PREVALEANCE OF DIABETES AND HYPERTENSION IN AMUWO ODOFIN LOCAL GOVERNMENT AREA OF LAGOS STATE, NIGERIA


Content

ABSTRACT

This study assess the prevalence of Diabetes and Hypertension in Amuwo Odofin Local Government Area of Lagos State, Nigeria. The populations under study were the inhabitants of Amuwo Odofin Local Government and 200 (two hundred) individuals were sampled for the study.

Twenty five research questions that focused on the objectives of the study were formulated to guide the study. A cluster sampling method was used to collect the data. The major instrument for Data collection was Questionnaire for the Respondents.

The method used for data analysis was that of percentage and further analysis was done using SPSS version 17.7 software package. The findings showed that 20% of the respondents in the sampled area that had both Diabetes and hypertensions were males, while the remaining 35% were females; a larger percentage (43%) smoke cigarette.

Prominent among the recommendations of the study were; that extensive awareness programs for the general public aimed at augmenting preventive programs of diabetes and Hypertension is required.

Medical check-ups should be integrated into the recruitment process so that hypertension and Diabetes could be picked early.

Treatment of hypertension should begin with non pharmacological methods such as weight loss, low salt intake, increase physical activity, smoking cessation and reduced alcohol intake.

Hence, control of Diabetes and Hypertension by appropriate methods, particularly dietary restriction and regular physical exercise, must be stressed in order to decrease both the prevalence of Diabetes and hypertension.            

 


TABLE OF CONTENT

Pages

Title page                                                                                          i

Certification                                                                                     ii

Dedication                                                                              iii

Acknowledgement                                                                           iv

Abstract                                                                                           v

 Table of content                                                                     vi

CHAPTER ONE

1.1       Introduction                                                                           1

1.2        Statement of the problems                                                   8

1.3        Purpose of the study                                                            10

1.4       Research questions                                                               10

1.5       Research hypothesis                                                              11

1.6       Significance of the study                                                        11

1.7       Scope of the study                                                                 12

 

 

CHAPTER TWO

2.1 Introduction                                                                              13

2.2 Concept of Islamic Education                                                  14

2.3 Western Educational systems in Nigeria                                 15

2.4 Islamic Educational system in Nigeria                                    18

2.5 Factors inhibiting the development of Islamic education in Nigeria                                                                                                21

2.6 The way forward for Islamic education in Nigeria                   25

2.7 The challenges facing Islamic education in Nigeria                28

2.8 The Vision of Islamic education                                               30

2.9 The emergence of Boko Haram                                                34

2.10 The Boko Haram uprising: Building on precedents             36

2.11 Fall-out of Boko Haram uprising                                          39

2.12 Lesson from Boko Haram uprising                                       46

2.13 Conclusion                                                                    51

 

CHAPTER THREE

3.1 Introduction                                                                              53

3.2 Research Design                                                                       54

3.3 Population of the study                                                            54

3.4 Sample and Sampling Technique                                             55

3.5 Research Instruments                                                              55

3.6 Validity of Research Instruments                                             56

3.7 Reliability of research Instruments                                          56

3.8 Method of Data Analysis                                                           56

CHAPTER FOUR

Analysis of data, results and interpretation                                  58

CHAPTER FIVE

5.1 Summary of finding                                                                  88

5.2 Conclusion                                                                                94

5.3 Recommendations                                                           96

References                                                                              99


 

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

In many developing countries, hypertension and diabetes mellitus are becoming a problem of importance. Urbanization and economic development have led to a nutritional transition characterized by a shift to reduction of physical activities resulting in changes in individual body composition. Hypertension and diabetes mellitus are both iceberg diseases, they are common, important and major global public health problems. Hypertension is the most common cardiovascular disorder, which poses a major public health challenge. It is one of the greatest risk factor for cardiovascular mortality

Diabetes mellitus is also one of the most common chronic diseases in nearly all countries, and continues to increase in number and significance, as economic development and urbanization leads to changing lifestyle characterized by reduced physical activity, and increased obesity. Hypertension is an extremely common co-morbidity amongst persons with diabetes mellitus and is said to be twice as prevalent in diabetics as in non-diabetic individual (Epstein et al 2000).

According to Med lexicon’s medical dictionary, hypertension means "High blood pressure; transitory or sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences."

Hypertension or High Blood Pressure, medical condition in which constricted arterial blood vessels increase the resistance to blood flow, causing an increase in blood pressure against vessel walls. Every time the human heart beats, it pumps blood to the whole body through the arteries. The heart must work harder to pump blood through the narrowed arteries. If the condition persists, damage to the heart and blood vessels is likely, increasing the risk for stroke, heart attack, and kidney or heart failure. Often called the “silent killer,” hypertension usually causes no symptoms until it reaches a life-threatening stage (Microsoft Encarta, 2008).

Hypertension can lead to damaged organs, as well as several illnesses, such as renal failure (kidney failure), aneurysm, heart failure, stroke, or heart attack.

Diabetes Mellitus is a disorder caused by the total (or relative) absence of insulin, which manifests clinically as an elevated blood glucose. Diabetes Mellitus, disease in which the pancreas produces insufficient amounts of insulin, or in which the body’s cells fail to respond appropriately to insulin. Insulin is a hormone that helps the body’s cells absorb glucose (sugar) so it can be used as a source of energy. In people with diabetes, glucose levels build up in the blood and urine, causing excessive urination, thirst, hunger, and problems with fat and protein metabolism. Diabetes mellitus differs from the less common diabetes insipid us, which is caused by lack of the hormone vasopressin, which controls the amount of urine secreted.

People with diabetes are at increased risk of cardiovascular, peripheral vascular and cerebrovascular disease.

TYPES OF HYPERTENSION

1.      Essential hypertension: Also known as primary hypertension. It is diagnosed in the absence of an identifiable secondary cause. This means the reason or cause is unknown, and over 90% of patients have this type of hypertension, but can be associated with being hereditary (a possible family history).

2.      Secondary Hypertension: This accounts for fewer eminent. The cause or reason for this kind of hypertension is known, for example a kidney disease (Armenian Medical Network, 2006).

3.      Gestational Hypertension: This is pregnancy induced or related hypertension, this is a surge in the rise of a patient (female) blood pressure due to the pregnancy she is carrying and it is a sign of Toxemia in pregnancy.

TYPES OF DIABETES

In 1998, a new classification system based upon the etiological factors at work in diabetes was proposed by the WHO and we have listed it below: this has now become the accepted system for classifying diabetes mellitus (1).

·        Type 1 diabetes: immune mediated and idiopathic forms of cell dysfunction, which lead to absolute insulin deficiency. This is an autoimmune mediated disease process which gives rise to absolute deficiency of insulin and therefore total dependency upon insulin for survival.

·        Type 2 diabetes: disease of adult onset, which may originate from insulin resistance and relative insulin deficiency or from a secretory defect. This is a disease, which appears to have a very strong genetic predisposition and is caused by a combination of inadequate insulin secretion and an insensitivity of the body tissues to insulin so leaving patients with this condition relatively deficient in insulin.

·        Type 3 diabetes: This covers a wide range of specific types of diabetes including various genetic defects in insulin action, and diseases of the exocrine pancreas.

·        Type 4 diabetes is gestational diabetes.

 

CAUSES OF HYPERTENSION

Though the exact causes of hypertension are usually unknown, there are several factors that have been highly associated with the condition. These include:

  • Smoking
  • Obesity or being overweight
  • Diabetes
  • Sedentary lifestyle
  • Lack of physical activity
  • High levels of salt intake (sodium sensitivity). According to the American Heart Association (AHA), sodium consumption should be limited to 1,500 milligrams per day, and that includes everybody, even healthy people without high blood pressure, diabetes or cardiovascular diseases.
  • Insufficient calcium, potassium, and magnesium consumption
  • Vitamin D deficiency
  • High levels of alcohol consumption
  • Stress
  • Aging
  • Medicines such as birth control pills
  • Genetics and a family history of hypertension
  • Chronic kidney disease
  • Adrenal and thyroid problems or tumors
  • Insulin resistant
  • Sleep Apnea
  • Liquorices
  • Kidney disease
  • Pregnancy

CAUSES OF DIABETES

Diabetes causes vary from type1 to type 2 and gestational diabetes, hence their causes are not exact for each, but summarized below:

·        Lack of insulin / insulin resistant

·        Genetic susceptibility / family history

·        Autoimmune destruction of beta cells / beta cells dysfunction

·        Viruses and infections

·        Reduced vitamin D supplements in infants

·        Overweight or Obesity

·        physical inactivity

·        Abnormal glucose production by the liver

·        Metabolic syndrome

·        High blood pressure

·        Damage to pancreas

·        Chemical toxins within food

·        Increasing age (45yrs or older)

·        Bad diet

·        Pregnancy

EFFECTS OF HYPERTENSION

1.      Gout: This is characterized by inflammatory form of arthritis. Joint inflammation in gout is due to deposits of sodium urate crystal, which form excess uric acid, a waste product circulating the blood. It usually affects a single joint mostly the toe, especially the big one. Gout development can be associated with excessive alcohol consumption, obesity and high blood pressure. Treatment is with proper diet, care and prevention of inflammation.

2.      Heart Disease and Stroke:

a.      Aneurysm: This occurs in blood vessels that have been weakened by Arteriosclerosis. It can also occur in normal blood condition if the blood vessels have been weakened from birth. Other causes are traumatic injury, syphilis. It is usually found in Aorta.

b.      Brain: A stroke may occur which is damage to the brain due to an interruption of blood supply / flow. This interruption may be due to a blood clot (Thrombosis), constriction of blood vessels, or rupturing of a vessel accompanied by bleeding.

c.      Circulatory System: Untreated hypertension can cause heart enlargement and thickening of the heart muscles, due to low oxygen supply or the demand for more, heart failure, brain stroke, or kidney impairment may occur.

d.      Heart: Persistent elevated blood pressure may result into a heart attack.

e.      Stroke: Nicotine in cigarettes can be associated to cause stroke after the elevation of the blood pressure from time to time (Heart Disease and Stroke Statistics, 2005).

3.      Vision Disorders

a.      Glaucoma: This condition is also associated with hypertension, affects about 20% age 40 and 80% of age 70, tend to run in families.

b.      Macular Degeneration: Age-related macular degeneration (AMD) cause is still unknown, but hypertension increases a person’s risk of developing AMD.

EFFECTS OF DIABETES

·        Long term damage, dysfunction and failure of various organs

·        Potential blindness

·        Renal failure

·        Foot ulcers, Amputation

·        Charcot joints

·        Sexual dysfunction

·        Cardiovascular / cerebrovascular disease

TREATMENT/ MANAGEMENT OF HYPERTENSION

The main goal of treatment for hypertension is to lower blood pressure to less than 140/90 - or even lower in some groups such as people with diabetes, and people with chronic kidney diseases. Treating hypertension is important for reducing the risk of stroke, heart attack, and heart failure. Medical options to treat hypertension include several classes of drugs. Angiotensin-converting enzymes (ACE) inhibitors, Angiotensin receptor blockers (ARB) drugs, beta-blockers, diuretics, calcium channel blockers, alpha-blockers, and peripheral vasodilators are the primary drugs used in treatment. These medications may be used alone or in combination, and some are only used in combination. In addition, some of these drugs are preferred to others depending on the characteristics of the patient (diabetic, pregnant, etc.).

In addition to taking medicine, you can do many things to help control blood pressure including:

·        Eat a heart healthy diet, including potassium and fiber and drink plenty of water.

·        Exercise regularly, at least 30minutes a day

·        Quit smoking

·        Limiting alcohol intake- 1 drink a day for women, 2 a day for men.

·        reducing sodium intake- aim for less than 1500mg per day

·        reduce stress

·        Maintain a healthy body weight

If blood pressure is successfully lowered, it is wise to have frequent checkups and to take preventive measures to avoid a relapse of hypertension.

TREATMENT/ MANAGEMENT OF DIABETES

The major components of the treatment of diabetes are:

1. Diet (combined with exercise if possible)

2. oral hypoglycemic therapy

3. Insulin treatment

Basic educational requirements

The person with diabetes should acquire adequate knowledge and skills in the

Following:

— Individual therapy targets

— Individual nutritional requirements and meal planning

— Type and extent of exercise and physical activity

— Interaction of food intake and physical activity with oral hypoglycemic drugs/insulin

— Improvements in lifestyle, for example harmful effects of smoking, obesity and alcohol Intake

— Self-monitoring and significance of results and actions to be taken

— How to cope with emergencies (illness, hypoglycemia)

— How to avoid complications and detect them at an early stage, e.g. how to take care of the feet.

Dietary treatment

Diet is a basic part of management in every case. Treatment cannot be effective unless adequate attention is given to ensuring appropriate nutrition.

Dietary treatment should aim at:

— ensuring weight control

— providing nutritional requirements

— allowing good glycemic control with blood glucose levels as close to normal as possible

— correcting any associated blood lipid abnormalities

— ensuring consistency and compatibility with other forms of treatment if used, for example oral agents or insulin.

The following principles are recommended as dietary guidelines for people with diabetes:

— Dietary fat should provide 25-35% of total intake of calories but saturated fat intake

should not exceed 10% of total energy. Cholesterol consumption should be restricted

and limited to 300 mg or less daily.

— Protein intake can range between 10-15% total energy (0.8-1 g/kg of desirable body

weight). Requirements increase for children and during pregnancy. Protein should be

derived from both animal and vegetable sources.

- Carbohydrates provide 50-60% of total caloric content of the diet. Although it has been

traditionally recommended that carbohydrates should be complex and high in fibre,

more emphasis should be placed on the total amount of carbohydrates consumed than

the source of carbohydrate. (WHO-EM/DIN6/E/G)

— Excessive salt intake is to be avoided. It should be particularly restricted in people with hypertension and those with nephropathy.

— Artificial sweeteners are to be used in moderation. Nutritive sweeteners (sorbital and

Fructose) should be restricted.

— The same precautions regarding alcohol intake that apply to the non diabetic

population also applies to people with diabetes. Additionally, however, alcohol tends to

increase the risk of hypoglycemia in those taking anti diabetic drugs and should be

particularly avoided in those with lipid abnormalities and patients with neuropathy.

— Except in special conditions like pregnancy and lactation, routine vitamin and mineral

supplementation is generally not needed in people with a well balanced diet. There is, at present, no definite evidence to confirm that such treatment has any benefits.

Exercise

Physical activity promotes weight reduction and improves insulin sensitivity, thus

lowering blood glucose levels.

Together with dietary treatment, a programme of regular physical activity and exercise should be considered for each person. Such a programme must be tailored to the individual’s health status and fitness. People should, however, be educated about the potential risk of hypoglycemia and how to avoid it.

Drug treatment

Oral hypoglycemic drugs (OHD) are considered only after a regimen of dietary treatment combined with exercise has failed to achieve the therapy targets set.

There are two major groups of OHD: sulphonylureas(SUs) and biguanides (BGs). SU act by stimulating insulin release from the beta cells and also by promoting its action through extra pancreatic mechanisms. BG exerts their action by decreasing gluconeogenesis and by increasing the peripheral utilization of glucose.

Several SU preparations are marketed in countries of the Eastern Mediterranean Region. Selection of a specific SU preparation will depend on factors such as availability, cost, and the physician’s experience. However, this group of drugs may be represented by

Glibenclamide or tolbutamide.

SUs can cause hypoglycemia and their use should therefore be closely monitored in the elderly and in those with nephropathy. .Tolbutamide is a short-acting SU and may be

selected in patients with renal impairment.

Glibenclamide may be given in an initial dose of 1.25-2.5 mg which can be increased

up to a maximum daily dose of 15 mg. For tolbutamide, the initial daily dose is 0.5 g

this can be increased, if necessary, to 1.5 g in divided doses.

Metformin is the only BG preparation now marketed in most Eastern Mediterranean

Region countries. Metformin is primarily used in the obese not responding to dietary

therapy. The starting dose is 500-850 mg with or after food, once daily, which can be

increased to 500 mg tds or 850 mg bd. Because of the risk of lactic acidosis, it is

contraindicated in:

o   patients with impaired renal function

o   elderly people above the age of 70 years

o   Patients with heart failure, hepatic impairment, or predisposition to lactic acidosis.

1.2 STATEMENT OF THE PROBLEM

According to the world health organization, research has shown that the prevalence of diabetes mellitus in adults worldwide estimated to be 4.0% in 1995 and is predicted to rise to 5.4% by 2025… Diabetes creates a huge economic burden not only due to the direct cost of treatment but also in terms of man hours lost due to the effects of the disease on individuals. Challenges in managing both hypertension and Diabetes Mellitus more effectively include factors at the patient, provider and system levels. There is an urgent need for an integrated approach at a primary health care level for addressing the burden of hypertension and Diabetes Mellitus. Based on these facts, the research has to be carried out so as to identify the problem as Stated, causes of the problem, extent of its damages and possible way of propounding solution to the problem so as to reduce the situation to a level that is below economic burden.

1.3RESEARCH QUESTIONS

1.      What do you understand or know about hypertension and diabetes?

2.      What are the causes of hypertension and diabetes?

3.      Which age range do you think they affect?

4.      What are the attitudes of people toward them?

5.      What are the risk factors associated with having both?

6.      To what extent has the damage caused by hypertension and diabetes been?

1.4 PURPOSE OF THE STUDY

The purpose of the study is to determine the prevalence rate of hypertension and diabetes among the male and females in Amuwo Odofin local government area, to determine the extent of the menace caused by these diseases and what facilities are put in place to proper orientate the populace on prevention and treatment of these diseases.

1.5AIM OF THE STUDY

 The aim of the study was to find out the prevalence of hypertension and diabetes in Amuwo Odofin Local Government Area in Lagos State, Nigeria. The aim is to be achieved through the following objectives.

1.6 OBJECTIVE OF THE STUDY

The objectives are as listed below:

i.        To determine the knowledge of people (males and females) towards hypertension and diabetes.

ii.     To assess the attitude of these people towards both hypertension and diabetes in order to prevent or manage the two when present.

iii.   To clarify their perception towards hypertension and diabetes.

iv.   To determine the constraints that hinder their knowledge, affects their attitude and perception towards hypertension and diabetes in Amuwo Odofin Local Government Area in Lagos State.

v.      To determine the level of health care facilities put in place towards the management of these diseases.

vi.   To determine what extent has the damage caused by hypertension and diabetes been among people living in this area.

 

1.7 SIGNIFICANCE OF THE STUDY

These are the significance of the study:-

1        That the study would give adequate knowledge about the impact of hypertension and diabetes on the society and general well-being of man

2        That this study will serve as a reference for others and particularly the government (Health Sector) on how to imbibe adequate knowledge on extent of hypertension and diabetes in the area under research.

3        To serve as a means of creating awareness and re-orientation of communal on the knowledge, causes or problem (complication) of hypertension and diabetes, their attitude towards it as a whole in terms of causes, beliefs, prevention etc.

1.8     LIMITATION OF THE STUDY

The research work is limited to men and women in Amuwo Odofin Local Government Area in Lagos State. In the process of the study, some workers may not be reached due to their busy schedule.

Some individuals may refuse to participate due to their inability to comprehend the question being asked. Also, inappropriately filled questionnaires, lack of interest in filling questionnaires and time constraint were other limitations of this study.

1.9     DELIMITATION OF THE STUDY

The study is solely meant for the men and women in Amuwo Odofin Local Government Area in Lagos State, irrespective of religion, tribe, age, culture, even if they are educated or illiterate.

1.10 PROFILE OF STUDY AREA

Amuwo Odofin is one of the 57 local government council that makes up Lagos State, which was created on 27 October 2003. The indigenous dwellers of Amuwo Odofin local government are mainly the aworis. Nonetheless, considering its location as a near border local government, international trade has found its root in the area, with people of various extractions engaging in various forms of trading activities. Another noticeable group is the retired and serving civil servants, industrialists and member of the armed forces of Nigeria who have taken advantages of the serene atmosphere of the estates located in the local government to reside in the area. The local government boasts of enterprising people. However, the indigenous are agrarian and engage mostly in fishing and production of crops such as cassava, maize, coconut and cashew nuts. Some parts of the local government are zoned as industrial estates by the Lagos State government. Commercial activities are well grounded in the local government area. This is made possible by such factors as adequate security, good road network, ready market and a generally conducive atmosphere which is prevalent in the area. The following are some of the business areas which investors find profitable:

·        Food processing

·        Tourism

·        Manufacturing

·        Printing and communications

·        Photography

·        Agro allied industry

 

 

 

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