knowledge, attitude and practices related to diabetes among community members in four provinces in...

3/11/2015 Knowledge, attitude and practices related to diabetes among community members in four provinces in Kenya: a cross-sectional study

http://www.panafrican-med-journal.com/content/article/7/2/full/ 1/15

Home|Feedback|Contactus|SupporttheJournal|Signin10Mar2015

Thisisanimageplaceholder

Betterhealththroughknowledgesharingandinformationdissemination

ThePanAfricanMedicalJournal

Thisarticle

Published:06/10/2010

Abstract

PDF(145Kb)

XML(NLMformat)

Logintocommentonthisarticle

Comments(0)

Articlecontent

[+]Thisarticlesections

Services

Emailthisarticletoafriend

SimilararticlesinthePAMJ

SimilararticlesinPubmed

DownloadtoCitationMgr

Articlemetrics

Accessarticlemetricshere

Altmetric

Key

Logintoemailcorrespondingauthor

Articlesbyauthor(s)

[+]InGoogleScholar

[+]InPubMed

SocialBookmark?



Tweet

TablesandFigures

Table 1: Levels ofcommunityknowledge ondifferent aspects ofdiabetes

Table 2: Regionaldifferences in levelof knowledge ofdiabetes

Table 3:Relationshipbetweencommunityknowledge ofdiabetes andpractices

Figure1:LevelofeducationandgoodknowledgeofdiabetesamongcommunitymembersinfourprovincesinKenya

Ratethisarticle

2Share



Research

Citethisarticle:

WilliamKiberengeMaina,ZacharyMuriukiNdegwa,EvaWangechiNjenga,EvaWanguiMuchemi.Knowledge,attitudeandpracticesrelatedtodiabetesamongcommunitymembersinfourprovincesinKenya:acrosssectionalstudy.ThePanAfricanMedicalJournal.20107:2

Keywords:Diabetes,knowledge,attitude,practices,community,Kenya

Permanentlink:http://www.panafricanmedjournal.com/content/article/7/2/full

Received:13/07/2010Accepted:28/09/2010Published:06/10/2010

WilliamKiberengeMainaetal.ThePanAfricanMedicalJournalISSN19378688.ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.

Knowledge, attitude and practices related todiabetes among community members in fourprovincesinKenya:acrosssectionalstudy

WilliamKiberengeMaina1,&, ZacharyMuriukiNdegwa2, EvaWangechi

Njenga3,EvaWanguiMuchemi4

1Ministry of Public Health and Sanitation Kenya, 2National Diabetes Control

Kenya, 3Diabetes Endocrinology Center Nairobi, 4Kenya Diabetes ManagementandInformationCentre(DMI)&CorrespondingauthorWilliam Kiberenge Maina, Ministry of Public Health and Sanitation, P.O. Box3001600100,phone:+254722334365/+254202717077,fax:+254202722599,Nairobi,KenyaBackground



The International Diabetes Federation estimated the prevalence of diabetes inKenya to be about 3.3% in 2007 [1]. However, local studies have shownprevalenceof4.2%inthegeneralpopulationwithaprevalencerateof2.2%intheruralareasandashighas12.2%inurbanareas.Theprevalenceofimpairedglucosetoleranceisequallyhigh8.6%intheruralpopulation,and13.2%intheurbanpopulation[2].Urbanization with adoption of western lifestyles has been incriminated in theabandonment of the healthier traditional lifestyles by people in developingcountries. The traditional lifestyle was characterized by regular and vigorousphysical activity accompanied by subsistence on high fiber, whole grainbaseddietrichinvegetablesandfruits[2,3].Urbanorevenwesternlifestylesinruralareas have resulted in overreliance on motorized transport and consumptionunhealthydietsrichincarbohydrates,fats,sugarsandsalts[4].Theselifestyleshavecontributedtoarise in levelsofobesityandoverweight inthe population increasing the risk for diabetes. For instance, the 2003 KenyaDemographic andHealth Survey about 20% ofwomen and 7% ofmen in thecountrywereoverweightorobese [5].Recent studieshave shownevenhigherfigureof60.3%and19.5%forwomenandmenrespectively inurbanareasascomparedto22.6%and10%inwomenandmenrespectivelyinruralareas[6].The rise of these determinants of chronic diseases reflects the major forcesdrivingsocial,economicandculturalchange intheKenyansociety.Thesesamefactorsaredrivingtheepidemiologicallandscapewithchronicnoncommunicablediseasesbecomingmajorcontributorstothenationaldiseaseburden[3].Diabetes is now emerging as an epidemic of the 21st Century. It threatens tooverwhelmthehealthcaresysteminthenearfuture[7].Sadly,themajorityofthe peoplewith diabetes in developing countries arewithin the productive agerangeof45to64years[3].Thesearethesameindividualswhoareexpectedtodrive the economic engines of these countries in order to achieve the agreedinternational development goals. Besides their reduced productivity, diabetesfurtherimposesahigheconomicburdenintermsofhealthcareexpenditure,lostproductivityandforegoneeconomicgrowth[3].To curb this scourge of diabetes, public health interventions are required topreventdiabetesordelaytheonsetofitscomplications.Thiswillentailintensivelifestylemodification for those at risk of diabetes and aggressive treatment forthosewith the disease [8]. A high risk approach targeting individual at risk of



diabetesandapopulationorpublichealthapproachaimedat reducing the riskfactorsfordiabetesatthecommunityarenecessary.Knowledge is the greatest weapon in the fight against diabetes mellitus.Informationcanhelppeopleassesstheirriskofdiabetes,motivatethemtoseekpropertreatmentandcare,andinspirethemtotakechargeoftheirdisease[9].It is therefore in the interest of the country to design and develop acomprehensivehealthpromotionstrategyfordiabetesmellitusanditsrelatedriskfactors. It is equally important to design and implement suitable diagnostic,managementandtreatmentprotocolsforpeoplewithdiabetes.Thisstudythereforewasconductedtoassessthelevelofcommunityawarenessof diabetes and how this knowledge influences their attitude and practices inprevention and control of the disease. The findings will help in identifyingpopulationknowledgegapandtheirbehaviourtowardsdiabeteswhichwillguidethedevelopmentofpreventionprogrammesinthecountry.MethodsThiswasadescriptivecrosssectionalstudyinvolving2000peopledrawnfrom8districts in4provinces.The4provinceswereselected froma totalof8due totheir high burden of diabetes as reported in the health management andinformationsystemsintheMinistryofHealth.2000respondentswereconsideredadequateas similar studiesdone in thecountryhaveworkedwithnearlyequalnumber.The4provinceshada totalof23districts, thedistrictswerestratifiedintoruralandurbandistrictsbasedontheirgeographical location.Twodistricts,oneruralandoneurbanwererandomlyselectedfromeachprovince.Eachofthe8districtswasassigned500 respondents.The respondentswereagedbetween13 and 65 years. Only one respondent was interviewed for every householdvisited.Amediumsizedfourpartquestionnairewasdesignedbytheresearchers.Itwaspeer reviewed by 5 colleagues including a biostatistician for validation of thequestions. The questionnaire was then piloted on 10 respondents in KajiadodistrictwhichisaruraldistrictnexttoNairobi.Thiswasdoneinordertoassessthe suitability of the contents, clarity, sequence and flow of the questionnaire.Thequestionnairewas then refined for finaluse.Allquestionnaireswere in theEnglishlanguage,whichisthenationalofficiallanguage.



The first part of the questionnaire covered the respondents demographicinformationwhich included:name,age, sex, levelofeducation,occupationandaveragemonthlyincome.Part two covered knowledge about diabetes. Knowledge on causes of diabeteswas based on responses to a question on what they knew was the cause ofdiabetes.Theoptionsgivenwere:lackofinsulin,failureofthebodytouseinsulinandconsumptionoflotsofsugarordontknow.Forknowledgeaboutsignsandsymptoms of diabetes, five options were given: frequent urination, excessivethirst, excessive hunger, weight loss, and high blood sugar. Knowledge ofcomplications of diabetes was assessed by asking respondents to describecomplications of the disease they knew.Options listed included, loss of vision,kidney failure, heart failure and stroke, poor healing wound and amputation.Respondents knowledge of diabetes was categorized as either good or poordependingontheirresponsestotheknowledgeareasassessed.Partthreeofthequestionnaireassessedtheattitudeoftherespondentstowardslifestyle characteristics such as diet, physical activity and health seekingbehaviour.Part fourassessedwhat therespondentspracticed in termsofadoptinghealthylifestylesthatpromotediabetesprevention.Thissectionlookedatconsumptionofhealthydiet,regularphysicalactivity,avoidanceofalcoholandtobaccouseandregularmedicalcheckup.The questionnaire was administered by interviewers who were people withmedicalbackgroundknowledgeofdiabetesand includednurses,clinicalofficersandnutritionists.Beforegoingtothefield,theinterviewersweretakenthroughaonedaytrainingtoacquaintthemselveswiththedatacollectiontoolsandalsotounderstand the whole concept. The interviewers then embarked on datacollectionbymoving fromhouse tohousewithin theirallocatedareas.The firstperson to be encountered in the household meeting the age criteria wasinterviewed. For those who declined, a second person was interviewed and intheirabsencethenexthouseholdwasvisited.All filled questionnaires were then submitted to the survey supervisors whochecked their completeness before the interviewer left that area. Whereinformation was missing the interviewer revisited the respondent for furtherinformationunless theyhad initiallydeclined todisclose.Uponprocessingofallthefielddata,analysiswasdoneunderthedomainofdescriptivestatisticsusing



SPSSsoftware.ResultsOfthetargeted2000respondents,1982(99.1%)wereinterviewedinthisstudy.Thereweremore females 1151 (58.1%) thanmales 831 (41.9%) interviewed.358 (18%) of the respondents had tertiary education, 737 (37.2%) hadsecondaryeducation,725(36.6%)hadprimaryeducationwhile162(8.2%)hadnoeducationatall.Only575(29%)ofrespondentshadgoodknowledgeofsignsandsymptomsofdiabeteswhile1407(71%)ofrespondentshadpoorknowledgeonwhatdiabetesis.518(26.1%)couldcorrectly identifytheprobablecausesofdiabetesmellituswhile1464(73.9%)couldnot.Only523(26.4%)oftherespondentscouldidentifycomplications of diabetes they knew while 1459(73.4%) had very little or noknowledgeofcomplicationsofdiabetes(Table1).Overall on average 539(27.2%) respondents had good knowledge of diabeteswhile1443(72.8%)hadpoorknowledgeofthedisease.Therewasthereforenosignificant difference in knowledge levels between genders. The proportion offemaleswhohadgoodknowledgewas26.8%comparedto27.7%inmales.RegionaldifferencesinlevelofknowledgeResultsrevealedasignificantisadisparityinthelevelofknowledgeindifferentregions.Coastprovincehadthelowestknowledgelevelofdiabetes118(23.7%)followedbyNairobi127(25.5%),Eastern140(28.9%)andCentral154(30.8%),respectively.Nearlyover70%ofall respondents fromeachof the four regionshadpoorknowledgeofdiabetes(Table2).VariationofknowledgeofdiabeteswithlevelofeducationAll the respondents with good knowledge were analyzed according to level ofeducation.Adirectrelationshipbetweenlevelofeducationandgoodknowledgeof diabetes was demonstrated. 52% of those who had good knowledge hadtertiary education, 25% had secondary education, and 14% had primaryeducationwhile9%hadnoformaleducation(Figure1).Communityattitudeandpracticestowardsdiabetes



To assess the attitude of community towards diabetes, the attitude of peopletowardslifestylecharacteristicssuchasdiet,physicalactivityandhealthseekingbehaviorwasassessed.Only28%ofrespondentsagreedwithstatementsrelatingto willingness to engage in physical activity, changing eating habits andmaintaininggoodbodyweights.Asignificant813(41%),oftherespondentsdidnot indicate any willingness to adopt these healthier lifestyles. 41% of allrespondentshadgoodpracticeswhiletherest59%hadbadpracticesinrelationtodiabetesprevention.75%ofthepeopleinterviewedhadpoordietarypractices,72%didnotparticipate in regularexerciseandover80%didnotmonitor theirbodyweights.RelationshipbetweenpracticesandknowledgeFurtheranalysisoftherelationshipbetweencommunityknowledgeandpracticesprovided valuable insights in the assessment of community attitude. 50.7% ofpeople with good knowledge of diabetes had good practices as compared to37.4% of people with poor knowledge of diabetes had good practices.Conversely,49.3%ofthosewithgoodknowledgehadbadpracticescomparedto62.6%ofthosewithoutknowledge(Table3).DiscussionMoststudiesontheknowledge,attitudeandpracticesofdiabetesdoneinAfricaandelsewheretargetpatientswithdiabetes.Unlikethese,thisstudytargetedthegeneralpopulation.Wethereforelackadequatecomparativedataforcommunityand our discussions are based on knowledge, attitude and practices of peoplewithdiabeteswhoinmostcaseshavebetterexposuretodiabeteseducation.The findings of this study reveal a serious deficiency in knowledge of diabetesamongcommunitymembersinKenya.Only27.2%ofthepeopleinterviewedhadgoodknowledgeofdiabetes.Puepetetal.,foundasimilarlevelofknowledgeofdiabetes,30.2%,amongpatientswithdiabetesinJosState,Nigeria[10].Dineshetal.,inastudyinwesternNepal,notedalackofawarenessofdiabeteseveninpatients who had had the disease for a long time [11]. Even in a developedcountrysetup,BaradaranandJonesalso foundthatknowledgeaboutdiabetesamongstethnicgroupsinGlasgowwasverylow[12].

Thesefindingsunderscoreveryimportantaspectsofeducationtothecommunity



asfarasdiabetesisconcerned.Firstlythereishistoricaldeficiencyinknowledgeaboutdiabetesandinequalitiesinthequalityofeducationreachingeachregioninthe country. Similar findings were documented by Hawthorne and Tomlinsonregarding Pakistani Moslems attending the Manchester Diabetic Centre [8,13].Secondlythelowlevelofcommunityknowledgeofdiabetesreflectsontheextentof health promotion for most chronic noncommunicable diseases. At themoment, therearenocomprehensiveprimarycareprogrammes fordiabetes inthecountryanddiabeteshealtheducationisdonewithinhealthfacilitiesthroughmicroteachingandonlytargetsthosewithdiabetes.Thisthereforeleavestherestthepublicignorantofthedisease.Mostofthediabeteshealthpromotioneffortsby different stakeholders are uncoordinated and the messages are notstandardized due to lack of clear guidelines regarding diabetes education [12].Lastly,thereisevenlowknowledgeofdiabetesamonghealthcareworkerswhoareexpectedtodeliverhealtheducationtothecommunity[14,15].

Community knowledge, culture and beliefs about diabetes is a prerequisite forindividualsandcommunitiestotakeactiontocontrolthedisease.Thisknowledgeaffects their attitude and uptake of health services, including health education[12].Yet research intohealthknowledgeandbeliefsarounddiabetes causationandpreventionamongthegeneralcommunityinKenyaislacking.Diabetespreventioninterventionsneedtotargethealtheducationdirectedtothecommunityandthehealthcareproviders.Goodknowledgeofdiabetesamongstcare givers is directly related to the quality of care given by such providers.Educationofpatients, likewise, improvescompliancetotreatmentsand leadstofavorabletreatmentoutcomes.Thisisduetothedirectinfluenceofknowledgeontheattitudeandpracticesofboththecaregiverandthepatients[16].Over49.3%ofthosewithgoodknowledgehadpoorpracticesasfarasdiabetesis concerned. Low knowledge of diabetes in the communitymay result in poorattitude however this does not explain the poor practices even in peoplewithgoodknowledgeofthedisease.AltamimiandPetersondemonstratedthatwomencontinued to consume sweetened foods, even though they knew about thedeleteriousimpactofsugaronoralanddentaltissues[17].Knowledgedoesnotalwaysresultinbehaviorchangeandneedtobereinforced[18].

Sincetheknowledgereferredtointhisstudywastheconventionalformobtainedfromthe formal information,communicationandeducationsystems, the reasonforgoodpracticeamong37.4%ofpeoplewithnoknowledgewasassociatedwiththeirindigenousknowledge.Itisthereforeimportanttoidentifyinterventionsthat



reinforce peoples attitudes despite their levels of knowledge of a particularsubject [19]. Proper education and awareness programs have previously beenshown to change the attitude of the public regarding diabetes. Improvingknowledgeofthepeoplecanimprovetheirattitudetowardsdiabetesandinthelong run change their practices to embrace healthier lifestyles such as eatinghealthyfoods,andengaginginphysicalactivity[20].Suchpracticeswillminimizetherisksfordiabetesinthegeneralpublicanddelaytheonsetofcomplicationsinthosealreadydiabetic.Thereisneedforfurtherindepthstudiestoinvestigatethesocialculturalbeliefsof health in Kenyan communities. These perceptions have reinforced unhealthydietaryhabitseven thoughpeopleareawareof the relationshipbetween thesepracticesandchronicdiseasessuchasdiabetes[21].Therewasmarkedregionaldiscrepancies inthe levelofknowledgewithCentralprovincehaving relativelyhigher level of 30.8%andCoastprovincehaving thelowestat23.7%.Thedifferences inthe levelofknowledgeorthe lowlevelsdonotimplyinanywaythatthereisdeficiencyinintelligenceinthevariousgroupsand communities in the different regions. It only implies a lack of exposure toknowledge about diabetes due to poor health education, inaccessibility of goodhealthcareservicesandalsolowliteracylevelsinsomeareas.Thishaspreviouslybeen noted among patients with diabetes in a primary health care setting inSouthAfrica[9]andamongPakistaniMoslemswithtype2diabetesinManchester[13].Preventingdiseasepotentiallyavoidsandcertainlypostponessufferingandmayhavemanyotherbenefitsthataredifficult toquantify(e.g. impactonfamilies),whichmaymake itpreferable to treatment.Thisstudy formsabaseline for thenational diabetes awareness campaigns and demonstrates the wide knowledgegapwhichrequiresaconcertedeffortbythoseinvolvedindiabetesmanagementand education. A systematic education curriculum for diabetes education isessentialforalllevelsofhealthcare,fromthecommunitytothehighestreferrallevel. The community health education interventions for diabetes need to takeinto account the disparity and uniqueness which exist between gender, agegroupsandregions.StudylimitationsThis survey did not identify thosewith diabetes among the respondents. Suchpeoplewouldhavehigherknowledgeduetothepatienteducationprovidedatthe



clinic.Thequestionnaireswere inEnglishand theiradministrationdependedonthetranslationofinterviewersfortherespondentstounderstand.Theresponsesdepended on the memory and truthfulness of the respondents which wasassumedtobereliable.Theentryofresponsesintothequestionnairedependedon the interviewers interpretation of the response and was subject tomisrepresentation.Thiswashoweverreducedduetotrainingofinterviewersanduseofpeoplewithmedicalbackground.In this study, we did not ask the community about their sources of healthinformation.Knowledgeofthesesourcesof informationwouldhavebeenusefulin identifying the appropriate media for delivery of health promotioninterventions.There is thereforeneed for furthercommunitysurveys to identifysources of health information and the validity of the information deliveredthroughsuchmedia.ConclusionKnowledge about diabetes mellitus is a prerequisite for individuals andcommunities to takeaction tocontrol thedisease.However, research toassessknowledgedeficienciesandtheirrelationtohealthseekingbehaviorislackinginmostdevelopingcountries. Diabeteseducation,withconsequent improvementsinknowledge,attitudesandskills,willleadtobettercontrolofthedisease,andiswidelyacceptedtobeanintegralpartofcomprehensivediabetescare.CompetinginterestsTheauthorsdeclarenoconflictofinterest.AuthorscontributionMWKparticipated in obtaining the ethical approval, study design, data analysisand in drafting themanuscript. NZ participated in study design, supervision ofdata collection and literature review. NE participated in the review of themanuscriptandMEparticipatedinreviewofthedataandthemanuscript.Tablesandfigures



Table1:LevelsofcommunityknowledgeondifferentaspectsofdiabetesTable2:RegionaldifferencesinlevelofknowledgeofdiabetesTable3:RelationshipbetweencommunityknowledgeofdiabetesandpracticesFigure1:LevelofeducationandgoodknowledgeofdiabetesAcknowledgementsTheauthorswouldliketoacknowledgetheWorldDiabetesFoundation(WDF)fortheir financial support to carry out this study. We particularly appreciate thecontribution of ScholasticaMwende,OnesmusMwaura and EdwardNdungu forassistinginsupervisingthedatacollectors.WealsoappreciateMr.BensonMainaand Retasi Strategic Solutions for assisting us in data entry and analysis. Weappreciate the contribution of Dr. Kathreen Karekezi in the peer review of themanuscript.References

1. InternationalDiabetesFederation.DiabetesAtlas.3rdEdition.Brussels,Belgium

2. DirkLChristensen,HenrikFriis,DavidLMwaniki,BeatriceKilonzo,IngeTetens,MichaelKBoit,OmondiB,LydiaKaduka,KnutBorchJohnsen.PrevalenceofglucoseintoleranceandassociatedriskfactorsinruralandurbanpopulationsofdifferentethnicgroupsinKenya.DiabetesResClinPract.2009Jun84(3):30310.Epub2009Apr9.ThisarticleonPubMed

3. InternationalDiabetesFederation.DiabetesAtlas.4thEdition.Brussels,Belgium

4. MehtaRS,KarkiP,SharmaSK.Riskfactors,associatedhealthproblems,reasonsforadmissionandknowledgeprofileofdiabetespatientsadmittedinBPKIHS.KathmanduUnivMedJ(KUMJ).2006JanMar4(1):113.20064(13):1113.ThisarticleonPubMed

5. GovernmentofKenya.KenyaDemographicandHealthSurvey.2003.

6. ChristensenDirk,EisJeanette,HansenAndreasW,Larsson,MelanieW,



Mwaniki,DavidL,KilonzoBeatrice,TetensInge,BoitMichaelK,KadukaLydia,BorchJohnsenKnut,FriisHenrik.ObesityandregionalfatdistributioninKenyanpopulations:impactofethnicityandurbanization.AnnHumBiol.2008MarApr35(2):23249.ThisarticleonPubMed

7. AlbertiGeorge.Noncommunicablediseases:tomorrowspandemics.BulletinoftheWorldHealthOrganization.200179(10):907.ThisarticleonPubMed

8. DawnWSatterfield,MicheleVolansky,CarlJCaspersen,MichaelMEngelgau,BarbaraABowman,EdWGregg,LindaSGeiss,GwenMHosey,JeannetteMay,FrankVinicor.Communitybasedlifestyleinterventionstopreventtype2diabetes.DiabetesCare.2003Sep26(9):264352.ThisarticleonPubMed

9. MoodleyLushen,RambiritchV.Anassessmentofthelevelofknowledgeaboutdiabetesmellitusamongdiabeticpatientsinaprimaryhealthcaresetting.SouthAfricaFamilyPractice.200749(10):16a16d

10. PuepetFH,MijinyawaBB,AkoguI,AzaraI.Knowledge,attitudeandpracticeofpatientswithDiabetesMellitusbeforeandaftereducationalinterventioninJos,Nigeria.TheJournalofMedicineintheTropics.20079(1):310

11. DineshKUpadhyay,SubishPalaian,PRaviShankar,PranayaMishra.Knowledge,attitudeandpracticeaboutDiabetesamongDiabetespatientsinWesternNepal.RawalMedicalJournal.200833(1):811

12. BaradaranHamid,KnillJonesRobin.Assessingtheknowledge,attitudesandunderstandingoftype2diabetesamongstethnicgroupsinGlasgow,Scotland.PracticalDiabetesInt.200421(4):143148

13. HawthorneK,TomlinsonS.PakistaniMoslemswithtype2diabetesmellitus:effectofsex,literacyskills,knowndiabeticcomplicationsandplaceofcareondiabeticknowledge,reportedselfmonitoringmanagementandglycaemiccontrol.DiabeticMed.199916(7):591.ThisarticleonPubMed

14. TreppRoman,WilleTonio,WielandThomas,ReinhartWalter.Diabetesrelatedknowledgeamongmedicalandnursinghousestaff.SwissMed



Wkly.2010Jun26140(2526):3705.ThisarticleonPubMed

15. GornallAnnie,LvesqueLucie,SigalJRonald.ApilotstudyofphysicalactivityeducationdeliveryinDiabeteseducationcentresinOntario.CanadianjournalofDiabetes.200832(2):123130

16. AlKhaldiYahia,KhanMohd.AuditofadiabetichealtheducationprogramatalargeprimaryhealthcarecenterinAsirregion.SaudiMedicalJournal.200021(9):838842.ThisarticleonPubMed

17. AltamimiS,PetersonP.OralhealthsituationofschoolchildrenmothersandschoolteachersinSaudiArabia.IntDentJ.1998Jun48(3):1806.ThisarticleonPubMed

18. McManusRuth,StittLarry,BarghGordon.PopulationsurveyofDiabetesknowledgeandprotectivebehaviours.CanadianJournalofDiabetes.200630(3):256263

19. BadruddinNaeema,BasitAbdul,HydrieIqbalZafar,HakeemRubina.Knowledge,attitudeandpracticesofpatientvisitingdiabetescareunit.PakistanJournalofNutrition.200211:99102

20. GagliardinoJuan,GonzlezClaudio,CaporaleJoaqun.ThediabetesrelatedattitudesofhealthcareprofessionalsandpersonswithdiabetesinArgentina.RevPanamSaludPublica.2007Nov22(5):3047.ThisarticleonPubMed

21. TrishaGreenhalgh,CecilHelman,Mu'minChowdhury.HealthbeliefsandfolkmodelsofdiabetesinBritishBangladeshis:aqualitativestudy.BMJ.1998Mar28316(7136):97883.ThisarticleonPubMed

knowledge, attitude and practices related to diabetes among community members in four provinces in...

Documents