PROBLEM STATEMENT
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In Nyamira county referral hospital there is an increase in number of Patients being admitted in both
medical and surgical wards and also those attending outpatient clinics due to several factors. However
non-adherence to diabetic diet at home appears to the main factor which in turn leads to high sugar
level even if there a researcher leads to compliance of prescribed medication. As a researcher I found
that many diabetic patients attending outpatient clinic, these in medical and surgical wards fails to
adhere diabetic to the diet recommendation that's why I dedicated to carry out the research in order to
teach these patients on diet and enlighten the public and community on the importance of adherence to
diet to manage and control diabetes mellitus.
BACKGROUND INFORMATION
Diabetes Mellitus is a chronic metabolic disorder that occurs when the body cannot produce enough
insulin or cannot use the available insulin leading to increase of blood glucose in the body above
required level. Type 2 diabetes accounts for 90% of all diabetic cases in the world and is usually due to
insufficient production of insulin or ineffectiveness of produced Insulin in the body.
The prevalence of type (2) diabetes has dramatically increased in estimation of about 482 million adults
of Worlds Population has diabetes mellitus as compared to 108 in 1980 (WHO 2022) Lifestyle changes
such as balanced diet and physical exercise are Important factors in achieving good controlling on type
(2) diabetes mellitus (MNHP 2022)
Diabetes is considered to be one of the most psychological and behavioural demanding of chronic
diseases. Non-adherence in chronic disease has been described as taking less than 80%. of prescribed
treatment generally to be sub-optimal ranging from 23% and 17% The Incidence of type (1) and type (2)
is increasing in very high rates accounting for cases more than 90% (WHO 2020)
A research that was Conducted In United states (USA) showed that the rate of compliance among
patient do diet varied from 25% to 65% and insulin administration was 20%. Besides the desired impact
on clinical outcomes, non-compliance would also cause increased financial burden to the society and the
world at large. It has been estimated that 33% -64% of medication related hospital admission in USA are
due to non-compliance with diet recommendation, and treatment regime (WHO 2021) In addition,
Previous studies done have generated various results of faders associated with non-adherence to
diabetic regime. However most studies were carned out in developed countries to run a gap in
knowledge to diet recommendation. In the view of need to parent complications, researcher reasoned
that diabetes patients should be empowered to manage their illness and need to be assisted to identify
and manage factors that contribute to non-adherence (UNICEF 2020).
In Uganda a study was carried out in 2019 in Mulayo Hospital showed that the prevalence on non-
compliance to therapeutic management was 4%-5% with male contributing to 40% and women 9.5% of
adherence in drug insulin and much lower in lifestyle prescription (Makerere University research and
ethic committee 2022). It was estimated that prevalence of diabetes in the country was about 3.3% and
was likely to increase to 4.5% if the trend is not properly checked and if people do not take into
consideration the required regime In kenya there was over 20 million Prople and 2500 childred with
diabetes type 2 experts blame people on Pour eating habits and Lock of physical exercise. Among 52%
do not adhere to dietary management A survey carried out in kitui County in outpatient cases were 86 in
2020, in 2021 the cases rised to 95. In January 2022 cases were 125 among them 50% do not adhere to
client management (MoH (2020).
In Nyamira County Referral Hospital statistics have shown there is an increased number of patients who
do not adhere to dietary recommendation. There is a rise or increased number of approximately 5% of
the cases each year. Therefore the researcher seeks to discover predisposing factors to non-adherence
to client management in patient attending Nyamira County Refferal Hospital (Medical record of 2022).