ADHERENCE OF DIABETIC PATIENT TO

DIABETIC TREATMENT IN LAGOS STATE

UNIVERSITY TEACHING HOSPITAL, LAGOS

STATE

BY

IJOJO-IGBORIA EMUATA ELIZABETH – 150710128

SHOLUADE TITLAYO OLUWATOBILOBA – 150710131

MODEBE CYNTHIA TEMILOLUWA – 130711037

SUBMITTED TO

DEPARTMENT OF COMMUNITY HEALTH AND PUBLIC

HEALTH CARE, LAGOS STATE UNIVERSITY COLLEGE OF

MEDICINE IKEJA, LAGOS.

SUPERVISOR: DR YETUNDE KUYINU

MAY 2021

i
 DECLARATION
This is to certify that this project titled “ADHERENCE OF DIABETIC PATIENT TO

DIABETIC TREATMENT IN LAGOS STATE UNIVERSITY TEACHING HOSPITAL”

is the original work of SHOLUADE TITILAYO OLUWATOBILOBA 150710131,

EMUATA ELIZABETH IJOJO-IGBORIA 150710128 and MODEBE CYNTHIA

TEMILOLUWA 130711037 of Lagos State University College of Medicine (LASUCOM),

Ikeja. It will be conducted under the supervision of DR KUYINU of the Department of

Community Health and Primary Health Care, Lagos State University College of Medicine, Ikeja,

Lagos.

…………………………. ………………………. ……………………….

SHOLUADE, T.O EMUATA, E.1 MODEBE, C.T

ii
 ATTESTATION

I certify that this research project titled; “ADHERENCE OF DIABETIC PATIENT TO

DIABETIC TREATMENT IN LAGOS STATE UNIVERSITY TEACHING HOSPITAL”

will be conducted by members of group; (SHOLUADE TITILAYO OLUWATOBILOBA

150710131, EMUATA ELIZABETH IJOJO-IGBORIA 150710128 and MODEBE

CYNTHIA TEMILOLUWA 150711037) of the Lagos State University College of Medicine,

Ikeja, under my supervision.

DR YETUNDE KUYINU ……………………………..

Supervisor Signature and Date
Department of Community health and Public health care,

Lagos State University College of Medicine, Ikeja, Lagos.

DR ADENIRAN ……………………………..
Head of Department, Signature and Date
Department of Community health and Public health care,

Lagos State University College of Medicine, Ikeja, Lagos.

iii
 TABLE OF CONTENT
Cover page................................................................................................................................i
Declaration................................................................................................................................ii
Attestation.................................................................................................................................iii
Table of content......................................................................................................................iv – v
List of Table ........................................................................................................................... vi
List of Figure ...................................................................................................................... vii
Abstract ..............................................................................................................................viii - ix

CHAPTER ONE:
1.1 Background………............................................................................................................1
1.2 Statement of Problem..............................................................................………………...2
1.3 Justification of Study.........................................................................................................4
1.4 Aims and Objectives …………………………………………………………………….5

CHAPTER TWO:
2.1 Introduction ……………….............................................................................................. 6
2.2 History ………….............................................................................................................. 6
2.3 Epidemiology of Diabetes................................................................................................. 6
2.4 Classification of Diabetes.................................................................................................. 7
2.5 Symptoms of Diabetes …………………………………………………………..….........7
2.7 Complications …….............................................................................................................8
2.8 Diagnosis ………….......................................................................................................... 8
2.9 Treatment ……………........................................................................................................8
2.10 Prevention ………….........................................................................................................9
2.11 Adherence to diabetic mellitus treatment ……………………………………………….9
2.12 Knowledge of anti-diabetic drugs among diabetic patients..............................................14
2.13 Attitude of diabetic patient towards diabetic treatment ……………………………......17

iv
CHAPTER THREE:
3.1 Study area...............................................................................................................................19
3.2 Study Design...........................................................................................................................20
3.3 Study Population.....................................................................................................................20
3.4 Sample size determination.......................................................................................................20
3.5 Sampling method ....................................................................................................................22
3.6 Data collection tool………………..........................................................................................22
3.7 Pre-testing …………………………………...........................................................................22
3.8 Data collection……………………….....................................................................................23
3.9 Data analysis …………………………................................................................................. 23
3.10 Ethical Consideration…………………............................................................................... 23
3.11 Limitation of study.................................................................................................................24

CHAPTER FOUR
RESULTS………………………………………………………………………………………..25
Table 1-8……………………………………………………………………………………...25-35
Figure 1…………………………………………………………………………………………..30

CHAPTER FIVE
Discussion……………………………………………………………………………………..…36
5.1 Knowledge of Diabetes Mellitus………………………………………………………..…...36
5.2 Attitude towards Diabetics Treatment…………………………………………….………....37
5.3 Adherence to Treatment………………………………………………………………...……38
5.4Socio-Demographics Factors Affecting Adherence to Diabetic Treatment………………….39
5.5 Conclusion……………………………………………………………………….…………..39
5.6 Recommendations…………………………………………………………………………....40
REFERENCE...............................................................................................................................................41
APPENDIX ONE: QUESTIONNAIRE .......................................................................................................46
APPENDIX TWO: LIST OF ABBREVIATIONS ........................................................................................51
APPENDIX THREE: CONSENT FORM ....................................................................................................52

v
LIST OF TABLES

TABLES PAGE NUMBER

Table 1 – Socio-demographics of respondents 25

Table 2 - Respondents` knowledge of diabetes mellitus 26 - 27

Table 3 – Respondents` overall knowledge of diabetes mellitus 28

Table 4- Respondents` attitude towards diabetes mellitus treatment 29

Table 5 – Respondents` adherence towards diabetes mellitus treatment 31 - 33

Table 6 - Respondents` overall adherence to diabetic treatment 34

Table 7 - Association between socio-demographics and adherence to diabetic treatment 35

vi
LIST OF FIGURES PAGE NUMBER

Figure 1: Respondents` overall attitude towards diabetes treatment 30

vii
 ABSTRACT

Background

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough

insulin or when the body cannot effectively use the insulin it produces. Globally in 2014, 8.5%

of adults aged 18 years and older had diabetes while in 2019 diabetes was the direct cause of 1.5

million deaths; however deaths due to higher-than-optimal blood glucose through cardiovascular

disease, chronic kidney disease and tuberculosis should be added, diabetes is the major cause of

kidney failure, lower-limb amputations, and adult blindness.

Nigeria is one of the countries in sub-Saharan Africa (SSA) that are currently groaning under a

rising prevalence of diabetes mellitus (DM). A recent meta-analysis reported that approximately

5.8% (about 6 million) of adult Nigerians are living with DM

Aim

The aim of the study is to assess the adherence of diabetic patient to diabetic treatment at Lagos

state university teaching hospital (LASUTH).

Methodology

This study was a descriptive cross sectional study. The sample size calculated was 146 however,

anticipated response rate of 10% was used, simple sampling technique was used while the

respondents from the diabetic clinic were chosen by simple random method. Data was collected

from each respondent using a semi-structured interviewer-administered questionnaire, the results

were analyzed electronically using epi info software and level of significance was p < 0.05 to test

for hypothesis was used.

viii
Results

A total of 324 questionnaires were shared with majority of the respondents correctly defined

diabetes mellitus while majority did not know the type of diabetes mellitus they suffer from,

about 86.5% knew increased urination as a symptom of diabetes mellitus, majority of the

respondents knew eye damage as a complication of diabetes mellitus however most of the

respondents had poor knowledge of diabetes mellitus.

Majority of the respondents agreed inappropriate use of medication will lead to more problems

(92.2%) while majority of the respondents disagreed herbal medicine are better than hospital

drugs, majority of the respondents had positive attitude towards diabetes treatment. A large

proportion of the respondents were adherent to their diabetic medication although overall

adherence to diabetic treatment was good as majority had good adherence.

There was no statistically significant relationship between adherence to diabetic treatment and
age group (p=0.40), religion (p=0.47), educational status (p=0.36) and monthly income (p=0.30).

Conclusion

Diabetes is a chronic disease which leads to several health complications, during this study it was

observed that majority were not aware of the type of diabetes mellitus they suffer which affected

their knowledge of diabetes mellitus although major showed good attitude towards adhering to

treatment while their overall adherence was good which would help respondents live a better life

and properly manage diabetes mellitus.

ix
 CHAPTER ONE

INTRODUCTION

1.1 Background

Diabetes Mellitus (DM) is a chronic disease that occurs either when the pancreas does not

produce enough insulin or when the body cannot effectively use the insulin it produces, insulin is

a hormone that regulates blood sugar.1 Hyperglycaemia is a common effect of uncontrolled

diabetes and over time leads to serious damage to many of the body's systems, especially the

nerves and blood vessels. There are three major types of diabetes which includes type 1, type 2

and gestational diabetes while symptoms include frequent urination, lethargy, excessive thirst,

and hunger.1

Globally in 2014, 8.5% of adults aged 18 years and older had diabetes while in 2019 diabetes

was the direct cause of 1.5 million deaths, however deaths due to higher-than-optimal blood

glucose through cardiovascular disease, chronic kidney disease and tuberculosis should be

added, diabetes is the major cause of kidney failure, lower-limb amputations, and adult

blindness.1 There isn’t a cure yet for diabetes, but losing weight, eating healthy food, and being

active can really help. Taking medicine as needed, getting diabetes self-management education

and support, and keeping health care appointments can also reduce the impact of diabetes on

their life.1 Diabetic patients’ adherence to treatment guidelines and undergoing self-management

is an important factor in the potential of the patient living a normal life with close to normal

range of blood sugar level.

Adherence with diabetic medication regimens is essential for attaining maximal therapeutic

benefits and control of blood sugar level, poor adherence to prescribed medications has been

identified as a barrier in controlling chronic illnesses including DM which lead to development

1
of complications of diabetes which include hypertension, poor wound healing among others.2

When patients do not take medications as prescribed they suffer with severe consequences that

lead to poor quality of life 2. Non-adherence is considered a key predictor for the failure of

patients to attain and maintain their treatment goals, which associates with poor health and

quality of life outcomes3. According to World Health Organization (WHO) report, 50% of

patients from developed countries with chronic diseases do not use their medications as

recommended.1 In DM, adherence rates are particularly problematic, generally ranging from 30%

to 70%.1

1.2 STATEMENT OF PROBLEM

Globally, DM is the third among the five leading global risks for mortality, according to the

International Diabetes Federation (IDF) about 425 million (8.8%) adults were living with

diabetes worldwide in 2017 and this is projected to increase to 629 million (9.9%) by 2045, out

of which about 108 million would be in the Africa region this is mainly due to lack of diagnosis

and high cost of diabetic treatment which could be a significant factor in the non-adherence of

diabetic treatment as they are too costly to maintain.4

In 2019 an estimated 1.5 million deaths were directly caused by diabetes 1. Some data indicate

rates are roughly equal in women and men but male excess in diabetes has been found in many

populations with higher type 2 incidence, possibly due to sex-related differences in insulin

sensitivity, consequences of obesity and regional body fat deposition, and other contributing

factors such as high blood pressure, tobacco smoking, and alcohol intake.5

The World Health Organization (WHO) estimates for Nigeria show that 4 million are diabetic

and nearly 4 – 11 per cent of the population lives with diabetes. 6 Experts say it is getting

2
commoner worldwide with the number of affected people rising yearly with projections showing

that Africa and Nigeria in particular, is likely to experience the highest increase in the near

future. Many Nigerians are living with undetected diabetes and even for those that have been

diagnosed, just a fraction is receiving proper care and treatment however a recent study showed

that pooled prevalence of diabetes mellitus in the six geopolitical zones were 3.0 percent in the

northwest, 5.9 per cent in the northeast, 3.8 percent in the north-central zone, 5.5 percent in the

southwest, 4.6 percent, in the south-east, and 9.8 percent in south-south zone.7

In Africa, Nigeria is currently the most affected country in Africa. It is estimated that over four

million Nigerians are living with either the type 1 or type 2 diabetes and findings show that more

than 50 per cent the persons with diabetes in the country are unaware that they have the

disease. Nigeria is one of the countries in sub-Saharan Africa that are currently groaning under a

rising prevalence of DM. A recent meta-analysis reported that approximately 5.8% (about 6

million) of adult Nigerians are living with DM. 8 This figure has been likened to a tip of an

iceberg as it is estimated that two-thirds of diabetes cases in Nigeria are yet undiagnosed.8

DM costs are high and increasing as it imposes a large economic burden on the global healthcare

system and the wider global economy, healthcare costs continue to increase with 12% of global

health expenditure dedicated to diabetes treatment and related complications that account for the

majority of the total expenditure.9 It is estimated that the majority of countries spend between 5%

and 20% of their total health expenditure on diabetes however the costs associated with diabetes

include increased use of health services, loss of productivity and disability this has however

influenced the level of adherence to treatment among diabetic patients as the treatments are too

expensive to continue while other feels they don’t experience much changes despite the cost of

treatment.9

3
Also in Nigeria, poverty, ignorance, attribution of symptoms to other myths, lack of tools and

basic infrastructure and inadequate training of health workers are responsible for much of the

failure to detect DM.10 A major challenge prevalent in Nigeria is the health belief system of

patients, with reliance on traditional, rather than on allopathic medicine which encourage use of

traditional medicine after starting a treatment plan in the clinic this however cause a decrease in

response to treatment due to non-adherence to treatment while switching to traditional therapy. 10

This is a major challenge that needs to be assessed as lack of adherence to treatment plan result

in diabetic complication therefore reducing the quality of life, hence it is important to assess the

level of adherence of diabetic patient to diabetic treatment.

1.3 JUSTIFICATION OF STUDY

Medication adherence is also one of the most important factors that determine therapeutic

outcomes, especially in patients with DM however, the efficacy of a drug won’t be working

unless the patient takes it as recommended by the health care worker and followed according to

the plan given2. DM is an expensive disease that is the costs result from treating the disease itself,

complications of the disease and costs of treating many other diseases where DM is an underlying

causal factor. summation of the double costs of DM care – costs of treatment and costs of disability

which impedes the ability of the diabetic person to be economically viable and generate income to

pay for treatment – makes DM management very expensive and a serious challenge to national

economic development and health budgets. Treatment satisfaction is an important factor of quality

of care, especially in treating chronic diseases such as DM, assessment will be helpful for

identifying factors that independently influence treatment satisfaction by improving clinical

outcomes. Furthermore, treatment satisfaction may be important for differentiating among

diabetes treatments, and for monitoring patient outcomes in clinical practice.11

4
This study will help understand the advantage of completely adhering to the treatment plan as this

will improve the quality of life, however challenges and different factors will be highlighted as well

as ways to overcome these challenges in the near future and approaches to help diabetic patient

understand the importance of maintaining adherence to treatment plan by healthcare professionals.

1.4 Aim and Objectives

Aim

The aim of the study was to assess the adherence of diabetic patient to treatment at Lagos state

university teaching hospital (LASUTH).

Objectives

1. To assess the knowledge and attitude to diabetic treatment among patient who attended

diabetic clinic at LASUTH.

2. To assess the level of adherence to treatment plan among diabetic patient who attended

diabetic clinic at LASUTH

3. To determine the socio-demographics factors affecting the level of adherence to diabetic

treatment.

5
 CHAPTER TWO

LITERATURE REVIEW

Diabetes Mellitus is a condition causing a metabolic disorder that leads to chronic

hyperglycaemia. There are two types of diabetes. Type 1 is when the beta cells in pancreas stop

the insulin secretion and type 2 occurs when there is resistance to the action of insulin. 12 The

World Health Organization definition of diabetes is fasting glucose over 7.0 mmol/l or whole

blood over 6.8 mmol/lI.12 All carbohydrate foods are broken down into glucose in the blood.

Insulin helps glucose get into the cells, over the long-term high glucose levels are associated with

damage to the body and failure of various organs and tissues.12

2.1 EPIDEMIOLOGY OF DIABETES

The WHO estimates that diabetes resulted in 1.5 million deaths in 2012, making it the 8th

leading cause of death however another 2.2 million deaths worldwide were attributable to high

blood glucose and the increased risks of cardiovascular disease and other associated

complications (e.g. kidney failure), which often lead to premature death and are often listed as

the underlying cause on death certificates rather than diabetes.13

Diabetes occurs throughout the world but is more common (especially type 2) in more developed

countries. The greatest increase in rates has however been seen in low- and middle-income

countries where more than 80% of diabetic deaths occur. 14 The fastest prevalence increase is

expected to occur in Asia and Africa, where most people with diabetes will probably live in

2030.15 The increase in rates in developing countries follows the trend of urbanization and

lifestyle changes, including increasingly sedentary lifestyles, less physically demanding work

and the global nutrition transition, marked by increased intake of foods that are high energy-

6
dense but nutrient-poor. The global number of diabetes cases might increase by 48% between

2017 and 2045.15

2.4 CLASSIFICATION OF DIABETES

There are different types of diabetes mellitus, the major classifications are Type 1 diabetes

mellitus, Type 2 diabetes mellitus and gestational diabetes mellitus

2.4.1 TYPE 1 DIABETES MELLITUS

Type 1 diabetes is a disease in which the body does not make enough insulin to control blood

sugar levels, type 1 diabetes is an autoimmune disease.16

2.4.2 TYPE 2 DIABETES MELLITUS

It is a chronic condition in which blood glucose can no longer be regulated, the cells of the body

become resistant to insulin (insulin resistant) when the cells become insulin resistant moving

sugar into the cells requires more and more insulin resulting in too much sugar stays in the blood,

however the cells require more and more insulin, the pancreas can't make enough insulin to keep

up and begins to fail.16

2.4.3 GESTATIONAL DIABETES

Gestational diabetes typically develops between the 24th and 28th weeks of pregnancy while it

resembles type 2 diabetes in several respects, involving a combination of relatively inadequate

insulin secretion and responsiveness.17

2.5 SYMPTOMS OF DIABETES

Some of the signs and symptoms of type 1 diabetes and type 2 diabetes include increased thirst,

frequent urination, extreme hunger, unexplained weight loss, presence of ketones in the urine

7
(ketones are a byproduct of the breakdown of muscle and fat that happens when there's not

enough available insulin), fatigue, irritability, blurred vision, slow-healing sores and frequent

infections, such as gums or skin infections and vaginal infections.18

2.7 COMPLICATIONS

Complications of diabetes develop gradually, the longer the duration of diabetes the less

controlled the blood sugar which results in higher the risk of complications. Eventually, diabetes

complications may be disabling or even life-threatening. Possible complications include;

cardiovascular disease (chest pain (angina), heart attack, stroke and atherosclerosis), nerve

damage, kidney damage, eye damage (blindness, cataract, and glaucoma), foot damage,

skin conditions, hearing impairment, alzheimer's disease, depression, preeclampsia.19

2.8 DIAGNOSIS

Diabetes is diagnosed and managed by checking blood glucose level in a blood test. There are

three tests that can measure blood glucose level which include fasting glucose test, random

glucose test, A1c test and oral glucose tolerance test.20

2.9 TREATMENT

Treatments for diabetes depend on type of diabetes how well controlled the blood glucose level

is among other existing health conditions. The goal of diabetes treatment is to keep blood

glucose levels as close to normal as safely possible, people with type 1 diabetes require multiple

insulin injections each day to maintain safe insulin levels while insulin is often required to treat

type 2 diabetes too. The different diabetes medication drug classes include: Sulfonylureas,

Glinides, Biguanides, Alpha-glucosidase inhibitors, Thiazolidinediones, Glucagon-like peptide-1

8
receptor agonists, Dipeptidyl peptidase-4 inhibitors, Sodium-glucose co-transporter 2 inhibitors,

Bile acid sequestrants, Dopamine agonist.21

2.10 PREVENTION

When at risk for diabetes this may be able to prevent or delay getting it, most times it requires

one to do things that involve having a healthier lifestyle. It may lower your risk of other diseases,

and you will probably feel better and have more energy. The changes include the following;

Losing weight and keeping it off, healthy eating plan, regular exercise, no smoking.22

2.11 ADHERENCE TO DIABETES MELLITUS TREATMENT

Patients with diabetes are often prescribed multiple medications to treat hyperglycemia, diabetes-

associated conditions such as hypertension, dyslipidemia among other comorbidities, adherence

to medication is an important determinant of outcomes in patients with chronic diseases. Also,

adherence to medications is associated with better control of intermediate risk factors , lower

odds of hospitalization, lower health care costs and lower mortality.23

Drug non-adherence is an underappreciated issue, but one that affects millions of people. In fact,

only 50% of people in developed countries adequately adhere to their medicines, according to a

published report from the World Health Organization (WHO). People with diabetes are no

exception to this veritable scourge. Adherence habits can also vary between people with type 1

and type 2 diabetes. Children with type 1 diabetes are instructed at a very young age about the

importance of taking their insulin as instructed. With this habit in place early on in a child’s life,

they are more likely to adhere to their prescriptions throughout their life. This allows a child to

ultimately lead a healthier life. For people with type 2 diabetes, however, that habit may not have

been in place to begin with. To counteract older lifestyle habits, such as poor diet and a lack of

9
exercise, new and healthier habits must be developed over time. By consuming a more simplified

diet that eliminates refined carbohydrates and uses protein and fats as a source of energy, all

while adding more physical activity to one’s lifestyle, people with type 2 diabetes can better

manage their lives and live longer. This idea about the importance of developing healthy habits is

being applied to fight non-adherence in people living with diabetes at all levels. Proper timing

and dosage of medication intake is crucial to the long-term and short-term treatment of diabetes,

and this requires the conscious development of new routines. For example, just changing the way

a patient takes their medicine could radically improve their experience with it. Changing the time

of day a patient takes their medicine could eliminate side effects altogether, while insulin pumps

and injection pens, which conceal needles, help reduce patient anxiety. These strategies increase

drug adherence and make it easier for people with diabetes to lead happy and healthy lives, while

it’s important for a person with diabetes to track prescription dosage and timing, it’s natural for

people to be forgetful at times. Having family and friends who can ensure that medication is

taken properly is imperative. In the event a patient intentionally or unintentionally does not take

their medication, family and friends can be there to serve as an encouraging reminder. New

technologies have likewise made it possible for patients and their loved ones to receive

reminders in the form of texts and other reminders.24

In a study conducted in Saudi Arabia it was found that a large proportion of the respondents

perform regular sugar monitoring after being diagnosed with diabetes mellitus while few of the

respondents perform regular exercises while over half of the respondents had regular medical

examinations, less than a third of the respondents take their medication regularly with about

20.2% have regular medical checkups and routine eye examinations.25

10
In a study conducted Assela General Hospital, Oromia Region, Ethiopia where 18.9% of the

respondents, were illiterate while 1.1% were reported of habit of smoking with few of them

being alcohol consumers. Majority of the participants were satisfied by service provided while

61.8% reported that they visit the health service every 2 months, few of the participants reported

that they get counseling service by health care providers on each visit.

It was reported majority were on diabetic treatment for 1–5 years while 58.2%, 33.4% and 24

had OHA, insulin, and both treatment intensity respectively, a larger proportion of patients

(70.5%) were on the simple regimen. At least one side effect to diabetic medication had been

reported by 32.2% of the participants while it was found that 71% of the respondents did not

have a family history of diabetes and only 17% respondents had a glucometer at home. Some of

the respondents reported to use additional treatment options besides hospital treatment with only

31.2% of participants who missed one or more doses in the last month during the study period. A

major reason for missed doses was forgetting to take the medication (60.7%).26

In a study conducted in Northern Ethiopia where it was found that during their follow-up, more

than half of the participants (54.5%) had to travel more than 5 kilometers (KM) to reach the DM

clinic while majority of diabetes mellitus patients had been diagnosed for less than or equal to

five years of which 40.8% had been on treatment for 1 to 5 years. Besides 64.2% patients had a

sign and symptom of low and high blood glucose while a few had a routine eye and foot checks,

concerning the type of medications they were taking majority used oral hypoglycemic agents

while only 16.2% used both drugs. Virtually half of the patients received one month of dose

while visiting the hospitals while few of the respondents reported co-morbidity and the most

commonly reported co-morbidity was hypertension, only few of the respondents had developed

diabetes mellitus complication with retinopathy been the most frequent. Concerning the number

11
of medications used about 33.0% of them utilized two-drug also in addition to this 62.3% of the

participants had an uncontrolled FBG level (>130 mg/dl).27

This study showed that 36.1% of the respondents were adherent to their medication 63.9% were

not adherent, about 52.0% rehearsed that they had not taken their pill the previous day while

some of the patients replied that they sometimes missed taking their pill. About the other

adherence-related questions where 19.9% of the respondents missed using their medications in

the past two weeks while 27.7% did not bring along with their medicines during the journey,

more than one-third of the study participants ever faced difficulty in remembering to consume

their medicines with only few of them who discontinued their medication without consulting

their physician because they feel the disease has improved.27

In a study conducted on non-adherence and contributing factors among ambulatory patients with

anti-diabetic medications in Adama Referral Hospital where it was found that 72.2% of patients

self-reported adherence to their anti-diabetic drug regimen while in the pattern of drug use 17.8

of patients have excellent adherence with 62.96% who had poor adherence, about 21.8% of the

participants ascribed their non-adherence to forgetting to take their medications while factors

include use of traditional and/or religious medicines, lack of finances do influence it. Majority of

the patients reported that they monitored their blood glucose levels monthly at the DM clinic of

the hospital on a regular basis, it was also noted that patients with a duration of diabetes ≤5

years (82.07%) were more compliant to their medication than those with diabetes >5 years

(60.8%) which was found to be statistically significant.28

Most of the participants’ duration of diabetes from first diagnosis indicates that 46.3% had been

diagnosed year before five years while majority had hypertension as comorbid condition while

12
others include visual impairment, nephropathy, limb paralysis. Only few of the respondents

monitor their blood glucose level on regular basis using their glucose measuring device at home

while all the respondents agreed that they needed to continue taking their hypoglycemic

medications throughout their lifetime and inappropriate use of medications will lead to

development of more problems, about 21.8% forgot to take the prescribed medication(s). Some

of the approaches reported to be adopted included taking the required dose of medication as soon

as remembered or skipping it if it is close to the next dose, doubling the next dose to make up for

the forgotten dose than forgetting it completely.28

In a study conducted in Ghana, it was found that diabetics’ level of adherence to diabetic

treatment regimen was satisfactory and higher (68.5%) as most of the patients knew of the effect

of missing the treatment or not taking the medication at all and admitted taking the drugs often.

A significant number of diabetics confirmed travelling with their diabetes mellitus drugs and

visited health facilities on a monthly basis for review and continuation of care. The study

discovered finances, forgetfulness, busy schedules and poor family support as some factors

accounting for diabetics’ non-adherence to treatment therapy. Opportunities for diabetics to ask

providers of the state of their health and involvement in decision making were in existence hence

ruled out as factors responsible for non-adherence to anti-diabetic therapy.29

In a study conducted at Alimosho General Hospital, Igando Lagos, Nigeria where a large

proportion of the respondents take three medications per day and while 2.0 % could not state the

number of medication they take per day. Furthermore, over half of the respondents had never

used herbal medicine to treat their ailment alongside their medications while about a third agreed

that they treat diabetes occasionally with herbal remedies, few of the respondents agreed they

13
always treat their ailment with herbal remedies and their medication concurrently. Few of the

respondents were reminded of taking their medication by family members while 6.0% set alarms

to remind themselves of their drugs, a large percentage of the respondents measured their blood

glucose monthly. About a third of the respondents knew all the anti-diabetic drugs they are

taking by name while 2.0% respondents did not know the name of the diabetic drugs they were

taking, majority of the respondents could only buy their drugs in bits due to high cost of

medication with only 31.0 % able to afford to buy all their drugs at once. Of the respondents that

buy their drugs in bit about half don't wait for the drugs to get finished while 31.4 % stay without

drugs between 4 – 7 days before refilling.30

2.12 KNOWLEDGE OF ANTI-DAIBETIC DRUGS AMONG DIABETIC PATIENT

In a study conducted on Knowledge of diabetes, its complications and treatment adherence

among diabetic patients in Ethiopia, it was found that majority knew that diabetes is not a

communicable disease while most of the respondents were aware that diabetes is not contagious,

about a third of the respondents knew increased urination was an early symptom while majority

knew a change in their diet like reducing excess intake of sweets. A large proportion of the

respondents knew regular exercise like walking for 30 minutes a day is needed which mean the

respondents are more aware of the importance of exercise, few of the respondents felt that

diabetes was curable while very few knew obesity is a risk factor for diabetes. According to this

study, diabetic patients were more conscious of their weight and realized that weight gain could

lead to complications of diabetes while most of the diabetics were aware that hypertension is a

complication of diabetes and also majority knew that diabetics are prone to co-morbidities like

hypertension.31

14
In a study conducted on the level of diabetic patients’ knowledge of diabetes mellitus in Saudi

Arabia, it was found that few had heard of the disease diabetes mellitus while majority had been

exposed to the health education on diabetes mellitus, also a large proportion of the respondents

had family history of diabetes mellitus while these information reveal that most of the respondent

have early knowledge of diabetes mellitus and majority of them have records of the ailment in

their generation. Based on the personal knowledge the respondents have acquired about diabetes

mellitus less than a third of the respondents were aware of at least one type of diabetes mellitus

while about 18.7% indicated knowledge of other types of diabetes mellitus. However, few of the

respondents are not aware or not sure notwithstanding, there is enough evidence that the

respondents are knowledgeable about various types of diabetes mellitus. The respondents offered

responses on the type of diabetes mellitus they have contracted of which 20.6% have type 1

while 39.7% have type 2. Less than half of the respondents were aware that diabetes mellitus can

lead to visual problems and blindness while 37.3% were aware that diabetes mellitus can cause

changes to the health of your retina, almost half of the respondents had sufficient knowledge

about the management of diabetic condition with over half who did follow a dietary modification

to control diabetes mellitus.25

In a study conducted in Ghana, it was found that an absence of self-monitored blood glucose

level among diabetes clients with the reason that they cannot afford the glucometer. Although

most diabetics surveyed did not have any form of education, a greater number of the diabetics

had knowledge on the importance of treatment regime. Most disclosed that the best way to

prevent progression of the disease stage to associated complications and co-morbidities and early

death was to take the diabetes mellitus treatment seriously, commonest signs and symptoms of

15
diabetes mellitus as mentioned by the patients were polyuria, polydipsia, blurry vision and other

such as a headache, sweating and weakness.29

In a study conducted on the knowledge of diabetes, treatment and complications amongst

diabetic patients in a tertiary care hospital, India. It was found that half of the respondents

thought that diabetes to be incurable while 46.5% of the patients thought that diabetes could be

prevented. Most of the patients did not know the risk factors involved in the development of

diabetes with 20.7% of the patients did not know their target fasting blood sugar while 39.6% of

the patients did not know their target post-prandial blood sugar. Less than half of the patients did

not know about the symptoms of hypoglycemia. Yet, 76.2% knew that sweets should be

consumed if they were hypoglycemic while 10.9% knew that they would definitely have taken

preventive measures seriously had they known earlier that diabetes could be prevented. Sixty

(59.4%) patients said that they would probably have taken preventive measures seriously.37

In a study conducted on Knowledge, Attitude and Practices of Diabetic Patients India, it was

found that most of the respondents were unaware of the diagnostic criteria for diabetes mellitus

(62.5%) while majority of the respondents knew the cause of diabetes. Less than a third of the

respondents knew the common symptoms of diabetes, 256 (28.4%) patients about symptoms of

hypoglycemia. Even patients with diabetes for more than 10 years, 18.8% were not aware of the

heart complications while 21.5% were not aware of the diabetes complications to eyes, kidneys

and nerves. Majority of the respondents diabetic patients were not aware of HbA1C (92.6%)

while 87.7% of the respondents did not know that fruits can be eaten by diabetics.38

In a study conducted on the knowledge of chronic complications of diabetes among persons

living with type 2 diabetes mellitus in northern Ghana, it was found that 57.8% of respondents

16
knew that diabetes could cause damage to the kidney while majority of the respondents knew

that one could develop neuropathy as a result of diabetes. Less than half, 45.0% and 49.4% had

knowledge that diabetes could cause retinopathy and hypertension respectively. About 58.8%

and 74.4% of the respondents knew that heart diseases and diabetic foot ulcers are complications

of diabetes. Less than a third of the respondents were aware of hypo-sexual dysfunction as a

complication of diabetes.39

2.13 ATTITUDE OF DIABETIC PATIENT TOWARDS DIABETIC TREATMENT

In a study conducted in Saudi Arabia it was found that about a third of the respondents agreed

that diabetes mellitus is hereditary while less than half agreed that risk factors for diabetes

mellitus development include genetics and hereditary factors, about 40.5% of the respondents

stated that the duration of diabetes mellitus represents an important risk factor in relation to

complication development while about half agreed that modifications to diet and lifestyle can

assist in reducing diabetes mellitus complications with few of the respondents who agreed that

blood glucose level control is critical in reducing diabetes mellitus.31

In a study conducted on Knowledge of diabetes, its complications and treatment adherence

among diabetic patients in Ethiopia, it was found that less than half believed that the duration of

diabetes mellitus is an important risk factor in the development of complications while about

40.3% agreed that diet and lifestyle modifications are important factors in reducing problems

associated with diabetes mellitus, few of the respondents agreed that the control of blood glucose

levels is an important factor in reducing diabetes mellitus. While these respective statistics do not

account for 50% of the total respondents the values obtained nonetheless are substantial and thus

reveal that a large number of the respondents are knowledgeable about the risk factors of

17
diabetes mellitus, a large proportion agreed diabetes is hereditary with less than half who agreed

that genetic and hereditary factors are risk.31

In a study conducted on Knowledge, attitude and practice related to diabetes mellitus among the

general public in Galle district in Southern Sri Lanka, it was found majority of the respondents

had poor attitude towards diabetes (88%) while about 73% believed that long term use of

medications for diabetes will eventually lead to organ dysfunction. Close to 38% of participants

who have heard about metformin believed that long term use of metformin can lead to kidney

damage. Around 73% believed that use of alternative medicine such as Thebu leaves was more

beneficial than the standard treatments. Around 20% of participants thought that long-term use of

daily insulin injections was harmful even when it was indicated to control blood sugar.

Furthermore, about 18% believed that the other complementary and alternative treatments such

as acupuncture, bali-thovil (traditional devil dance), herbal remedies, etc. were better in

controlling DM than the usual methods such as diet and medications.40

18
 CHAPTER 3

METHODOLOGY

3.1 STUDY AREA

Lagos state is one of the states found in the South West Geo-Political Zone of Nigeria, Lagos

state and until December 1992, used to be the capital of Nigeria, and it is the economic backbone

of the nation with highest focus of industries and financial institutions, Lagos state is popularly

referred to as the Centre of Excellence. Despite being the smallest state in the country with an

area of 356,861 hectares, it is the most populous state, as at 2006 the population of Lagos was

17.5 million. There are 20 LGAs and 37 LCDAs in Lagos State. The divisions are Epe, Ikeja,

Badagry, Lagos (Eko) and Ikorodu which were created in May 1968 by a virtue of

Administrative Divisions Edict No 3.

The Lagos State University Teaching Hospital Ikeja emerged from a modest cottage hospital

which was established 25th of June, 1955 by the old Western Regional Government to provide

health care services for the people of Ikeja and its environment. The cottage hospital later

metamorphosed into a full-fledged general hospital which served as a secondary level health care

facility. The driving objective of LASUTH is to become a world class teaching hospital, using

cutting edge technology and highly developed human resources to render excellent medical

care/services to the good people of Lagos State and beyond. This will reduce the number of

patients seeking medical tourism abroad. Lagos state university teaching hospital different

departments; medicine, surgery, psychiatry, obstetrics and gynecology and pediatrics which has

different wards. The diabetic clinic is located at the Lions building in LASUTH.

3.2 STUDY DESIGN

19
The study was a descriptive cross sectional study carried out to determine the adherence of

diabetic patient to treatment in Lagos state university teaching hospital.

3.3 STUDY POPULATION

This study was carried out among diabetic patients in Lagos state university teaching hospital

Inclusion criteria: The participants in this study were diabetic patients receiving treatment at

Lagos state university teaching hospital.

Exclusion criteria: Participants who came for treatment but not diabetic, unconscious patient,

patient less than 18 years

3.4 SAMPLE SIZE DETERMINATION

It was recorded that approximately 200 adults with diabetes visit diabetic clinic monthly, out of

this number about 50 come for either weekly or two weekly checkups or were referred for the

first time from other clinics or hospital. The clinic days are Tuesdays, a total number of 200

patients visit the clinic per month.

For population greater than 10,000 people, sample size was calculated using the Cochrane

formular

n= z2pq/d2

Where;

nf = minimum required sample size in population < 10,000

N = Population size which is 847

n= minimum required sample size in population > 10,000 which is calculated as n= z2pq/e2

20
z= confidence interval set at 1.96 for 95% confidence interval

p= Prevalence/ proportion estimated to have particular characteristics

q= 1-p = 0.64

e= precision value/ degree of error set at 0.05

According to a study conducted on a study conducted on medication non-adherence and

associated factors among diabetic patients visiting general hospitals in the eastern zone of Tigrai,

Northern Ethiopia, the level of adherence to anti-diabetic medication was 36.0% 27 , the sample

size was calculated thus:

n= 1.962 (0.36*0.64) / 0.052

= 1.962(0.2304) / 0.0025

= 3.8416(0.2304) / 0.0025

= 0.88510464/ 0.0025

n= 354.04

The formula nf = n/ (1 + n/N) was used to determine the minimum required sample size since the

study population is less than 10,000.

Therefore,

nf = 354.04/ (1+354.04/ 200)

nf = 354.04/ (1+ 1.7702)

nf = 354.02/ 2.7702

21
nf= 127.79

nf= 128

Using anticipated response rate of 10%, the sample size was increased to 141 respondents

3.5 SAMPLING METHOD

A simple random sampling method was used; respondents that match the inclusion criteria and

have given consent to respond was given questionnaires. The respondents that met the inclusion

criteria on clinic day which was Tuesday were administered the questionnaires

The questionnaires were shared randomly among patient visiting the diabetic clinic in LASUTH,

the starting point was chosen through balloting to avoid bias.

3.6 DATA COLLECTION TOOL

The questionnaire was a structured, interviewer-administered questionnaire and was adopted

from previous studies from the literature review30,31,32,33,34,35, it is divided into 4 sections.

Socio demographic data, knowledge of diabetic mellitus, attitude towards diabetic treatment and

adherence towards diabetic treatment

3.7 PRE-TESTING

The pre-testing exercise was carried out among diabetic patients in Lagos university teaching

hospital. The purpose of pre-testing the questionnaires is to determine if the questions was easy

to understand by the respondents and to determine any need for revising the questionnaires.

3.8 DATA COLLECTION

22
Data was collected from each respondent using an anonymous, structured, interviewer-

administered questionnaire. The data was collected by the researchers every clinic days which

are on Tuesdays for a period of one month, each respondent were interviewed in the clinic during

clinic hours.

3.9 DATA ANALYSIS

The information obtained was analyzed electronically using Epi-info Statistical software 2018

Data was presented using frequency table and the statistical tests will be considered significant at

a level of ≤5% (≤0.05). In the knowledge section there were a total of eight questions, each

correct answer was given 1 mark while incorrect answer was given 0 marks with a total mark of

14 marks, respondents who had ≤7 were graded as poor while those with ≥8 were graded has

having good knowledge. In the attitude section there were a total of six questions, using likert

scale there were a total of 18 marks, respondents that had ≤9 were graded has having negative

attitude than those that had ≥9 were graded has having positive attitude 40. In the adherence

section there were a total of twelve questions, each correct practice was given 1 mark while

incorrect practice was given 0 marks with a total mark of 14 marks, respondents who had ≤7

were graded as poor adherence while those with ≥8 were graded has having good adherence27.

3.10 ETHICAL CONSIDERATION

Ethical approval was obtained from the Research & Ethics Committee of Lagos State University

Teaching Hospital (LASUTH). Confidentiality was ensured by not including the names and

addresses of respondents. The participants were enlightened on the aims and implications of the

study. Informed consent was obtained while autonomy that is they were allowed to choose which

information they disclose, confidentiality and anonymity was ensured both during and after the

course of the study.

23
3.11 LIMITATION OF STUDY

This survey was interviewer-administered questionnaire, respondents left out some questions

which were corrected by convincing the respondents of the need to answer the questionnaire for

proper analysis and to assure them the response was confidential. Courtesy bias was a problem as

some respondent feel it’s their private information or not like the approach of the research, this

was solved by approaching and greeting the respondent and explaining the reason of the

research, the objectives of the research was explained to each respondent and that honest

responses are required and were appreciated.

CHAPTER FOUR

RESULTS

24
Table 1: Socio-demographics of respondents

Variable Frequency (n=141) Percentage %

Age group (years)
Less than 45 19 13.5
45 – 55 40 28.4
56 – 66 47 33.3
More than 66 35 24.8
Mean= 57.91±12.02
Sex
Female 67 47.5
Male 74 52.5
Ethnic group
Yoruba 104 73.8
Igbo 31 22.0
Hausa 6 4.3
Religion
Christian 86 61.0
Muslim 55 39.0
Educational status
No formal education 4 2.8
Primary education 28 19.9
Secondary education 56 39.7
Tertiary education 53 37.6
Monthly income
Less than N30,000 33 23.4
N30,000 – N50,000 23 16.3
N50,001 – N70,000 14 9.9
N70,001 – N100,000 36 25.5
More than N100,000 35 24.8
A large proportion of the respondents were between age 56 – 66 (33.3%) with a mean of
57.91±12.02 while about 52.5% were male, most of the respondents were Yoruba tribe (73.8%)
while 61.0% were Christians. About 39.7% had secondary education with 25.5% earning
N70,001 – N100,000 monthly.

Table 2: Respondents` knowledge of diabetes mellitus

Variable Frequency (n=141) Percentage %

25
Definition Diabetes mellitus
Diabetes is a communicable 1 0.7
disease
It is an increase in blood sugar 112 79.5
level
I don’t know 28 19.8
Type of diabetes mellitus
suffering from
Type 1 diabetes mellitus 2 1.4
Type 2 diabetes mellitus 38 27.0
Gestational diabetes mellitus 2 1.4
I don’t know 99 70.2
Diabetes mellitus is curable
Yes 67 47.5
No 74 52.5
Diabetes mellitus is
hereditary
Yes 92 65.2
No 49 37.8
Type 2 diabetes mellitus can
be prevented
Yes 114 80.9
No 27 19.1
Majority of the respondents knew diabetes mellitus as an increase in blood sugar level (79.5%)
while 70.2% didn’t know the type of diabetes mellitus they are suffering from. More than half
(52.5%) of the respondents knew diabetes mellitus is not curable while 65.2% knew diabetes
mellitus is hereditary with 80.9% who knew type 2 diabetes mellitus can be prevented.

Table 2b: Respondents` knowledge of diabetes mellitus

Variable Frequency (n=141) Percentage %

26
*Diabetes mellitus
preventive practice
Adequate checking of blood 41 29.7
sugar
No smoking 63 44.6
Taking herbs 24 17.0
Regular exercise 74 52.5
Taking fruits 38 27.0
Taking no sugar 67 47.5
Losing weight 36 25.5
*Symptoms of diabetes
mellitus
Increased urination 122 86.5
Cough 7 5.0
Fatigue 43 30.5
Slow healing 94 66.7
Weight gain 26 18.4
Blurred vision 65 46.1
Weak foot 31 22.0
*Complications of diabetes
mellitus
Nerve damage 19 13.5
Hypertension 47 33.3
Foot damage 84 59.6
Kidney damage 55 39.0
Eye damage 106 75.2
Pneumonia 10 7.1
Obesity 17 12.1
Stroke 34 24.1
*Multiple choice questions

More than half (52.5%) of the respondents knew regular exercise as a means of preventing
diabetes mellitus while 86.5% knew increased urination as a symptom of diabetes mellitus,
majority of the respondents knew eye damage as a complication of diabetes mellitus (75.2%).

Table 3: Respondents` overall knowledge of diabetes mellitus

27
Overall knowledge Frequency Percentage %
Good 43 30.5
Poor 98 69.5
Total 141 100.0
Most of the respondents had poor knowledge of diabetes mellitus (69.5%) while 30.5% had good
knowledge of diabetes mellitus.

Table 4: Respondents` attitude towards diabetes mellitus treatment

28
Variable Agree Undecided Disagree Total
n(%) n(%) n(%) n(%)
Continue taking 96(68.1) 30(21.3) 15(10.6) 141(100.0)
hypoglycemic
medications for
life
Blood glucose 133(94.3) 5(3.5) 3(2.1) 141(100.0)
level control is
essential
Herbal 7(5.0) 6(4.2) 128(90.8) 141(100.0)
medicine are
better than
hospital drugs
Discontinue 3(2.1) 9(6.4) 129(91.5) 141(100.0)
medication
since it
aggravates the
disease
Inappropriate 130(92.2) 6(4.3) 5(3.5) 141100.0)
medication will
lead to more
problems
Modifications to 135(95.7) 6(4.3) 0(0.0) 141(100.0)
diet and lifestyle
reduce diabetes
mellitus
complications
Most of the respondents agreed one need to continue taking hypoglycemic medications
throughout life time (68.1%) while 94.3% agreed blood glucose level control is essential,
majority of the respondents disagreed herbal medicine are better than hospital drugs (90.8%) also
about 91.5% disagreed one should discontinue medication since it aggravates the disease.
Majority of the respondents agreed inappropriate use of medication will lead to more problems
(92.2%) while 95.7% agreed modifications to diet and lifestyle reduce diabetes mellitus
complications

29
 Overall attitude towards diabetes treatment

25%

Positive
Negative

75%

Figure 1: Respondents` overall attitude towards diabetes treatment

Table 5: Respondents` adherence towards diabetes mellitus treatment

30
Variable Frequency (n=141) Percentage %
Adhere to diabetic treatment
Yes 118 83.7
No 23 16.3
Take medication the (n=118)
previous day
Yes 104 88.1
No 14 11.9
Occasionally miss
medications
Yes 75 63.6
No 43 36.4
Occasionally miss
medications because i felt
improved condition
Yes 24 20.3
No 94 79.7
Use alternative medicine in
the treatment of diabetes
Yes 46 39.0
*Reason(s) for use of
alternative medicine in the
treatment of diabetes
It is more effective 11 23.9
Lack of trust in modern 4 8.6
medicine
Lack of trust in health system 10 21.7
Was not getting better with 19 41.3
use of prescribed drugs
Treatment plan too expensive 22 47.8
to continue
Ever felt annoyed about (n=118)
adhering to the treatment
plan
Yes 29 24.6
No 89 75.4
*Multiple choice questions

Most of the respondents adhere to their diabetic treatment plan (823.7%) while most of the respondents
missed medication the previous day (88.1%) also a large proportion of the respondents occasionally miss
their medications (63.6%), majority of the respondents do not occasionally miss medications because they
felt improved condition (79.7%) while 61.0% used alternative medicine in the treatment of diabetes. Less
than half (47.8%) of the respondents` reason for use of alternative medicine in the treatment of diabetes
was because treatment plan too expensive to continue while 75.4% never felt annoyed about adhering to
the treatment plan.

Table 5b: Respondents` reasons for not following recommended diet

31
Variable Frequency (n=118) Percentage %
Followed the recommended
diet plan
Always 63 53.4
Never 2 1.7
Sometimes 76 64.4
Reasons for not following (n=2)
the recommended diet plan
Diet plan is expensive 1 50.0
Not comfortable 0 0.0
Forgetfulness 1 50.0
Do not think it helps 0 0.0
Food not readily available 0 0.0
Have any instrument for (n=118)
checking sugar level at home
Yes 62 52.5
No 56 47.5
If no, where else to check (n=56)
blood sugar level
Health centre 20 35.7
Nearby laboratory 22 39.3
Private hospital 9 16.1
A family friend 0 0.0
Until I come for check up 5 8.9
Most of the respondents sometimes followed the recommended diet plan (64.4%) while half of
the respondents` reason for not following the recommended diet plan was due to diet plan being
expensive and forgetfulness (50.0%) while 52.5% of the respondents had instrument for
checking sugar level at home, a large proportion of the respondents checked their blood sugar
level at nearby laboratory (39.3%).

Table 5c: Respondents` adherence towards diabetes mellitus treatment

32
Variable Frequency (n=118) Percentage %
How often blood glucose
level is checked at home or
elsewhere
Once daily 10 8.5
Before each meal 0 0.0
Once a week 49 41.5
Once a month 8 6.8
Only when I feel sick 12 10.2
Twice a week 35 29.7
When I come for check-up 4 3.4
Reason for not adhering to (n=23)
treatment plan or using drug
as one should
Forgetting to take drug 4 17.4
Use of traditional medicine 3 13.0
Lack of finances 12 52.2
Lack of changes in wellbeing 0 0.0
Side effects of drugs 2 8.7
Feel the rug is not effective 2 8.7
Less than half (41.5%) of the respondents checked their blood sugar level once a week while
3.4% was when they come for checkup, more than half (52.2%) of the respondents` reason for
not adhering to treatment plan or using drug as they should was due to lack of finances.

Table 6: Respondents` overall adherence to diabetic treatment

33
Adherence to diabetic Frequency (n=141) Percentage %
treatment
Good 94 66.7
Poor 47 33.3
Most of the respondents had good adherence to diabetic medication (66.7%) while 33.3% had
good to diabetic medication.

Table 7: Association between socio-demographics and adherence to diabetic treatment

34
 ADHERENCE TO DIABETIC TREATMENT
Variable Good Poor Total X2 Df P-value
n(%) n(%) n(%)
Age group 2.969 3 0.40
(years)
Less than 45 10(52.6) 9(47.4) 19(100.0)
45 – 55 28(70.0) 12(30.0) 40(100.0)
56 – 66 30(63.8) 17(36.2) 47(100.0)
More than 66 26(74.3) 9(25.7) 35(100.0)
Total 94(66.7) 47(33.3) 141(100.0)
Religion 1.059 2 0.47
Christian 58(67.4) 28(32.6) 86(100.0)
Muslim 36(65.5) 19(34.5) 55(100.0)
Total 94(66.7) 47(33.3) 141(100.0)
Educational 3.216 3 0.36
status
No formal 4(100.0) 0(0.0) 4(100.0)
education
Primary 20(71.4) 8(28.6) 28(100.0)
education
Secondary 34(60.7) 22(39.3) 56(100.0)
education
Tertiary 36(67.9) 17(32.1) 53(100.0)
education
Total 94(66.7) 47(33.3) 141(100.0)
Monthly 4.916 4 0.30
income
Less than 23(69.7) 10(30.3) 33(100.0)
N30,000
N30,000 – 14(60.9) 9(39.1) 23(100.0)
N50,000
N50,001 – 11(78.6) 3(21.4) 14(100.0)
N70,000
N70,001 – 27(75.0) 9(25.0) 36(100.0)
N100,000
More than 19(54.3) 16(45.7) 39(100.0)
N100,000
Total 94(66.7) 47(33.3) 141(100.0)
There was no statistically significant relationship between adherence to diabetic treatment and
age group (p=0.40), religion (p=0.47), educational status (p=0.36) and monthly income (p=0.30).

CHAPTER FIVE

35
 DISCUSSION

This study was conducted to assess the adherence of diabetic patient to diabetic treatment in

Lagos state university teaching hospital where it was found that 33.3% of the respondents were

between age 56 – 66 years while more than (52.5%) were male also 73.8% of the respondents

were Yoruba tribe, most of the respondents were Christians (61.0%) while about 39.7% had

secondary education with 25.5% earning N70,001 – N100,000monthly.

5.1 KNOWLEDGE OF DIABETES MELLITUS

During this study it was found that 79.5% of the respondents defined diabetes mellitus as an

increase in blood sugar level while 70.2% didn’t know the type of diabetes mellitus they are

suffering from, more than half (52.5%) of the respondents knew diabetes mellitus is not curable

this is in contrast to a study on knowledge of diabetes, its complications and treatment adherence

among diabetic patients where few of the respondents knew diabetes mellitus is curable 30. Most

of the respondents knew diabetes mellitus is hereditary (65.2%) while a large proportion of the

respondents knew type 2 diabetes mellitus can be prevented (80.9%) this is similar to a study on

level of diabetic patients’ knowledge of diabetes mellitus where 39.7% of the respondents had

type 2 diabetes mellitus31.

This study revealed that more than half (52.5%) of the respondents knew regular exercise as a

means of preventing diabetes mellitus while about 86.5% knew increased urination as a symptom

of diabetes mellitus this is similar to a study on knowledge of diabetes, its complications and

treatment adherence among diabetic patients where a third of the respondents knew increased

urination as symptom30. A large proportion of the respondents knew eye damage as a

complication of diabetes mellitus (75.2%) while 7.1% identified pneumonia as a complication of

36
diabetes mellitus this is in contrast to a study on knowledge of diabetes, its complications and

treatment adherence among diabetic patients where most of the respondents identified

hypertension as a complication30, most of the respondents had poor knowledge of diabetes

mellitus (69.5%) however this implied that respondents did not possess the right information

about the condition they are being treated for which is evident as most of the respondents do not

know the type of diabetes mellitus they are suffering from, however this can be corrected when

doctors fully inform the patients of the type of diabetes they are suffering from for adequate and

effective adherence.

5.2 ATTITUDE TOWARDS DIABETIC TREATMENT

According to this study 68.1% of the respondents agreed to continue taking hypoglycemic

medications throughout life time this is similar to a study in Adama Referral Hospital where all

the respondents agreed that they needed to continue taking their hypoglycemic medications

throughout their lifetime and inappropriate use of medications will lead to development of more

problems35, most of the respondents agreed blood glucose level control is essential (94.3%) this

is similar to a study conducted in Saudi Arabia where few of the respondents who agreed that

blood glucose level control is critical in reducing diabetes mellitus 31. A large proportion of the

respondents disagreed herbal medicine are better than hospital drugs (90.8%).

According to this study about 91.5% of the respondents disagreed one should discontinue

medication since it aggravates the disease while 92.2% agreed inappropriate use of medication

will lead to more problems. Majority of the agreed modifications to diet and lifestyle reduce

diabetes mellitus complications (95.7%) this is similar to a study conducted in Saudi Arabia

where about half agreed that modifications to diet and lifestyle can assist in reducing diabetes

37
mellitus complications31, a large proportion of the respondents had positive attitude towards

diabetes treatment (75.2%) this implies that majority of the respondents were willing to follow

the necessary rules or guide in the effective management of their disease.

5.3 ADHERENCE TO TREATMENT

During this study it was found that majority of the respondents adhere to their diabetic treatment

plan (83.7%) this is in contrast to a study in Northern Ethiopia where 63.9% were not adherent 34,

majority of the respondents missed medication the previous day (88.1%) this is similar to a study

conducted in Northern Ethiopia where 52.0% rehearsed that they had not taken their pill the

previous day21. Most of the respondents occasionally missed their medications 63.6% while most

of the respondents do not occasionally miss medications without physician instruction because of

felt improved condition (79.7%).

This show showed that 61.0% used alternative medicine in the treatment of diabetes also less

than half (47.8%) respondents` reason for use of alternative medicine in the treatment of diabetes

was because treatment plan too expensive to continue. It was found that 75.4% never felt

annoyed about adhering to the treatment plan with 64.4% who sometimes followed the

recommended diet plan, half (50.0%) of the respondents` reason for not following the

recommended diet plan was due to diet plan being expensive and forgetfulness.

According to this study 52.5% of the respondents had instrument for checking sugar level at

home this is in contrast to a study conducted in Assela General Hospital, Oromia Region,

Ethiopia where 17% respondents had a glucometer at home33, about 39.3% of the respondents

checked their blood sugar level at nearby laboratory. A large proportion of the respondents

checked their blood sugar level once a week (41.5%) this is in contrast to a study conducted at

38
Alimosho General Hospital, Igando Lagos, Nigeria where a large percentage of the respondents

measured their blood glucose monthly36.

This study revealed that 52.2% of the respondents` reason for not adhering to treatment plan or

using drug was due to lack of finances this is similar to a study conducted in Adama Referral

Hospital where 21.8% of the participants ascribed their non-adherence to forgetting to take their

medications35.

5.4 SOCIO-DEMOGRAPHICS FACTORS AFFECTING ADHERENCE TO DIABETIC

TREATMENT

This study showed that there was no statistically significant relationship between adherence to

diabetic treatment and age group (p=0.40), educational status (p=0.36) and monthly income

(p=0.30). This indicates that age group, educational status and monthly income were not factors

that affected the level of respondents` adherence to diabetic treatment.

5.5 CONCLUSION

This study was conducted to assess the adherence of diabetic patient to diabetic treatment in

Lagos state university teaching hospital where it was found that majority of the respondents did

not know the type of diabetes mellitus they are suffering from while most of the respondents

knew increased urination as a symptom of diabetes mellitus. A large proportion of the

respondents had poor knowledge of diabetes mellitus while less than a third had good knowledge

of diabetes mellitus.

During this study it was found that most of the respondents agreed blood glucose level control is

critical in controlling diabetes mellitus while a large proportion disagreed herbal medicine are

39
better than using drugs from hospital, majority of the respondents had positive attitude towards

diabetes treatment. Most of the respondents adhere to their diabetic treatment plan while a large

proportion used alternative medicine in the treatment of diabetes, less than half of the

respondents` reason for not adhering to treatment plan or using drug was due to lack of finances.

There was a statistically significant relationship between adherence to diabetic treatment and

educational status (p=0.01).

5.6 RECOMMENDATIONS

The following are the recommendations made based on the findings of this study;

1. Doctors should help properly inform patients about their diabetes mellitus types also

about symptoms and complication.

2. The health practitioners should help organize health talks among patients on the

importance of following diet and treatment plan.

3. Seminars on social media should be used by health practitioners in the addressing the

importance of knowing their diabetes mellitus status, the complications and the need for

proper follow-up in the hospital for effective management.

4. Doctors should encourage patient and emphasize the importance of drug adherence and

desist from taking other plans involving herbs among others.

REFERENCE

40
1. World Health Organization “Fact sheet on Diabetes” available at

https://www.who.int/news-room/fact-sheets/detail/diabetes cited at May 2022

2. Shamkuwar CA, Kumari N, Meshram SH, Dakhale GN, Motghare VM “Evaluation of

Knowledge, Attitude and Medication Adherence among Asthmatics Outpatients in

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Pharmacists; 2016; 8(2); 39.

3. Price D., Harrow B., Small M., Pike J., Higgins V. “Establishing the relationship of

inhaler satisfaction, treatment adherence, and patient outcomes: a prospective, real-world,

cross-sectional survey of US adult asthma patients and physicians” World Allergy

Organization Journal; 2015; 3(1); 24 – 25.

4. World Health Organization: Global health risks: mortality and burden of disease

attributable to selected major risks available at Cited at May 2021

5. Uloko AE, Musa BM, Ramalan MA, Gezawa ID, Puepet FH, Uloko AT, et al.

“Prevalence and risk factors for diabetes mellitus in Nigeria: a systematic review and

meta-analysis”. Diabetes Therapy journal. 2018;9(3):1307–16.

6. International Diabetes Federation. Diabetes atlas 8th Edition. International Diabetes

Federation 2017. Available at http://www.diabetesatlas.org. Cited at May 2021

7. HEMOCUE “The global burden of diabetes mellitus” Available at

https://www.hemocue.com/en/health-areas/diabetes/global-burden Cited at May 2021

8. Ogonna Oguejiofor, Charles Odenigbo and Chikezie Onwukwe “Diabetes in Nigeria:

Impact, Challenges, Future Directions” Endocrinology Metabolic Syndrome

journal ,2014, 3(2), 130.

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9. Biderman A, Noff E, Harris SB, Friedman N, Levy A “Treatment satisfaction of diabetic

patients: what are the contributing factors” Family practice journal; 2014;3(1): 102–108.

10. International diabetes federation “what is diabetes” Available at

https://idf.org/aboutdiabetes/what-is-diabetes.html Cited at May 2021.

11. Medical news today “Diabetes: Past treatments, new discoveries” available at

https://www.medicalnewstoday.com/articles/317484#pancreas-insulin-and-insulin-

resistance Cited at May 2021.

12. Ripoll, Brian C. Leutholtz, Ignacio “Exercise and disease management” CRC Press. ;

2011; 2(1); 25.

13. Shi Y. and Hu F." The global implications of diabetes and cancer"

Lancet;2014:3(1):1947–1948.

14. Gale EA, Gillespie KM "Diabetes and gender" 2013;44 (1): 3–15.

15. Meisinger C, Thorand B, Schneider A"Sex differences in risk factors for incident type 2

Diabetes Mellitus: The MONICA Augsburg Cohort Study". JAMA Internal

Medicine.2013; 162 (1): 82–89.

16. Mathers CD, Loncar D. "Projections of global mortality and burden of disease from 2002

to 2030". PLOS Medicine:2014: 3 (11): 442.

17. Havard Health Publishing “Type 1 Diabetes Mellitus” Available at

https://www.health.harvard.edu/a_to_z/type-1-diabetes-mellitus-a-to-z Cited at May

2021.

18. Medicinenet “Type 2 Diabetes” Available at

https://www.medicinenet.com/type_2_diabetes/article.htm Cited at May 2021.

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19. Soldavini Jessica "Krause's Food & The Nutrition Care Process". Journal of Nutrition

Education and Behavior: 2019: 51 (10): 1225

20. Healthline “Gestational diabetes mellitus” Available at

https://www.healthline.com/health/gestational-diabetes#causes Cited at May 2021.

21. National Institute of Diabetes and Digestive and Kidney Diseases "Managing & Treating

Gestational Diabetes | NIDDK" Available at https://www.niddk.nih.gov/health-

information/diabetes/overview/what-is-diabetes/gestational/management-treatment Cited

at May 2021.

22. MAYOCLINIC “Diabetes Mellitus” Available at https://www.mayoclinic.org/diseases-

conditions/diabetes/symptoms-causes/syc-20371444 Cited at May 2021.

23. Cleavland clinic “Diabetes: an overview” Available at

https://my.clevelandclinic.org/health/diseases/7104-diabetes-mellitus-an-overview Cited

at May 2021.

24. America Diabetes Association “Understanding Aic” Available at

https://www.diabetes.org/a1c/diagnosis Cited at May 2021.

25. University of California San Francisco “Diabetes Mellitus Treatments ” Available at

https://www.ucsfhealth.org/conditions/diabetes-mellitus/treatment Cited at May 2021.

26. MEDLINE PLUS “How to Prevent Diabetes” Available at

https://medlineplus.gov/howtopreventdiabetes.html Cited at May 2021.

27. Community Diabetes Prevention and Management “Diabetes Prevention and

Management” Available at

https://www.worlddiabetesfoundation.org/sites/default/files/WDF09-436%20Community

%20Diabetes%20Control%20Participant%20Booklet%201.pdf Cited at May 2021

43
28. M. Sue Kirkman, Megan T. Rowan-Martin, Rebecca Levin, Vivian A. Fonseca, Julie A.

Schmittdiel et al “Determinants of Adherence to Diabetes Medications: Findings From a

Large Pharmacy Claims Database” Diabetes Care 2015; 38(4): 604-609.

29. Diabetes in control “A Major Diabetes Complication That We Fail to Address” Available

at http://www.diabetesincontrol.com/a-major-diabetes-complication-that-we-fail-to-

address/ cited at June 2021

30. Deepali B., Mangala S., Soumya G., Vikyath B., Aarudhra P. et al. “Knowledge of

diabetes, its complications and treatment adherence among diabetic patients”

International Journal of Community Medicine and Public Health; 2017;4(7):28 – 34.

31. Ahmed, I. B., Binnwejim, M. S., Alnahas, T. M., Asaad AliRaes, A., Abdulqader

Basamad, M., Eidhah Alqurashi, A. and et al.An assessment of the level of diabetic

patients’ knowledge of diabetes mellitus, its complications and management in Saudi

Arabia.ArchPharma Pract 2019;10(4):80-6.

32. Awuni Prosper and Mandela Amaltinga “Non Adherence to Diabetic Medication Among

Diabetic Patients, a Case Study of Dormaa Hospital Ghana” Science Journal of Public

Health; 2017:5(2);88-97.

33. Ashebir Kassahun, Fanta Gashe, Eshetu Mulisa, Wote Amelo Rike “Nonadherence and

factors affecting adherence of diabetic patients to anti-diabetic medication in Assela

General Hospital, Oromia Region, Ethiopia” J Pharm Bioallied Science: 2016; 8(2): 124–

129.

34. Araya EM, Gebrezgabiher HA, Tekulu GH, Alema NM, Getnet D et al. “Medication

Non-Adherence and Associated Factors Among Diabetic Patients Visiting General

Hospitals in the Eastern Zone of Tigrai, Northern Ethiopia”. 2020;14(3):2071-2083

44
35. Belayneh Kefale, Abdela Mohammed, Gobezie Temesgen, Amsalu Degu, Muluneh

Fromsa et al. "Nonadherence and Contributing Factors among Ambulatory Patients with

Antidiabetic Medications in Adama Referral Hospital" Journal of Diabetes

Research:2014, 3(1); 21 – 30.

36. Olufunsho Awodele and Jemeela A Osuolale “Medication adherence in type 2 diabetes

patients: study of patients in Alimosho General Hospital, Igando, Lagos, Nigeria” African

Health Science.2015; 15(2): 513–522.

APPENDIX ONE

QUESTIONNAIRE

45
 We are 600level medical student of the Lagos State University College of Medicine. We are

conducting a research on the ADHERENCE OF DIABETIC PATIENT TO DIABETIC

TREATMENT IN LAGOS STATE UNIVERSITY TEACHING HOSPITAL This is in

partial fulfillment for the award of my MBBS degree. It is completely anonymous and any

information given therein will be treated with the strictest confidentiality. Thank you in

anticipation of your cooperation.

Please read and tick as appropriate.

Section A: Socio- demographic data

1) Age. …………………………

2) Sex: (i) Male [ ] (ii) Female [ ]

3) Ethnic group: (i) Hausa [ ] (ii) Yoruba [ ] (iii) Igbo [ ]

(iv) Others please specify ………………………

4) Religion (i) Christian [ ] (ii) Muslim [ ] (iii) Others please specify

…………………………………….

5) Educational status (i) No formal education [ ] (ii) Primary education[ ] (iii)

Secondary education [ ] (iv) Tertiary education [ ]

6) Monthly income (i) Less than N30,000 [ ] (ii) N30,000 – N50,000 [ ] (iii) N50,001

– N70,000 [ ] (iv) N70,001 – N100,000 [ ] (v) More than N100,000 [ ]

Section B: Knowledge of diabetes mellitus

46
7) What is diabetes mellitus? (a) Diabetes is a communicable disease [ ] (b) It is due to an

increase in blood sugar [ ] (c) I don’t know [ ]

8) Do you know the type of diabetes mellitus you have? (a) Type 1 diabetes mellitus [ ]

(b) Type 2 diabetes mellitus [ ] (c) Gestational diabetes mellitus [ ] (d) I don’t know [ ]

9) Is diabetes mellitus curable? (a) Yes [ ] (b) No [ ]

10) Do you think diabetes mellitus is hereditary? (a) Yes [ ] (b) No [ ]

11) Can type 2 diabetes mellitus be prevented? (a) Yes [ ] (b) No [ ] if no please go to

question 13

12) If yes, what is/are the means of diabetic prevention? (you may tick more than one

response)

(a) No smoking [ ] (b) Adequate checking of blood sugar [ ] (c) Taking herbs [ ] (d)

Regular exercise [ ] (e) Taking no sugar [ ] (f) Losing weight [ ] (h) Taking fruits

[ ] Others …………………………………. Please specify

13) What are the symptoms of diabetes mellitus? (a) increased urination [ ] (b) cough [ ]

(c) fatigue [ ] (d) slow healing[ ] (e) weight gain [ ] (f) blurred vision [ ] (g) weak

foot [ ] Others …………………………… please specify

14) What are the complications of diabetes mellitus? (a) nerve damage [ ] (b)

hypertension [ ] (c) foot damage [ ] (d) kidney damage [ ] (e) eye damage [ ] (f)

pneumonia [ ] (g) Obesity [ ] (b) stroke [ ] Others ………………………………

please specify

47
Section C: Attitude towards diabetic treatment

How strongly do you AGREE or DISAGREE with each of the following statements ? Please tick

appropriately.

A: Agree U: undecided D: Disagree

S/N QUESTION A U D

15 I need to continue taking hypoglycemic medications throughout

lifetime

16 Blood glucose level control is critical in controlling diabetes

mellitus

17 Herbal medicine are better than using drugs from hospital

18 I should discontinue medication without consulting the

physician because the medication aggravates the disease

19 Inappropriate use of medications will lead to development of

more problems

20 Modifications to diet and lifestyle can assist in reducing

diabetes mellitus complications

Section D: Adherence to treatment

48
21) Do you adhere/follow your diabetic treatment? (a) Yes [ ] (b) No [ ] If no go to question

33

22) Did you take your medication the previous day? (i) Yes [ ] (ii) No [ ]

23) Do you occasionally miss your medication? (a) Yes [ ] (b) No [ ]

24) Do you occasionally miss your medication without your physician instruction because

they feel improved? (a) Yes [ ] (b) No [ ]

25) Did you use alternative medicine in the treatment of your diabetes? (a) Yes [ ] (b) No

[ ] if no please go to question 27

26) If yes, what is/are your reasons for use of alternative medicine in the treatment of your

diabetes? (you may tick more than one response)

(a) It is more effective [ ] (b) No trust in modern medicine [ ] (c) Lack of trust in the

health system [ ] (d) Was not getting better with use of prescribed drugs [ ] (e) Treatment

plan to expensive to continue [ ] Others …………………………………. Please specify

27) Did you ever feel annoyed about adhering to the treatment plan? (a) Yes [ ] (b) No

[ ]

28) Do you follow the recommended diet plan?

(a) Always [ ] (b) Sometimes [ ] (c) Never [ ]

29) If never , what are your reasons not following the recommended diet plan?

49
 (a) Diet plan is expensive [ ] (b) Not comfortable [ ] (c) Forgetfulness [ ] (a) Do

not think it helps [ ] (b) Food not readily available [ ]

30) Do you have any instrument for checking your sugar level at home?

(a) Yes [ ] (b) No [ ] if yes go to question 32

31) If no, where else do you check your sugar level?

(a) Nearby laboratory [ ] (b) Health centre [ ] (c) Private hospital [ ] (d) A family friend

[ ] (e). Until I come for check-up [ ]

32) How often do you check your blood glucose level at home or elsewhere?

(a)Once daily [ ] (b) Before each meal [ ] (c) Once a week [ ] (c) Once a month [ ] (d)

Only when I feel sick [ ] (e) twice a week [ ] (f)when I come for check-up [ ]

33) Reason for not adhering to treatment plan or using your drugs as you should?

(a)Forgetting to take drug [ ] (b) Use of traditional medicines [ ] (c) Lack of finances [ ] (d)

Lack of changes in wellbeing [ ] (e) Side effects of drugs [ ] (f) Feel the drug is not effective

[ ] Other ....................................... please specify

Thank you.

50
 APPENDIX TWO

LISTS OF ABBREVIATION

Diabetes Mellitus – DM

World health Organization – WHO

APPENDIX THREE: CONSENT FORM

51
Name of principal investigator(s): Emuata Ijojo-Igboria

Department: Community Health and Primary Health Care

E-mail: [email protected]

Phone number: 07032061874

Title of the research: Adherence of diabetic patient to diabetic treatment at Lagos State
University Teaching Hospital.

Names of researchers: This study is conducted by Sholuade Titilayo, Emuata Ijojo-Igboria and
Modebe Cynthia who are all final year medical students of Lagos State University College of
Medicine and supervised by Dr Kuyinu.

Sponsor(s) of the research: This study is self-funded.

Purpose of the research: The purpose of this research is to assess the adherence of diabetic
patient to diabetic treatment at Lagos state university teaching hospital (LASUTH).

Procedure of the research, what shall be required of each participant and approximate
total number of participants that would be involved in the research: Each participant will
receive a interviewer-administered questionnaire that will be required to be answered
completely. In total we are expected to recruit 146 participants into this study in Lagos state
university teaching hospital.

Expected duration of research and of participant(s)’ involvement: In total, we expect you to

be involved in this research for two months from June 24th – October 20th, 2021. Each
participant is expected to spend an average of 15 Minutes on each questionnaire.

Risks: No risk involved in your participation in this research.

Costs to the participants, if any, of joining the research: Your participation in this research
will not cost you anything.

52
Benefit(s): We hope that our study will provide information that can be used in decision making
process concerning the adherence of diabetic patient to diabetic treatment at Lagos state
university teaching hospital (LASUTH)..

Confidentiality: All information collected in this study will be given code numbers and no name
will be recorded. This cannot be linked to you in anyway and your name or any identifier will
not be used in any publication or reports from this study without any punishment
Voluntariness: Your participation in this research is entirely voluntary.
Alternative to participation: If you choose not to participate, this will not affect you in any
way.
Due Inducement(s): Not applicable to this study.
Consequences of participants’ decision to withdraw from research and procedure for
orderly termination of participation: You can also choose to withdraw from the research at
any time.
Modality of providing treatments and action(s) to be taken in case of injury or adverse
event(s): Not applicable to this study.
What happens to research participants and communities when the research is over: Not
applicable to this study.
Statement about sharing of benefits among researchers and whether this includes or
exclude research participants: Not applicable to this study.
Any apparent or potential conflict of interest: No apparent or potential conflict of interest.
Statement of person obtaining informed consent:

I have fully explained this research to ____________________________________ and have

given sufficient information, including about risks and benefits, to make an informed decision.

DATE: _____________________ SIGNATURE: _______________________________

NAME: ______________________________________________

Statement of person giving consent:

I have read the description of the research. I understand that my participation is voluntary. I
know enough about the purpose, methods, risks and benefits of the research study to judge that I

53
want to take part in it. I understand that I may freely stop being part of this study at any time. I
have received a copy of this consent form and additional information sheet to keep for myself.
DATE: ___________________ SIGNATURE: _________________________________

NAME: _____________________________________________

WITNESS’ SIGNATURE (if applicable): ___________________________

WITNESS’ NAME (if applicable): ______________________________________

Detailed contact information including contact address, telephone, fax, e-mail and any
other contact information of researcher(s), institutional HREC:
This research has been approved by the Health Research Ethics Committee of the Lagos State
University College of Medicine. In addition, if you have any question about your participation in
the research, you can call 07032061874

54