secondly, and most often, HRQOL studies are conducted to compare the impact of different regimens on the patient’s well-being and the treatment satisfaction (Snoek, 2000).