Effect of Health Education Intervention in the Management of Type-II Diabetes Mellitus among Adults Attending Garissa County Referral Hospital, Kenya
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Diabetes mellitus (DM) is a metabolic disorder that is characterized by hyperglycaemia due to defective insulin action and/or secretion. Diabetes mellitus type-2 (DM2) is the most common and a major public health burden in Kenya. It is projected to reach a prevalence of 4.5% by the year 2025. Effective interventions for DM2 comprise improving diabetes knowledge, individualized health education, lifestyle and behavioural change, monitoring body mass index (BMI) and diabetes control markers, as well as pharmacological interventions. Despite studies showing that health education and improved knowledge of diabetes predict improved plasma levels of diabetes control markers in the DM2 patients, these markers have not been used in the management and control of the disease in Garissa County. The main objective of this study was to establish effect of group health education in the control and management of DM2 at Garissa County Referral Hospital. This study utilized an unequal proportion prospective quasi-experimental study among a total of 152 adults stratified into intervention (cases, n=83) and control (n=69) groups. The cases were individuals with DM2 from among those (n=500) who were screened following fasting. The controls comprised DM2 patients on standard care. The study participants were purposively selected into each arm of the study. Structured questionnaires were used for collecting socio-demographic, socio-economic, and lifestyle data. The intervention group was offered group based standard health education program. Baseline and post-test measurements of the diabetes control markers were analysed in both the cases and the control group. Data analysis was done using IBM/SPSS version 27.0. Socio-demographic and socio-economic assessment indicated that the distribution of age, gender, education levels, marital status, monthly house-hold income, house-hold size, and familial history of diabetes was similar between the cases and controls. The prevalence of type-2 diabetes was 16.6%. Lifestyle evaluation indicated higher rates of smoking a pack of cigarettes daily (71.1% vs. 24.6%) or more than a pack of cigarettes daily (9.6% vs. 17.4%; χ2=33.289; df=2; P<0.0001) in the cases and controls, respectively. Overall levels of good knowledge in the cases and controls at baseline (57.8% vs. 72.5%; χ2=3.816; df=1; P=0.051); and after intervention (88.0% vs. 66.7%; χ2=11.058; df=1; P=0.001), respectively. Diabetic control marker analysis indicated that only HbA1c levels were significantly lower in the cases compared to controls at baseline (P=0.002). After intervention, BMI (P=0.005), HbA1c (P<0.0001) and fasting glucose (P<0.0001) were significantly lower in the cases relative to the controls. In addition, among the intervention group, the BMI, HbA1c, LDL-cholesterol, HDL-cholesterol, triglycerides and fasting glucose were significantly lower after intervention compared to baseline levels (P<0.01 for all). Altogether, these results indicate that group health education intervention had an effect in improving the levels of knowledge on diabetes as well as improving the levels of diabetes control markers. Thus, it is recommended that promotion of group-based health educational programs improves management of DM2.