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SCHOOL OF PUBLIC HEALTH 
COLLEGE OF HEALTH SCIENCES 
UNIVERSITY OF GHANA 
DIABETES MELLITUS: RISK FACTORS AND COMPLICATIONS IN 
PATIENTS ATTENDING MAAMOBI GENERAL HOSPITAL 
BY 
NANCY APE WE BlAH 
(10598567) 
THIS DISSERTATION IS SUBMITTED TO THE UNIVERSITY OF GHANA, 
LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE 
AWARD OF MASTER OF PUBLIC HEALTH DEGREE 
NOVEMBER, 2017 
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DECLARATION 
I, Nancy Apewe Biah do hereby declare that, except for reference made to other people's work 
which have been duly acknowledged, this work was done by me under supeIVision .I also declare 
that this work has not been submitted for the award of any degree in this university or elsewhere. 
NANCY APEWE BlAH ~o-v9 -IT 
SIGNATURE DATE 
PROF. K \V ASI TORPEY ........ ~ 
(SUPERVISOR) SIGNATIJRE DATE 
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DEDICATION 
I dedicate this work to the Almighty God for providing me with wisdom, knowledge and good 
he:ll~h which culminated to the success of this work. To my dad Colonel (Rtd.) Biah and my mum 
Mary Biah and my mother-law Benedicta Awe Moutrage for their prayers and encouragement. To 
my husband Faisal Webre Keliou and my two sons Akiwele and Zanbajia and my siblings Marci, 
Kingsley, Linda, Eva, Selina and Patience for the inspiration that I can do it all. To Shafic 
(h"11crin-law) who helped with the kids. God richly bless you all. 
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ACKNOWLEDGEMENT 
Thanks to the Almighty God for His care, guidance and protection for the successful completion 
ofmv dissertation. 
My heartfelt gratitude to my supervisor Professor Kwasi Torpey for his fatherly advice and 
patience and most importantly for his constructive criticism and suggestion which resulted in the 
success of this work. Prof, God richly bless you. 
AI,,' i would like to thank my husband Faisal Webre Keliou for his insightful comments and 
encouragements through my work. 
I am equally indebted to the Maamobi General Hospital Administration especially Madam Mary 
y 011 for their cooperation and to the respondents for their time. 
Finally, my gratitude to my family and friends for their immense contribution. Colonel Emelia 
Duah, Aunty Peace, Ibrahim and my colleagues at work, want to say God bless you. 
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ABSTRACT 
Background: Unhealthy diet, smoking, physical inactivity, overweight/obesity, impaired glucose 
tr' ", "ce nGT) and/or impaired fasting glycaemia (JFG) result in diabetes mellitus. The 
hyperglycemic condition in diabetics leads to the development of some complications driven by 
both modifiable and non-modifiable risk factors. This study therefore seeks to determine the risk 
factors and associated complications in patients with diabetes mellitus at the Maamobi General 
l-! " " '~l 'r. ,"'rder to help guide policies and practices in diabetic care management plans. General 
Aim: To detennine diabetes mellitus risk factors and complications in patients attending Maamobi 
General Hospital. 
Mcthodolo~': This was a descriptive cross-sectional study using a quantitative method. This 
i~' , : "': "", use of structured questionnaires. The study population included all diabetes mellitus 
paticnt attending the diabetic clinic at the Maamobi General Hospital. Simple Random Sampling 
Without Replacement (SRSWOR) technique was employed to select 132 diabetes mellitus 
patients. Information was captured on sociodemographic characteristics, behavioral risk factors 
c' " '~l':,; mellitus related complications. Data from the questionnaire were entered into 
Microsoft Excel and then transferred to STATA Version 14 for analysis. Simple proportions and 
means were used to describe categorical and numerical data, respectively. Chi square and Cramer's 
v tests were used to test for association and strength between the explanatory variables and the 
O';'C"'1;(, variables. A confidence interval of 95% was used to show significant relations between 
the dependent and the independent variables. 
ResultslFindings: The results show a high prevalence of complications with predominance of 
di~h~tic retinopathy (46.0%), followed by diabetic foot (24.0%) and erectile dysfunction (24%). 
Thc prevalence of hypertension was very high at 97.07% among the respondents. Additionally, 
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respondents' level of commitment to physical activity and good diet is low. There was also a 
significant association between gender of respondents and diabetes mellitus complications where 
" ,..' ::'ce rate was high in males than females. Age, educational level, marital status and 
religiOUS affiliations of the respondents were not significantly related to the complications 
observed. 
Conclusion: The study concludes that there is a high prevalence of diabetes mellitus 
COil" ,.'~': :5 and hypertension comorbidity among diabetes patients at the Maamobi General 
Hospital. The study calls for regular medical screening of complications to prevent progression. 
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TABLE OF CONTENTS 
DECLARATION ............................................................................................................................. i 
Dr:T)TCATION ................................................................................................................................ ii 
ACKNOWLEDGEMENT ............................................................................................................. iii 
ABSTRACT .................................................................................................................................. iv 
LIST OF TABLES ............................................................... · .. ··· ...... ···· .... ·. ..................................... x 
Lr,,"" OF FIGURES ....................................................................................................................... xi 
LIST OF ABREVlATIONS ......................................................................................................... xii 
CHAPTER ONE ............................... · .. ····· .................... ··· ............................................................... 1 
INTRODUCTION .......................................................................................................................... 1 
t.O Backl!Tound ....................................................................' . ...................................................... 1 
1.2 Problem Statement ................................................................................................................ 3 
1.3 Objective of the Study .......................................................................................................... 4 
1.4 Research Questions ............................................................................................................... 5 
1. 5 Justification of Study ............................................................................................................ 5 
: ," Scppc and Limitations ........................................................................................................... 5 
1.7 Conceptual framework .......................................................................................................... 6 
CHAPTER TWO ............................................................................................................................ 7 
LITERATURE REVIEW ............................................................................................................... 7 
:: ' :·l;-C't"lction ........................................................................................................................... 7 
2.2 Diabetes mellitus as a global burden ..................................................................................... 7 
2.3 Diabetes mellitus burden in Ghana ....................................................................................... 8 
2.4 Risk Factors of Diabetes mellitus ......................................................................................... 8 
:: 4.1 Sociodemographic Risk Factors ..................................................................................... 8 
2.4.2 Lifestyles Risk factors .................................................................................................. 10 
2.5 Complications of diabetes mellitus ..................................................................................... 12 
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2.5.1 Cardiovascular Condition ............................................................................................. 12 
2.5.2 Diabetic Foot Disease ............................................ ·. ..................................................... 13 
::.5.3 Di abetic Retinopathy .................................................................................................... 13 
2.5.4 Diabetic Nephropathy ................................................................................................... 14 
CHAPTER TIlREE ...................................................................................................................... 15 
METHODOLOGY .....•................................................................................................................. 15 
~. , "1: ( ,··Jction ......................................................................................................................... 15 
3.2 Research Design .................................................................................................................. 15 
3.3 Study Area .......................................................................................................................... 15 
3.4 Study Population ................................................................................................................. 16 
~.~ inchl<;ion criteria ................................................................................................................. 16 
3.6 Exclusion Criteria ............................................................................................................... 16 
3.7 Vnnables ............................................................................................................................. 17 
3.8 Sample Size Detennination ................................................................................................. 17 
3. 0 Sampling Procedure ............................................................................................................ 18 
3. i II Qu'::stionnaire Design and Administration ........................................................................ 19 
3.11 Quality Control ................................................................................................................. 19 
3.12 Data Processing and Analysis ........................................................................................... 19 
3.) 3 Data Storage / Data Protection .......................................................................................... 20 
.~. , . ~ ;' ;·Cksting ........................................................................................................................... 20 
3.15 Ethical Consideration ........................................................................................................ 20 
CHAPTER FOUR ........................................................................................................................ 22 
RESULTS ..................................................................................................................................... 22 
;;11-0l lction ......................................................................................................................... 22 
4.1 Demographic characteristics of respondents ....................................................................... 22 
4.1.1 Type of employment by respondents ............................................................................... 24 
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4.2 Family History of Respondents .......................................................................................... 25 
4.:1 \1cdical history of respondents ............................. ··· ............ · .. ·· .. · .... · .... · .......... ··' ................ 26 
.:." Sl~,(\kmg status of respondents .............................. · .................. · .. ·· .. · .. ········ ......................... 27 
4.5 Alcohol consumption by respondents ................................................................................. 27 
4.6 Physical activity by respondents ......................................................................................... 28 
4.7 Dietary habits by respondent .............................................. ······ .. · ........................................ 29 
.~ . ;, c r :1dents on diabetes mellitus complications .............................. · .... · .... · ........ ··· ...... ·. ... · 30 
4.9 Diabetic Comorbidity in respondents ................................................................................ 30 
4.10 Association between demographic characteristic and diabetic complications ................. 31 
4.11 Conclusion ........................................................................................................................ 32 
CT: " :'TfT: SIVE .......................................................................................................................... 33 
DISUCUSSION OF FINDINGS .................................................................................................. 33 
5.0 Introduction ......................................................................................................................... 33 
5.1 Risk factors ......................................................................................................................... 33 
:;.1.1 Phy<ical activity ............................................................................................................... 33 
5.1.2 Tobacco smoking ............................................................................................................. 34 
5.1.3 Alcohol consumption ....................................................................................................... 34 
5.1.4 Dietary habit ..................................................................................................................... 34 
5.2 Complications of diabetes mellitus ..................................................................................... 35 
5.2.1 Diabetic retinopathy ......................................................................................................... 35 
5.22 Diabetic foot disease ........................................................................................................ 36 
5.2.3 Erectile dysfunction ......................................................................................................... 36 
5.2.4 Cardiovascular disease ..................................................................................................... 36 
5.':' Association between demographic characteristics and diabetic complications .................. 37 
5.3.1 Gender .............................................................................................................................. 37 
5.3.2 Age ................................................................................................................................... 37 
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5.3.3 Educational level .............................................................................................................. 38 
5.3.4 Religion ............................................................................................................................ 38 
5.3.5 ;Vlarital status .................................................................................................................... 39 
5.5 Conclusion .......................................................................................................................... 39 
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS ................................................ 40 
6.0 Introduction ......................................................................................................................... 40 
I'" i Summary of the study ......................................................................................................... 40 
6.2 Conclusions ......................................................................................................................... 40 
6.3 Recommendations and future research ............................................................................... 41 
6.4 Limitations of the study ...................................................................................................... 41 
F ..... ? r' ( :::S ............................................................................................................................. 43 
APPENDICES .............................................................................................................................. 51 
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LISTOF TABLES 
Table 4.la Social demographic characteristics ................................................... 22 
Table 4.lb Age and weight of respondents ........................................................2 3 
Table 4.2 Family history ............................................................................. 25 
Table 4.3 Medical history of respondents ......................................................... 26 
Table 4.4 Smoking status of respondents .......................................................... 27 
Table 4.5 Alcohol consumption by respondents ................................................... 27 
Table 4.6 Physical activity by respondents ........................................................ 28 
Table 4.7 Dietary habits of respondents ............................................................2 9 
Table 4.8 Respondents diabetes mellitus complications .........................................3 0 
Table 4.9 Comorbidity by respondents ............................................................. 30 
Table 4.10 Association between demographic characteristics and diabetes complications .. 31 
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LIST OF FIGURES 
Figure 3.1 Map of AM.A. .............................. , ....................................... 18 
Figure 4.1 Type of ernployznent. ................................................................. 24 
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LIST OF ABREVIAT IONS 
A:-':'. Accra Metropolitan Assembly 
BMI Body Mass Index 
DM Diabetes Mellitus 
DM2 Diabetes Mellitus 2 
GHS Ghana Health Service 
IDr International Federation on Diabetes 
IFG Impaired Fasting Glucose 
IGT Impaired Glucose Tolerance 
MOH Ministry of Health 
Out patient Department 
PFRH Population, Family and Reproductive Health 
SPH School of Public Health 
SSA Sub-Saharan Africa 
SRSWOR Simple Random Sampling without Replacement 
r:-: Peripheral Neuropathy 
PVD Peripheral Vascular Disease 
TIA Transient Ischemic Attack 
TV Television 
WHO World Health Organization 
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CHAPTER ONE 
INTRODUCTION 
1.0 BackgrouDd 
Diabetes mellitus is a group of metabolic disease of multiple etiology which is characterized by 
ckv:1ted levels of blood sugar. It occurs either when the pancreas does not produce enough insulin 
or .. ,' hen the body cannot effectively use the insulin it produces (WHO, 2016). Diabetes mellitus is 
a chronic non-communicable disease whose global distribution has given it the characteristics of 
a pandemic. 
:' :~ I< lJitus may present symptoms such as polyuria (frequent urination), polydipsia (excess 
thirst) blurred vision, glycosuria (sugar in urine), dehydration and weight loss with or without 
polyphagia (increased hunger). 
Di~h~tcs mellitus is grouped into three (3) types. Type one (I) diabetes is characterized by lack of 
insulm production in the body. Regular insulin injection is needed on daily basis by type I and 
believe to be caused by genetic and unpreventable causes (Diabetes care, 2009). Type 2 refers to 
the body's ineffective use of insulin, it accounts for 90 - 95% of all diabetes mellitus cases ( 
Intc'11ation:11 Federation on Diabetes (IFD), 2012). This may go undiagnosed for many years until 
complications set in. Type 2 diabetes mellitus was seen only in adults but has begun to manifest 
in children. Gestational diabetes is a temporary condition that occurs in pregnancy which can result 
in long term-risk of type 2 diabetes. Women with gestational diabetes are at a greater risk of 
CP',n'i-::ation during pregnancy and delivery (WHO, 2016). 
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High blood glucose can result in life threatening conditions such as ketoacidosis and low blood 
glucose. It can also cause seizures or loss of consciousness especially when a meal is skipped 
during strenuous exercise or high dosage of anti-diabetic medication (WHO, 2016). 
The number of people living with diabetes mellitus has quadrupled from 108 million in 1980 to 
4:'~ :'~illi0n in 2014 (WHO, 2016). Additionally, Shaw et al (2010) projected that by 2030, the 
number of diabetics within the age group 18 years and older would increase to six hundred million 
(600,000,000) within Sub-Saharan African countries alongside non-communicable diseases (Hall 
et ..a l. 2011). Compounding this is the fact that, majority of these people are oblivious of their 
s' .' .. ~"': :j-':refore do not receive any treatment (WHO, 2016). This resulted in 1.5 million direct 
cause of death due to diabetes mellitus in 2012 and 2.2 million of indirect cause (WHO, 2016). 
According to the WHO (2016), risk factors associated with diabetes mellitus include unhealthy 
diet. ~moking, physical inactivity, overweight/obesity. Coupled with these factors are impaired 
glucose tolerance (lOT) and impaired fasting glycaemia (JFO) which are intermediate conditions 
in the transition between normality and diabetes mellitus (WHO, 2013). However according to 
Nsiah (2015), the hyperglycemic condition in diabetics makes them prone to developing some 
complications driven by both modifiable and non-modifiable risk factors. 
These complications include, renal impairment, peripheral neuritis, disease of the eye, erectile 
dysfunction, diabetic foot disease, cardiovascular and cerebrovascular conditions (Amissah & 
Amoako-Boateng, 2014). The prevalence of these conditions significantly increase with duration 
0; : - :iiness. lndividuals with undiagnosed diabetes mellitus are however at a higher risk of 
complications than the non-diabetic population (Fowler, 2008). 
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M"rcover the level of diabetes management is very challenging especially in low and middle 
income countries such as Ghana (MOH, 2012). Studies by Amissah & Amoako-Boateng, (2014) 
recorded an increased incidence of lingering complications including 97.2% prevalence of 
hypertension among type two (2) OM patients at Cape Coast Teaching Hospital. This is expected 
t(l ~"'C11~ iT"! I"w and middle income countries like Ghana (Woodward et al. 2003). In Ghana type 2 
diabetes mellitus affects about 10.3% of adults in Greater Accra Region (Agyemang et al., 2016). 
The impact of diabetes mellitus makes it a global health concem. To curb the pandemic, people 
should have knowledge on risk factors and its complications and adopt healthy lifestyle behaviors. 
" " , ..... ,; 'las however been done on diabetes mellitus in the study area to enable generalization 
or estimation of the true burden of the disease (AMA report, 2016). Ayawaso East sub-district 
where Maamobi General Hospital (the study area) is located is one of the most popUlated sub-
districts of the Accra Metropolis. In this area majority of the people are engaged in sedentary 
1.2 Problem Statement 
Diabetes mellitus is now one common non-communicable disease and is reaching epidemic 
proportions globally (Shaw et al. 2010). In sub-Saharan Africa (SSA), the death rates of diabetes 
111(':i .1" ;lll(: hypertension are among the highest worldwide (Danquah et aI., 2012). While today 
an overall diabetes mellitus prevalence of 4% is assumed, the number of affected patients is 
projected to double from 12 to 24 million within the next 20 years (Danquah, et aI., 2012). In 
Ghana, type 2 diabetes mellitus affects at least 6% of adults and is related to age and obesity. Some 
::~" "l adults are overweight, and this has been related to advanced age, gender, urban 
environment, high income and tertiary education (Danquah, et aI., 2012). 
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Unll':~lthy diet, smoking, physical inactivity, overweight/obesity, impaired glucose tolerance 
(IGn and/or impaired fasting glycaemia (IFG) results in diabetes mellitus (WHO, 2016). The 
number of people living with diabetes mellitus bas quadnJpled from lOS million in 19S0 to 422 
million in 2014 (WHO, 2016). However, more than half of these people are unaware of their 
di~e;'\,'~ ,tr"IS and therefore do not receive any treatment (WHO, 2016) resulting in 1.5 million 
deaths and high blood glucose was the cause of another 2.2 million deaths (WHO, 2012). It is 
therefore not surprising that the WHO in its 2016 World Health celebration calls for action on 
diabetes mellitus, drawing the attention to the need to step-up prevention and treatment. 
Diai'ctcs mcllitus remains one of the top 10 causes ofOPD hospital attendance in Ghana (DeGraft, 
2007). This results in 6.8% of all adult admissions and 7.S% of all adult death (Bruce et al., 2015). 
Difference in the pattern, management and outcome of diabetes mellitus in sub-Saharan Africa 
including Ghana compared to the western world has been observed (Majaliwa et ai, 200S). Poor 
or i:1ck of management of diabetes mellitus results in renal impairment, peripheral neuritis, diabetic 
foot disease. disease of the eye, cerebrovascular, erectile dysfunction and cardiovascular 
conditions (Amissah et ai, 2016). An increased incidence of prolonged complications including 
97.2n/n prevalence of hypertension was found among type two (2) diabetes mellitus patients at a 
G:~:\;:~ian teaching hospital (Amissah et ai, 2016). Nonetheless, the impact of diabetes mellitus 
makes it a global health concern and to curb this pandemic, people generally should have 
knowledge on risk factors and its complications and adopt healthy lifestyle behaviors. 
U C'hjccthe ofthe Study 
The general objective is to determine associated risk factors and complications of diabetes mellitus 
in patients attending Maamobi General Hospital. 
The specific objectives of the study are: 
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Unhclllthy diet, smoking, physical inactivity, overweight/obesity, impaired glucose tolerance 
(IGn and/or impaired fasting glycaemia (JFG) results in diabetes mellitus (WHO, 2016). The 
number of people living with diabetes mellitus has quadrupled from lOS million in 19S0 to 422 
million in 2014 (WHO, 2016). However, more than half of these people are unaware of their 
d:'" I'~ ~·;,t'lS and therefore do not receive any treatment (WHO, 2016) resulting in I.S million 
deaths and high blood glucose was the cause of another 2.2 million deaths (WHO, 2012). It is 
therefore not surprising that the WHO in its 2016 World Health celebration calls for action on 
diabetes mellitus, drawing the attention to the need to step-up prevention and treatment. 
Diabetes mcllitus remains one of the top 10 causes ofOPD hospital attendance in Ghana (DeGraft, 
2007). This results in 6.8% of all adult admissions and 7.S% of all adult death (Bruce etal., 2015). 
Difference in the pattern, management and outcome of diabetes mellitus in sub-Saharan Africa 
including Ghana compared to the western world has been observed (Majaliwa et ai, 2008). Poor 
or bck of management of diabetes mellitus results in renal impairment, peripheral neuritis, diabetic 
foot disease, disease of the eye, cerebrovascular, erectile dysfunction and cardiovascular 
conditions (Amissah et ai, 2016). An increased incidence of prolonged complications including 
97.2% prevalence of hypertension was found among type two (2) diabetes mellitus patients at a 
G::1::~iall teaching hospital (Amissah et ai, 2016). Nonetheless, the impact of diabetes mellitus 
makes it a global health concern and to curb this pandemic, people generally should have 
knowledge on risk factors and its complications and adopt healthy lifestyle behaviors. 
l.~ (~:ljccthe of the Study 
The general objective is to determine associated risk factors and complications of diabetes mellitus 
in patients attending Maamobi General Hospital. 
The specific objectives of the study are: 
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-: ' ; c ~ess the risk factors for diabetics at Maamobi General Hospital. 
To identify common complications among diabetics attending Maamobi General Hospital. 
To assess the associations between diabetes mellitus complications and 
sociodemographics. 
I.: ; .nc:lrch Questions 
1. What are the risk factors for diabetics? 
2. What are the common complications among diabetics studied? 
_'. Are there any associations between diabetes mellitus complications and socio-
demographics of respondents? 
1.5 Justification of Study 
T1~ ': '-. (: i:1 '" of the study will help increase awareness on risk factors and complications of diabetes 
mcllitus. It will also help improve diabetes mellitus health programs and help health professionals 
to better manage diabetics. It will also help policy makers make informed decisions the best 
avenues to address the disease burden. 
1. ' , . d Limitations 
This study will be conducted within Maamobi General Hospital in the Greater Accra and the study 
is confined to exploring risk factors among diabetics, identify common complications as well as 
determine comorbidities among diabetics. A major limitation of this study will be the time 
1I1;",--",('d for the study. The study will also be restricted from exploring other issues such as 
diabetes awareness. 
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1.7 Concer'ual framework 
Lifestvles factors: 
Demographic Factors: o Smoking 
o Alcohol 
0 Age 
Occupation Consumption 0 
0 Sex 
Diet 
Physical activity 
0 E~",.~tion Weight/Obesity 
0 Income 
1 
Genetir", 
--) 
o Retinopathy 
o Hypertension 
o Nephropatby 
o Cardiovascular Diseases 
o Erectile dysfunction 
o Diabetic foot disease 
Diabetes mellitus is a major public health issue and is due to increased urbanization and lifestyles 
changes. Sociodemographic characteristics have been recognized to influence health care in most 
countries. These include sex, age, occupation. body mass index (BMI), income, education, family 
h:-: ".::. Jjf('~tyle factors influence ones risk of diabetes mellitus and ifit is not controlled can lead 
to complications. Lifestyle factors interact with genetics to result in non-communicable disease. 
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CHAPTER TWO 
LITERATURE REVIEW 
2.1 J ntroduction 
Til,' section reviewed literatures on the subject matter and important published studies by other 
researchers relevant to this study. The literature review is structured around the objectives of this 
study and research process and presented as follows: 
2.2 Diabcte~ mellitus as a global burden 
Thc :';;0\':11 burden of diabetes mellitus is increasing across the world (WHO, 2016). Adults with 
diabetes mellitus in 2014 was 422 million representing 8.5% of the world population, compared 
to 108 million (4.7%) in 1980 (WHO, 2016). This resulted in 1.5 million deaths in 2012 and an 
additional 2,2 million indirect deaths by increasing the risks of cardiovascular and other diseases. 
1\.1 ('I :o\'cr, the number of adults suffering from any form of diabetes mellitus globally is expected 
to increase to 600 million in 2030 (Shaw et 01.,2010). However nearly 80% of these diabetics live 
in low- and middle-income cOlUltries (IFO, 2012). Meanwhile the epidemic of diabetes mellitus 
h;,,, "l~jor health and socioeconomic impact, especially in developing countries (Dall et ai, 2010; 
Chodick ct ai, 2010). Sub-Saharan Africa is experiencing this increase in diabetes mellitus 
prevalence alongside other non-communicable diseases (Hall et al., 2011). Obesity which is a 
major risk factor for diabetes mellitus continues to escalate in both the developed and the 
dcveloping world. For instance, in 2014, more than 1 in 3 adults aged over 18 years were 
ovcrweight and more than one in 10 were obese (WHO, 2016). Complications of diabetes mellitus 
can lead to functional limitations in daily life and can result in shortening of life expectancy by 
several years (Seshasai et ai, 2011; O'Reilly et 01,2011; Schunk et 01,2012). 
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2.~ Diahetes mellitus burden in Ghana 
Earlier studies in Ghana on the prevalence of diabetes mellitus in the 1960s recorded 0.2 % in a 
population of men living in Ho (Aikins, 2007). However in the late 1990s, the crude prevalence of 
diabetes mellitus in the general population of people living in Accra was 6.3 %, with age adjusted 
prc\'alcnce and impaired glucose tolerance (IGT) of 6.1 and 10.7 % respectively (CookHuynh et 
al., 2012). 
Diabetes mellitus remains one of the top 10 causes ofOPD hospital attendance in Ghana (DeGraft, 
2007). This results in 6.8% of all adult admissions and 7.8% of all adult death (Bruce et al., 2015). 
Similar studies recorded high prevalence of chronic complications including a 97.2% prevalence 
of hypertension among type two (2) DM patients at a Ghanaian teaching hospital (Amissah & 
Amoako-Boateng, 2014). Compounding this however is the fact that management of diabetes 
m"iii'llS in Ghana is a challenge (MOH, 2012). There is therefore the need to understand the risk 
factors associated with diabetes mellitus in order to facilitate its management. 
2.4 Risk Faeton of Diabetes mellitus 
There are several risk factors of diabetes mellitus. However for the purpose of this study, the risk 
ro" "", nrc categorized and presented as follows: 
2.4.1 Sociodemognphic Risk Factors 
Studies have shown significant associations between diabetes mellitus and demographic 
characteristics (Akter, Rahman, & Abe, 2014). These demographic characteristics are categorized 
T' • ' .. :,rr"d as follows: 
2.4.1.1 Age 
Studies have shown increasing diabetes mellitus prevalence with age (Kumar, 2008). Several other 
studies reported similar findings (Ghorpade et ai, 2013). Studies by Zhao et ai, (2016) revealed 
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that prevalence of prediabetes and diabetes mellitus vary substantially with the individual's age 
and are similar to those observed around the world. However Zhao et al, (2016) identified that the 
prevalence of diabetes mellitus peaked in the age group of 20-40 years and fell in the age group 
(If j 1 -fiO years. This is however contrary to other studies where the peak age group was in 35-44 
YC:lr, (in males) and 45-54 and 55-64 years (in females) in rural areas in Shanghai (Li et al, 2006). 
Further, recent studies shows the prevalence of diabetes mellitus and pre-diabetes increase with 
the increasing age (Muthunarayana et aI, 2015). Moreover the risk of heart failure in patients with 
di;>h~tes mellitus increases with the advancing age (Seshasai et ai, 2011). 
2.4.1.2 Gender 
According to Sesbasai et aI, (2011) 'gender and diabetic are related. Gender has been found in 
several other studies as a risk factor that influences the progression of diabetic nephropathy' (lmai 
c' ,: "'nns). Similar studies found higher prevalence of diabetes mellitus among males compared 
to females (Adejoh, 2013). However this is contrary to other studies which identified higher 
prevalence among females compared to males (Ekpenyong et ai, 2012). Moreover, gender is a 
globally identified risk factor for diabetes mellitus (Ekpenyong et al, 2012). Further, a study by 
~"'·.-~i ct ai, (2011) identified higher prevalence of prediabetes and diabetes mellitus among 
women compared to men. Similar finding was reported by Soewondo & Pramono, (2011). 
However contrary to this, a study by Mohan et ai, (2008) and (Sajjadi et ai, 2008) reported, higher 
prevalence of diabetes mellitus in men compared to women. 
2.4.1.3 Education 
Prevalence of prediabetes and diabetes mellitus vary significantly with the individual's educational 
level (Odume, 2015). This association varies internationally (Odume, 2015). In contrast, another 
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study in Nigeria found that the prevalence of diabetes mellitus was generally unaffected by 
educational level (Adejoh, 2013). Moreover, studies from both developing and developed 
countries have found inverse associations between diabetes mellitus and educational level perhaps 
h""~"~e the better-educated were more health-conscious (Kumar, 2008; Adejoh, 2013). 
Similarly, other studies found association between illiteracy and diabetes mellitus (AI-Moosa et 
aI, 2006; Laramee et aI, 2007). 
2.4.1.4 Marital Status 
s· .. · : 1_~'.~ shown no difference observed in the prevalence of diabetes mellitus and being 
married (K.. Rahmanian et ai, 2013). But other studies suggests that individuals who are single, 
divorced and widowed are significantly associated with diabetes mellitus (Azimi-Nezhad M. et ai, 
2008). 
F':I:' c:-:llorc. evidence from Poljicanin T. et ai, 2012, shows that individuals who are widowed, 
divorced/separated or single are predisposed to diabetes development due to unhealthy lifestyle, 
lack of social support and stress. 
V.l.:' ReJi~oD 
According to (Sridhar, G R, 2013) 'the relationship between religion and diabetes mellitus might 
be attributed to lifestyle habits promoted by religious practices and not merely adhering to a 
specific religion.' Similar studies found religiosity was associated with short-term but not longterm 
gl "ccmic c0ntrol. However, religion on the other hand was significantly associated with longterm 
but not short-term glycaemic control (How, B. et ai, 2011). 
2.4.2 Lifestyles Risk racton 
According to the WHO (2016), 'risk factors associated with diabetes mellitus include unhealthy 
Tc-',il':;. alcohol, physical inactivity and overweight/obesity.' The effects of these lifestyles 
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risk factors may show up in individuals as raised blood pressure, raised blood glucose, raised blood 
lipids, overweight and obesity. Similar studies reported cardiovascular risk factors for diabetes 
mellitus include overweight and obesity, sodium intake, alcohol intake, sedentary lifestyle. These 
ri' ., :''''~; ~re categorized for discussion as follows: 
2.4.2.1 Diet 
Several studies have shown that too much caloric intake is a major driving force behind 
accelerating obesity and type 2 diabetes mellitus epidemics worldwide (Hu, 2011; WHO, 2016). 
QU:1::' Y( If hts and carbohydrates play an important role in the development of diabetes mellitus, 
independent of BMI and other risk factors (Qi et ai, 2009; de Munter et ai, 2007). Additionally 
higher dietary glycemic load (GL) and trans fat are associated with increased diabetes mellitus 
risk, whereas greater consumption of cereal fiber and polyunsaturated fat is associated with 
(I.. "d r:sk (Hu, 2011). Similarly studies have shown that a 2 serving/day increment in 
wholegrain intake is associated with a 21% lower risk of diabetes mellitus (Sun et ai, 2010). 
However, higher consumption of white rice is associated with increased risk of diabetes mellitus, 
whereas consumption of brown rice, a whole grain, protects against the disease (Hu, 2011). 
V.:.: Physica'activity 
Studies indicate that being ovetweightlobese and low level of physical activity are the potential 
risk factors of diabetes mellitus (Barik et aI, 2016). Also, irrespective of economic status, people 
li\'in~ in both the urban and rural areas increasingly refrain from labor-intensive activities leading 
to I(I\\' physical activity (Hu, 2011; WHO, 2016). Various epidemiologic studies show that 
increased physical activity reduces risk of diabetes mellitus, whereas sedentary behaviors increase 
risk. (Hu, 2011; WHO, 2016). Increased mechanization and driving have displaced physical 
activity over the last century in industrialized nations (WHO, 2016). 
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2.4.2.3 Smoking 
Cigarette smoking is an independent risk factor for type 2 mellitus diabetes (Batik et al, 2016). A 
meta-analysis found that current smokers had a 45% increased risk of developing diabetes mellitus 
c'- - ;ed "'ith nonsmokers (Willi et al, 2007). Several possible biological mechanisms may 
explain the association between cigarette smoking and diabetes mellitus. First, although smokers 
tend to be leaner than nonsmokers, smoking has been associated with increased risk of central 
obesity or abdominal fat which is an established risk factor for insulin resistance and diabetes 
:li et ai, 2007; Bruin et ai, 2008). 
2.4.2.4 Alcohol 
Light-ta-moderate alcohol consumption is associated with reduced risk of diabetes mellitus 
(Koppes et ai, 2005). On the other hand, heavy alcohol intake has multiple deleterious metabolic 
c.. . ·.lCclding excess caloric intake and obesity, increased triglyceride levels, pancreatitis, 
disturbance of carbohydrate and glucose metabolism, and impairment ofliver function (Koppes et 
al,2005). 
2.:: (>m"i~ations of diabetes mellitus 
Persons with diabetes mellitus have an increased risk of developing a number of serious health 
problems. Consistently high blood sugar levels can lead to serious sicknesses affecting the heart 
and blood vessels, eyes, kidneys, nerves and teeth (International Federation of Diabetes, 2016). 
-:- •• ' ~('-- .. 1 ications are categorized and presented as follows. 
2.5.1 Cardiovascular Condition 
Cardiovascular disease is the most common cause of death in people with diabetes mellitus. High 
blood pressure, high cholesterol, high blood glucose and other risk factors contribute to increasing 
,diovascular complications (Mostafavi-Pour-Manshadi & Naderi, 2016). 
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These complications and diseases are the main and notable causes of morbidity and mortality in 
the patients with diabetes mellitus and cc:msequently, the financial burden and clinical 
involvements are considerably high (Freire et ai, 2007). Diabetes mellitus increases the risk: of 
c:,rd;<lvasculardiseases independently, especially coronary artery disease, in both male and female 
diabetic patients by 2-4 times and the associated morbidity by 2-6 folds (preis, Hwang & Coady, 
2009). 
25.2 Diabetic Foot Disease 
S: \I ( j c.; !~.! \: shown that the rates oflower limb amputation are 10 to 20 times higher for people 
with diabetes mellitus (WHO, 2016). Foot complications are common in diabetic patients and are 
considered one of the most expensive diabetes mellitus complications to treat (Al-Maskari & 
F.l~~rli\!, 2007). Peripheral neuropathy (PN) and peripheral vascular disease (PVO) have been 
rcrnltcd as well-known common long-term complications of diabetes mellitus (Freire et ai, 2007). 
However people with PN and PVD are known to be at high risk of foot complications including 
foot ulceration, infection and amputation (Al-Maskari & El-Sadig, 2007). Peripheral neuropathy 
(P:"\') ~nd PVD are the main causes of non-traumatic lower limb amputation (Al-Maskari & 
EiS:!ciig, 2007). 
2.5.3 Diabetic Retinopathy 
Consistently high levels of blood glucose, together with high blood pressure and high cholesterol, 
:IT" '''mel 10 be the main causes of retinopathy (Kotlarsky et ai, 2015). Further, studies indicate 
that most people with diabetes mellitus will develop some form of eye disease (retinopathy) 
causing reduced vision or blindness (Kotlarsky et ai, 2015). 
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Diabetic retinopathy is the leading cause of blindness among the working population in the United 
States of America (IOF, 2012). Similar studies report 10.1 % of all blindness cases in Israel is due 
to di:tbetic retinopathy and with this figure is constantly rising (IOF, 2012). 
2.3.": Diahctic Nephropatby 
Diabetic nephropathy is the leading cause of end stage kidney disease among type 2 diabetics 
worldwide (Brenyahlet aI, 2013). Diabetic nephropathy results in damage to small blood vessels 
in Ii'': kidneys make it less efficient or fail altogether (Kotlarsky et ai, 2015). Kidney disease is 
much more common in people with diabetes mellitus than in those without. Maintaining near 
normal levels of blood glucose and blood pressure can greatly reduce the risk of kidney disease 
«(Iamba et ai, 2013). 
S~r~"" c"r.Tlation is reported between diabetic retinopathy and diabetic nephropathy (Kotlarsky 
et ai, 2015). The chronology of appearance of microvascular complications in type I diabetes 
mellitus is retinopathy prior to nephropathy (Romero-Aroca et aI, 2010). 
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CHAPTER THREE 
METHODOLOGY 
3.1 Introduction 
This chapter presents the methods that were employed to carry out the study. It discusses the 
research design, study area, population, sample size, sample and sampling procedure. Others are 
datn collection method, data analysis and ethical considerations. They are presented as follows: 
3.2 Research Design 
This is a descriptive cross-sectional study using a quantitative approach to detetmine the risk 
factors and associated complications in patients with diabetes mellitus at the Maamobi General 
3.3 Study Area 
The study was conducted at the Maamobi General Hospital. Maamobi General Hospital is located 
within the Ayawaso East sub-district of the Accra Metropolitan Assembly of Ghana (AMA). The 
rr:"·~ti(\n of AMA according to the 2010 Population and Housing Census, is 1,665,086 
representing 42 percent of the region's total population. Males constitute 48.1 percent and females 
represent 51.9 percent. The Metropolis is entirely urban (100%). It has a sex ratio of 93 and 
youthful population (42.6%) depicting a broad base population pyramid which tapers off with a 
51'1;,,"' number of elderly persons (60+ years) constituting 5.9 percent. 
The population of Maarnobi is 49,812. Most residents are involved in infonnal businesses such as 
trading. Their surrounding conditions is characterized by poor drainage, inadequate housing, and 
disorganized development. (AMA, 2016). Maamobi General Hospital is the biggest public health 
:':11:: the Ayawaso East Sub District that serves Maamobi and surrounding communities. 
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The AMA is one of the 17CEMMin Gh_ 
and ona of the 10 MMIIINhe 
GnIeIer Accra FI",,1on 
• GEOGRAPHIC 
AREA COVEFlED· about l11nq 
ItOUNDAItIES 
~g::c. 4aEut MunI~~X. . 
North W .... -GaWUI Munl~ly 
~= =~'t~mblY 
No~~emeMetropolllaAu_Y 
'lME METROPOUS IS LOc:alltl 
LONGtTUDErlSNANDON 
......t - ,.A,JITUDJIlO"OIrW t,::--
ACCRA METROPOLITAN ASSEMBLY ADMINSTRATIVE AREA 
3.4 Study Population 
The study population was all diabetes mellitus patients attending the diabetic clinic of the 
Maamobi General Hospital. 
3.5 Inclusion criteria 
The study included all persons with blood sugar related diseases diagnosed based on WHO 
standards (WHO, 1999) i.e. fasting plasma glucose ~7.0mmollL and lor 2 hours postprandial 
plasma glucose or random plasma glucose ~ 11.1 mmol/L, > ISyrs old who agreed to participate. 
3.6 Exclusion Criteria 
We excluded all those who are below 18 years of age. 
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3.7 Variables 
• Dependent Variables 
,. Risk factors of diabetes mellitus 
~ Complications of diabetes mellitus 
Independent Variables 
~ Socia-demographics: age, religion, education, sex, marital status and occupation. 
3.8 Sample Size Determination 
Adopting sample size fonnula by Cochran for cross-sectional study: 
:.,)'!,(l-p) 
n=~ ............................ (1) 
where: 
n: sample size p: prevalence of diabetes mellitus p=8.5%, global prevalence 
(WHO, 2014) d: margin of error, 5% 
Zal2=1.96 since a=5% at 95% Confidence Level 
Inputting the above into equation (l), the minimum sample size for external clients required for 
n (1.96)'xO.08S(1-0.91S) = 119512 
(0.05)' • 
Using expected loss ratio of 10%, 
119.512xO.l=11.9512 
119.512+11.9512=131.463 
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Therefore sample size is (approximate) is 132 
3.9 ~:lmpling Procedure 
Simple Random Sampling without Replacement (SRSWOR) technique was employed to select 
132 diabetes mellitus patients. SRSWOR means that once a participant is selected, he or she was 
not selected again (Ahmed, 2009). Simple random sampling technique was based on the patients' 
rrf';'0rti(1n~ at the diabetic clinic at the time of the data collection. The principal researcher and 
the ;~ssistants using a structured questionnaire interviewed the participants who attended routine 
review visits at the clinic. 
Information was captured on socio-demographic characteristics (gender, age, religion and 
Ct:-'. ,'j,'n). diabetes type (1, 2 or gestational), and related/associated factors including family 
history, smoking and amount/frequency, sedentary lifestyle, age at which diabetes was initially 
diagnosed, period of the diabetes mellitus diagnosis and other diabetic related complications. 
Related diabetes mellitus complications was extracted from participants' folders. Diabetes mellitus 
c.':~~:<Jl·,1:lOilS that were considered in this study was diabetic neuritis, erectile dysfunction (in 
men), cardiovascular conditions, eye problems and diabetic foot diseases. Foot diseases will 
consist offoot ulcer and amputation; cardiovascular conditions are heart failure; eye problems will 
include cataracts, retinopathy, glaucoma, blindness, blurry vision etc. Essentially, hypertension 
\\';1; ~(1n~jdt:red as a co-morbid condition and not a complication. The diagnosis of diabetes 
mellitus complications was gotten from participants' medical records with no extra assessments 
clinically. Data collection was carried out during diabetic clinic day (Wednesday). Thirty-three 
(33) questionnaires were estimated to be issued out to participants each clinic day. 
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3.10 Questionnaire Design and Administration 
Questionnaires will be used and participants were given consent fonn to read and sign prior to 
:mS\'. c:ring the questionnaire. Questionnaire and consent fonns was read out and explained to 
participants who were not able to read or write and consent fonn signed I thumbprint by a witness. 
The questionnaire bad three sections. Section one encompass the sociodemographic 
characteristics (gender, age, religion and education), diabetes mellitus types (1, 2 or gestational), 
ami rei at cd/associated factors including family history, smoking and amount/frequency, sedentary 
lifestyle, age at which diabetes was initially diagnosed and period of the disease. Section two 
consist of the diabetes mellitus related complications. Each questionnaire took 15-30 minutes on 
the average to be completed. 
3.11 Quality Control 
Pretesting of Data collection tool was done at the 37 Military Hospital prior to data 
collection to validate the survey tools. 
Questionnaires were explained to participants prior to interview. 
Research assistants were trained to carry out sUIVey accurately. 
Questionnaires was cross checked by principal researcher at the time of the interview. 
3.: ~ ":1f:1 Processing and Analysis 
Data from the questionnaires were entered into Microsoft Excel and then transferred to STATA 
Version 14 for cleaning, merging and analysis. Cleaning of the data was done by running 
frequencies of the variables. This checks inconsistently coded data. Inconsistently coded data was 
('" ',:', ' ,~ c hec '.:ed with raw data from the questionnaire. Simple proportions and means were used to 
describe categorical and numerical data, respectively. Chi square and Cramer's v tests were used 
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to test for association and strength between the explanatory variables and the outcome variables. 
A confidence interval of 95% was used to show significant relations between the dependent and 
the inucpcndent variables. 
3.13 Data Storage I Data Protection 
Questionnaires were kept in a locked file and stored in a locked cabinet. A soft copy of data 
c"lkcted was coded and locked on a computer using a password and only accessible to principal 
resc:lrchcr. 
3.14 Prete~ting 
The questionnaire was designed to reflect objectives of the study. Pretesting of Data collection 
t<",ls wa~ (lnne at the 37 Military Hospital with 10 participants to validate survey tools. The 
purpose is to establish if the tool is clearly worded and devoid of major biases and can seek the 
type of infonnation intended. Pretesting was also carried out with the aim of eliminating irrelevant 
questions so as to make it reliable. 
~.::' ~thic~' Consideration 
Introductory letter was obtained from the Department of Population, Family and Reproductive 
Health (PFRH) of the School of Public Health (SPH) to Greater Accra Regional Health Directorate 
to be introduced to the head of the facility for permission from hospital authorities prior to the 
~i·,(l. T.ct~('~ of support from Ayawaso District Health Direcotorate was obtained and attached to 
the proposal. 
The proposal was then submitted to the PFRH Department of the School of Public Health who 
then forwarded it to the review board of the Ghana Health Services (GHS) where ethical approval 
\\'~c . 'C'1 "cfore data collection started (GHS-ERC:86/02l17). Participation in this study was 
entirely voluntary and participants had the option not to participate or to discontinue their 
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participation without any adverse consequence. Participants were given sufficient infonnation 
ahout the study to enable them decide whether to take part or not. Participants were assured of the 
fact that this work is purposely academic and that no hanD is intended. The study did not enquire 
any major cost for participants except the participants' time that was spent in answering the 
questionnaire and interviews. Written informed consent forms was given to participants to sign. 
AI! ;:lfcmned consent were in English. However consent form was be read out to patients who 
C;ll1110t rcad and write and then signed I thumbprint by a witness. 
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CHAPTER FOUR 
RESULTS 
4.0 Introduction 
This chapter of the study presents analysis of data collection and discusses findings. It gives 
infonnation on sociodemographic characteristics, family and medical histories, risk assessment, 
C( :1"10n complications, relationship between diabetes mellitus and sociodemographic 
characteristics of respondents. The data was collected from Maamobi General Hospital Diabetes 
Clinic. 132 respondents were interviewed for this study. 
4.1 Demographic characteristics of respondents 
j ,. ',:'e 4.1 a: Socia-demographic characteristics 
Characteristics Frequency (N=132) Percent(%) 
Gender 
Male 42 31.8 
Female 90 68.2 
},;:1~::al sta:us 
Single 11 8.3 
Married 89 67.4 
Separated 3 2.3 
Divorced 4 3.0 
Widowed 25 18.9 
Religion 
Cl,ri~!i~·l 65 49.2 
l'viuslims 66 50.0 
Traditionalist 1 0.8 
Educational level 
None 70 53.0 
Primary I JHS 12 9.1 
SHS 50 37.9 
Er.~:'ioy:nent 
Employed 69 52.3 
Unemployed 60 45.5 
Pensioner 3 2.3 
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T;I"; 4.1 a i:ulicates 90 respondents are females representing 68.2 %. A total number of sixty six 
(66) respondents were Muslims representing 50 %, whilst Christians were 49.2 % and 1 (0.8 %) 
traditionalist. With regards to educational level, 70 respondents representing 53.0 % had no formal 
education, 50 (37.9 %) attended secondary school and 12 (9.1 %) attended Primary/ISS. More than 
h.,:: . ::,': : ~spondents (52.3 %) were employed, 60 (45.5 %) were unemployed and 3 (2.3 %) of 
the respondents were pensioners. 
Table 4.Ib: Age and Weight of respondents 
V:triable Observations Mean Standard deviation Min Max 
A~:(' \ycars) 132 62.89 10.25 37 86 
Weight (kg) 132 72.33 8.16 52 103 
T:1': :<1ble 4.1b indicates age and weight of respondents. A mean age of 62.89 with standard 
deviation of 10.25 with a minimum age of 37 and maximum age of 86. The mean weight of 
respondents is 72.33 with standard deviation of 8.16 having a minimum of 52 kilograms and 
m;>ximum of 103 kilograms. 
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4.1.1 Type of employment by respondents 
Figure 4. I. I: Type of Employment 
- Formal - Informal " Self-employed 
Figure 4.1.1 shows type of employment by respondents. Sixty-three (91 %) of the respondents who 
work were self-employed, 4 (6%) are in the fonnal sector while 2 (3 %) are in the informal sector_ 
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4.2 Family History of Respondents 
T·I, ./.2: Flmily History 
Family history Frequency Percent (%) 
Family history of diabetes 
Yes 53 40.2 
No 51 38.6 
Don't know 28 21.2 
RcJ;1;ion to family member with diabetes 
Father 16 30.2 
Mother 26 49.1 
Brother 5 9.4 
Sister 5 9.4 
Uncle 1 1.9 
F:1mily knowledge of diabetes 
125 94.7 
:-;0 7 5.3 
Family support 
Yes 82 65.6 
No 43 34.4 
*Totals differ based on number responding to the question. 
About 53 (40.2 %) of the respondents had at least a family member with diabetes, 51 (38.6 %) had 
no family history and 28 (21.2 %) were unsure. Out of the 
53 respondents with a family history of diabetes, 26 (49.1 %) said their mothers had diabetes, 16 
OO.::! %) mentioned their father, whilst 5 (9.4 %) and 5 (9.4%) were siblings. 
Majority representing125 (94.70 %) of respondents had family members knowing about their 
diabetes status whereas 7 (5.3 %) had their relatives not knowing about their status. Out of the 125 
respondents, more than half representing 82 (65.60 %) receive support from family members and 
4:: '.' .. :;, ':., ) do not. 
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4.3 Medical history of respondents 
T;I:)lc 4.3 shows the medical history of respondents in the study. This is presented as follows: 
Table 4.3: Medical history of respondents 
Variable Frequency Percent (%) 
Type of diabetes 
T:-:-c :! 132 100.0 
Type I 0 0.00 
Duration of diabetes 
:S 2years 15 11.4 
>2:S 5 years 43 32.6 
>5years 74 56.1 
CI1n-n! \!~c of diabetes medication 
\',:.> 132 100.0 
No 0 0.00 
If yes, which do you use? 
Oral antidiabetics 130 98.5 
Insulin 2 1.5 
Type of druc use 
I\;ctfonnin 130 100.0 
Thiazolidinedione 0 0.0 
Sulfonylureas (Daonil) 0 0.0 
Peptic analogues 0 0.0 
Alpha glucosidase inhibitors 0 0.0 
"'Totals differ based on number responding to the question. 
Table 4.3 indicates medical history of respondents. All the 132 respondents had type 2 diabetes. 
Majority of respondents, 74 (56.1 %) have been living with diabetes for more than five (5) years, 
43 (32.6 %) of the respondents have also been living with the disease between two to five years 
(~-5y cars) nnd the least is 15 (11.4 %) of them who have been living with it forless than two years 
(2ycars). 
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All respondents (132) take diabetic medication with the majority using oral antidiabetic drugs. All 
respondents use metfonnin. 
4.4 Smoking status of respondents 
Table 4.4: Smoking status of respondents 
Frequency (N=132) Percent (%) 
Tobacco smoking 
Yes 6 4.5 
No 126 95.5 
Duration of tobacco smoking 
<5yellrs 0 0.0 
:- - 1f1yt '~s 2 33.3 
>lOyears 4 66.7 
Only 6 (4.5%) of respondents smoked tobacco and the majority (66.7%) of them smoked for more 
tl'"" ten years. 
4.5 Alcohol consumption by respondents 
Table 4.5: Alcohol consumption by respondents 
Variable Frequency (N=132) Percent (%) 
Al~"'lnl h!lke 
II 8.3 
No 121 91.7 
Duration of alcohol intake 
<5years 0 0.0 
5 -IOyears 2 18.2 
>10years 9 81.8 
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121 (91.7%) respondents do not take alcohol and 11(8.3%) do take alcohol. Out of the 11 
respondents, 9 (81.8%) have been taking alcohol for more than ten years and 2 (18.8%) for five to 
ten years. 
4.6 Physical activity by respondents 
T, . '. . : r,. Physical activity of respondents 
Variable Frequency Percent (%) 
Exercise regularly 
Yes 71 53.8 
No 61 46.2 
Duration of exercise? 
S':;Omins 49 69.0 
>30mins Sl hour 20 28.2 
>1 hour 2 2.8 
Exercise per week? 
Once a week 27 38.0 
Two times a week 24 33.8 
Th",'e times a week 20 28.2 
More than three times a week o 0.0 
*Totals difJer based on number responding to the question. 
Table 4.6 indicates more than half, 71 (53.8 %) of the respondents do engage in physical activity. 
O~"~' 71 fC'<pondents, 49 (69.0%) do exercise for less than thirty (30) minutes, 28.2 % do exercise 
for more than thirty minutes to one hour and 2.8 % exercise for more than one hour per day. 
For the 71 respondents who exercise, 27 (38.0 %) exercise once a week, 24 (33.8 %) do exercise 
two times a week and 20 (28.2 %), three times a week. 
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4.i njct:l~' habits by respondent 
Table 4.7: Dietary habits of respondents 
Variable Frequency (N 132) Percent (%) 
Fruits Consumption 
Often 43 32.6 
Sometimes 89 67.4 
Vegetables Consumption 
Often 43 32.6 
Sometimes 89 67.4 
Fats and oils Consumption 
Often 5 3.8 
127 96.2 
Grains and cereals Consumption 
Often 67 50.8 
Sometimes 65 49.2 
Protein Consumption 
31 23.5 
.,' ;.1C'IIllt:S 101 76.5 
Table 4.7 shows dietary habits by respondents, 89 respondents representing 67.4 % take fruits 
sometimes and 43 (32.6 %) often take fruits. 89 (67.4 %) sometimes take vegetables whilst 43 
n~.6 %) often take it. Majority of the respondents representing 96.2 % sometimes conswne fats 
and oil and 5 (3.8 %) often consume it. In the consumption of grains and cereals, it was realized 
that 67 (50.8 %) consume grains and cereals often whilst 65 (49.2 %) said they consumes it 
sometimes. As indicated in the table, more than balf(76.5%) of the 132 respondents affirmed that 
they ~omctimes consume protein whilst 23.4 said they often consume it. 
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4.~ l~~<p/l'lrlents on diabetes mellitus eompUeations. 
Table 4.8: Respondent' diabetes mellitus eompUcations 
Variable Frequency (N-132) Percent (%) 
Complications of diabetes? 
Yes 50 37.9 
'-"('\ 82 62.1 
Complications 
Diabetic foot disease 12 24.0 
Diabetic retinopathy 23 46.0 
Diabetic nephropathy 0 0.0 
Erectile dysfunction 12 24.0 
Cardiovascular disease 3 6.0 
Almost two-thirds of 62.1 % of respondents (N=82) do n('lt have any complications of diabetes 
mellitus. Out of the fifty respondents with complications, 46 % have diabetic retinopathy, 24 % 
have diabetic foot disease and erectile dysfunction and 6 % have cardiovascular disease. 
4.9 Diabetic Comorbidity in respondents 
Table 4.9: COlllorbidity by respondents 
Characteristics Frequency (N=103) Percent"110 (%) 
C01"·'~hidity 
Hypertension 100 97.1 
Cardiac disease 3 2.9 
Duration of disease since diagnosed 
<2 years 6 5.8 
2-Syears 24 23.3 
>5 years 73 70.9 
Cum:ntly on medication for comorbidities 
Yes 101 98.1 
No 2 1.9 
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(' t I . ';; -, .:; 2 respondents, 97.1 % had hypertension and 2.9% had cardiac disease. Of the 103 
respondents, 70.9 % have had comorbidity for more than five years, 23.3 % for two to five years 
and 65.8 % for less than two years. Many of the respondents (98%) are on medication for the 
disease. 
4.11: \SSoci.ltion between demographic characteristic and diabetic complications 
Table 4.10 shows the results of the association between respondents' demographic characteristics 
and their diabetes complications. This is presented as follows; 
Tahle 4.10: Association between demogl'tlphic characteristics and diabetes complications 
-Ch-ar-ac-te-ll,'-;(;5 Diabetic Diabetic Erectile CVD Cramer's v p-value 
foot retinopathy dysfunction 
N(%) N(%) N(%) N (010) V t 
Gender 
Male 8(29.6) 6(22.2) 12(100.0) 1(3.7) 0.612 <0.001 
Female 4(17.4) 17(73.9) 0(0.00) 2(8.7) 
Age(ye~::;) 
18-39 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0.245 0.420 
40-59 3(37.5) 3(37.5) 2(25.0) 0(0.0) 
60-79 9(23.1) 19(48.7) 9(23.1) 2(5.1) 
~80 0(0.0) 1(33.3) 1(33.3) 1(33.3) 
Educational level 
None 8(25.8) 12(38.7) 8(25.8) 3 (100.0) 0.267 0.309 
Primary/JHS 1(14.3) 6(85.7) 0(0.00) 0(0.00) 
Secondary 3(25.0) 5(41.7) 4(33.3) 0(0.00) 
Employment 
Employed 9(30.8) 8(30.8) 7(26.9) 2(7.7) 0.252 0.387 
Unem"';0:'~c1 3(13.0) 14(60.9) 5(21.7) 1(4.3) 
Religion 
Christian 3(15.8) 12(63.2) 3(15.8) 1(5.3) 0.257 0.360 
Moslem 8(26.7) 11(36.7) 9(30.0) 2(6.7) 
Traditionalist 1(100.00) 0(0.00) 0(0.00) 0(0.00) 
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Marital 51:::,', 
Single 0(0.00) 1(100) 0(0.0) 0(0.0) 0.252 0.673 
Married 9(25.0) 15(41.7) 10(27.8) 2(5.6) 
Separated 0(0.00) 0(0.00) 1(100) 0(0.0) 
Widowed 2(20.0) 6(60.0) 1(10.0) 1(10.0) 
Divorced 1(100) 0(0.00) 0(0.0) 0(0.) 
·S!atisticallv significant difference between socio-demographic and diabetes complications (p < 
0.05). 
The association between socio-demographic and diabetes complication shows a statistically 
significant (V=O.612, p<O.05) difference between gender and diabetic complications of 
rc;;,'rndents Males have more complications compared to females. 17 (73.9%) females suffer 
from diabetic retinopathy compared to 22.2% among males. There is no statistical difference 
(V=O.245, p>0.05) between the age of the respondents and diabetes complications in this study. 
Also. there is no statistically significant association (V=0.267, p>O.05) between the educational 
level of the respondents and their diabetes complications. The results showed that there is no 
significant relationship (V=O.252, p>O.05) between the employment status of the respondents and 
their diabetes mellitus complications. 
Fi\'~'\:·. :here was no statistically significant association between religion and marital status of the 
respondents and diabetes complications. 
4.11 Conclusion 
The chapter presented sought to address the risk factors and complications of diabetes mellitus in 
pI"'" '5 :l(tr::1ding Maamobi General Hospital. It presented a detailed analysis of data collected 
from respondents and established the relationship between these complications and their 
demographic characteristics 
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CHAPTER FIVE 
DISCUSSION OF FINDINGS 
5.0 Introduction 
This chapter presents the findings of the study in relation to reviewed literature on the research 
topic as well as the stated objectives and research questions. The study sought to assess the risk 
factors and complications of diabetes mellitus in patients attending the Maamobi General Hospital 
and consequently establish the relationship between these complications and their demographic 
characteristics. This chapter is in four sections. Section one presents the discussions on the risk 
factors. Section two presents the complications of diabetes mellitus identified in the study. Section 
three presents the relationship between these complications and their demographic characteristics 
and section four presents the conclusion on the chapter. 
5.1 Risk factors 
The assessment of risk factors associated with diabetes mellitus revealed areas where improvement 
is needed. Although the study population is not representative for the Maamobi community as a 
whole, it displays many features ofwban life in Africa. These findings are similar to other studies 
(Danquah et ai., 2012; Seyum et al, 2010). This is discussed and presented as follows: 
5.1.1 Physical activity 
Respondents' level and commitment to physical activity was low. This agrees with other studies 
(Barik et ai..2016; Danquah et al., 2012; Hu, 2011) which showed that people living in both the 
urban and rural areas increasingly refrain from physical activity. However, research has shown 
that diabetes complication reduces in those who practice vigorous physical activity (Williams. 
2008). Physical activity is one of the principal therapies to acutely lower blood glucose in type 2 
diabetes mellitus because of its synergistic action with insulin in insulin-sensitive tissues and 
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thereby reducing diabetes complications (Bhatti et al, 2014). The findings of this study may 
probably be because the respondents are unaware of the health benefits that come with physical 
activity. This may be attributed to lack of health education on the benefits of physical activities. 
Tllis suggests an important area for improvement to combat the menace of diabetes and its 
complications. 
5.1.2 Tobacco smoking 
The study showed that majority of the respondents do not engage in tobacco smoking This is a 
g(H'l' :mlctice since tobacco smoking is an independent risk factor for type 2 diabetes (Hu, 2011; 
Barik et ai, 2016). Although only 4.5% of the respondents engaged in tobacco smoking, it is 
important that the general patient population at Maamobi General Hospital continue to be 
counselled and educated on the harmful use of tobacco. 
5.1.3 Alcohol consumption 
The study showed low intake of alcohol by respondents (8.3%). This is consistent with a study by 
Seyum et al (2010). However, majority of the respondents in this current study had been drinking 
thl' n1cohol for more than ten years. Meanwhile, heavy alcohol intake has multiple deleterious 
metabolic effects, including excess caloric intake and obesity, increased triglyceride levels, 
pancreatitis, disturbance of carbohydrate and glucose metabolism, and impairment of liver 
function (Koppes et ai, 2005). Further patient education is needed in this regard. 
5.1.4 Dietary habit 
Respondents' level and commitment to good dietary habit was low. This confirms studies carried 
out in Ghana (Danquah et al., 2012). This is an indication that respondents may not be aware of 
tl~" "'ne'i~< of vegetables, fiuits, cereals and grains, proteins and polysaturated fat since most of 
34 
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them nre uneducated. However greater consumption of vegetables, fruits, cereals and grains and 
polysaturated fat are associated with decreased risk to diabetes mellitus and its complications (Hu, 
2011; de Munter et ai, 2007). Effective education on dietary habits is necessary to help with the 
m.'na~ernent of diabetes mellitus and reduction in the overall incidence and morbidity in the 
catchment area. 
S.2 Complications of diabetes meUitus 
From the study, 37.9% of the respondents suffered at least one chronic complication of diabetes 
11~'I;. This is lower compared to the fmdings by Amissah & Amoako-Boateng (2014), where 
more than half (61.4%) of the respondents suffered from at least one chronic complication when 
the prevalence ofDM complications were assessed among people with type two (2) DM attending 
a tenching hospital in Ghana. This current study further found high prevalence of hypertension 
(j :-.' ., :'1 :t],lOng the respondents. Similar fmdings (97.2%) was obtained by Amissah & Amoako-
Boateng (2014). Effective measures to prevent hypertension in the Maamobi catchment area are 
essential for reducing the overall morbidity due to diabetes. The predominant diabetes mellitus 
complicntions in this study were diabetic retinopathy (46%) followed by diabetic foot (24%), 
erectile dYSlunction (24%) and cardiovascular diseases (6%). These are discussed and presented 
as follows: 
S.2.1 Diabetic retinopathy 
The predominant diabetes mellitus complication in this study population was diabetic retinopathy 
(<1(,: ).1 his rmding is contrary to previous evidence( Amissah & Amoako-Boateng (2014) and 
Mohan, Shah and Saboo (2013) that have neuropathy as the most common diabetes - related 
complication .Evidence from China«McNeely & Boyko, 2005) and Britain( Morgan et ai, 2000) 
found cardiovascular diseases as the predominant complication among inpatients and outpatients 
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type 2 diabetes respectively. Although the prevalence (46%) is lower compared to 58.6% observed 
by Amissah & Amoako-Boateng (2014), it is higher compared to findings obtained from similar 
studies carried out in Cameroon, 28% (Djirolo et aI, 2012 ) and 23.6% (Tamba et aI, 2013). A 
r~"l-~"lc reason for the predominance of diabetic retinopathy may be because majority of the 
respondents in this study were old. 
5.2.2 Diabetic foot disease 
TIle prevalence of diabetic foot disease (24%) was higher than 4.9% reported by Amissah & 
J\ :1:( ,ko-B0ateng (2014) for a teaching hospital in Ghana and the 8.0% by McNeely and Boyko, 
(2005) for the Asian-Americans. The differences observed in this study and that of Amissah & 
Amoako-Boateng (2014) is quite huge although both studies employed same criteria (the use of 
doctor's diagnosis) to establish the diabetic foot disease. The older age and low level of education 
of respondents in this study may be the contributing factors to these differences. 
5.2.3 Erectile dysfunction 
TIle prevalence of erectile dysfunction among the male respondents in this study was 24.0%. This 
• ;'.\,-" :"an the 31.0% reported by Amissah & Amoako-Boateng (2014). This high prevalence 
may be due to the long duration of the diabetes mellitus among the respondents. Most of the 
respondents in this study had been suffering from diabetes mellitus for more than five years, 
Another probable factor may be because of the older ages of the study respondents. However, the 
r,:;, ':'(: i: the prevalence between this current study and that by Amissah & Amoako-Boateng 
(2014) could be as a result of the smaller sample size of the latter. 
5.2.4 Cardiovascular disease 
The prevalence of cardiovascular disease was 6.0%. This was the complication with the lowest 
p: '.'\.- '.~ .,,.~ 1 this study. Similar study in a teaching hospital observed 21.0% prevalence ( Amissah 
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& Arnoako-Boateng, 2014). This is contrary to studies done in Britain and China where 
cardiovascular diseases were found to be the predominant complications among type 2 diabetes 
mellitus patients (Morgan et al, 2000; Shi et al, 2004). 
5.3 ,\ssociation between demographic characteristics and diabetic complications 
The study showed some significant association between the demographic characteristics and 
diabetic mellitus complications. These are categorized, discussed and presented as follows: 
In this study, the association between gender of respondents and complications was statistically 
significant (p<O.05) with the prevalence of diabetes mellitus complications. This agrees with 
similar study conducted in a teaching hospital in Ghana (Amissah & Amoako-Boateng, 2014). 
:-' . :1;,d more prevalence of diabetes mellitus complication in this study due to women'sm h 
health seeking behaviour. This finding confirms the result of similar studies which found higher 
prevalence among males compared to females (Adejoh, 2013). 
More femnles suffered from diabetes retinopathy in this study compared to their male counterparts. 
This tindings signify that special attention needs to be paid to patients in relation to the prevention 
and management of erectile dysfunction which is evident in men and diabetes retinopathy in both 
sexes. 
5.3.2 Age 
There exists no statistically significant relationship between the age ofthe respondents and diabetes 
complications in this study. This is contrary to other studies which identified diabetes complication 
with advancing age (Seshasai et aI, 2011). Further, respondents within the age group 
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(60-79) years experienced more complications compared to age groups (40-59) years and those of 
80 years and above. Similar findings were obtained by Amissah and Amoako-Boateng (2014) 
when diabetes complication was assessed among patients in a teaching hospital in Ghana. 
5.3.3 Educational level 
There was no significant association between the educational level of the respondents in this study 
and their diabetes mellitus complications. This finding confirms those obtained in studies 
C('T'("!cted in Nigeria where diabetes and its complications were unaffected by educational level 
(Adejoh, 2013). However, our results further showed that though not statistically significant, 
lower level of education and those without any formal education are associated with higher 
prevalence of diabetes mellitus complications. This might be because of the indirect biological 
(""',. 0f ,'('lIcational level on the disease (Sacerdote et aI, 2012). The effects of education on 
diabetes mellitus are mediated by other risk factors such as dieting, smoking, physical activity 
which can be biologically related to the disease. 
5.~.4 Religion 
1'1'; .~h~',()\1s affiliations of respondents had no significant association with the diabetes mellitus 
complications they suffer. This fmdings was consistent with (How, B. et ai, 2011). Again, 
Obisesan et ai, 2006 have shown no significant associations between diabetes and metabolic risk 
factors such as serum lipids, dietary intake, prevalence of coronary heart disease and religiosity 
and/pr spirituality. The relation between religion and diabetes might be attributed to lifestyle habits 
promoted by religious practices and not merely by adhering to a specific religion (Sridhar, G R, 
2013). There is the need to undertake more studies in the future to have a more defmed relationship 
between religion and diabetes complications. 
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5.3.5 Marital status 
This study found no association between marital status of respondents and diabetes mellitus 
comolications. However, there was higher prevalence of diabetes complication among the married 
compared to the singles, divorced, widowed and the separated. Only one of the respondent who is 
single had a complication in this study. Consistent to this was a study conducted in Iran where 
there was no significant difference observed in the prevalence of diabetes mellitus between the 
IT'~::ied (K. Rahmanian et al, 2013). Another study reported a similar results (Azimi-Nezhad M. 
ct ai, 2008). However, some findings (Poljicanin T. et ai, 2012), suggested that single, divorced, 
and widowed statuses are significantly associated with diabetes mellitus. Further studies in future 
with much bigger sample size can help to ascertain a more distinctive understanding of the 
relntion~hip between marital status and diabetes mellitus. 
5.5 Conclusion 
The chapter has analysed the fmdings of the study and related them to existing literature. It has 
demonstrated that while gender of the respondents was significant in influencing diabetes mellitus 
C< ':~~:io:'s, others were not significant. The next chapter presents the conclusions and 
recommendations of the study. 
39 
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CHAPTER SIX 
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS 
6." TntrnductioD 
This chapter presents the summary, conclusions and recommendations of the study. These are in 
four sections. Section one presents the summary of the study. Section two presents the conclusion 
of the study. Section three presents the recommendations of the study and future research and 
<" ", " [Pl:r presents the limitations. 
6.1 Summary of the study 
This study sort to determine the risk factors and complications of diabetes mellitus in patients 
attending the Maamobi General Hospital. This was achieved by using quantitative research method 
".::~' (:;':1. The data was analysed using Stata version 14 . Inferential statistics using Chi Square 
and Cramer's V tests were used to assess the association between demographic characteristics and 
diabetes mellitus complications. The key conclusions presented as follows: 
ti.2 Cnnclusions 
nc study provides estimates of the prevalence of diabetes mellitus risk factors, complications and 
the relationship between these complications and their demographic characteristics. A high 
prevalence of complications was found with the predominance of diabetic retinopathy (46.0%), 
f011nwcd by diabetic foot (24.0%) and erectile dysfunction (24%). The prevalence of hypertension 
W<lS vcry high at 97.07% among the respondents. 
Additionally, respondents' level of commitment to physical activity and good diet was low. 
However most of the respondents do not engage in alcohol intake and smoking. There was a 
si~"",~:1( ;'~sociation between gender of respondents and diabetes mellitus complications. Age, 
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educational level, marital status and religious affiliations of the respondents were not significantly 
related to the complications observed. 
6.3 Recommendations and future research 
Based on the [mdings from this research, the following recommendations were made: 
1. There is the need for gender specificity in regards to diabetes mellitus disease interventions 
at the Maamobi General hospital. 
2. The differences observed in the prevalence of the diabetes mellitus complications in this 
study and previous studies call for the need to allocate medical resources efficiently per 
the local burden of the disease. 
3. There is the need for regular monitoring of diabetes by health facilities to prevent 
complication. 
4. The lack of good dietary habits and the lack of commitment towards physical activity 
observed in this study demands for more intensive health education on the risk factors of 
diabetes mellitus both within the Maamobi General Hospital and the Maamobi catchment 
Area by individuals and health personnel. 
s. There is the need to create awareness about diabetes mellitus to facilitate early diagnosis 
and prevent complications by health facilities. 
6.4 Limitations of the study 
This study has some limitations. The e study focused on the risk factors and complications of 
diabetes mellitus in patients at the Maamobi General Hospital, any conclusions drawn from the 
study may not be generalizable. However, the conclusions might extend to the other health 
institutions that share similar characteristics. The study could not obtain data on the income of the 
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respondents. This was because, most of the respondents were informal self-employees with small 
scale business and so did not know how much they earn at the end of a month. 
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Estimation of the impact of diabetes-related complications on health utilities for patients with 
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Sampling. Biostatistics Department School of Hygiene and Public Health Johns Hopkins 
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50 
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APPENDICES 
Appendix 1: Informed Consent Form for Patients 
Project Title: Diabetes Mellitus: risk factors and complications in patients attending Maamobi 
General Hospital. 
Prinr:ipal T-:"estigator: Nancy Apewe Biah 
Address: School Of Public Health 
Department of Population Fertility and Reproductive Health (PFRH) 
University Of Ghana, Legon. 
Email:nayybby@yahoo.com 
Telephone: 0244080259 
Introduction 
Dc:!' P~rticinants, diabetes mellitus is a disease which occurs either when the pancreas does not 
prod uce enough insulin or when the body cannot effectively use the insulin it produces, resulting 
in elevated levels of blood sugar. Insulin is a honnone that regulates blood sugar. This study 
seeks to detennine the risk factors and associated complications in diabetes mellitus patients at 
tho • b:l"~V,l'i General Hospital in order to help guide policies and practices in diabetic care 
m~l1agement plans. 
Procedure, Possible Risk and Benefits 
Questions will be asked based on diabetes mellitus, its risk factors and complications. It will 
ir ~' ""'c t he use of questionnaire. No risk or discomfort is foreseen concerning your participation 
in this research apart from your time that will be spent on answering the questionnaire. Each 
questionnaire will take 15-30 minutes on the average to complete. There is no direct benefit to the 
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p~:-ticipants of this study. However the outcome of this study will be used to infonn policy on 
diabetes management. 
Right to Refuse and Confidentiality 
Your participation in this study is voluntary and you are at liberty to withdraw at any time. There 
will not be any penalty in opting out of this study or not answering any question. This study has 
been reviewed and approved by the Ethical Review Committee of Ghana Health Services. 
Participant personal identification such as names and address will not be written on questionnaire. 
Whatever information you provide will be handled with strict confidentiality, it will be used solely 
f0r the research purpose and will never be used against you. Each questionnaire will he given a 
unique identification number. 
Thank you. 
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PARTICIPANT CONSENT FORM 
I have been thoroughly briefed on the entire methodology and significance of the ongoing study 
which is being conducted by Nancy Apewe Biah. On my own free will, I hereby consent to be part 
of the study, based on my understanding of what the study entails. 
I ~m r oj n!! this on condition that under no circumstance should my references be made to my actual 
identity to any other person{s) after providing aU the information requested from me for this 
particular study as promised by the researcher. 
__, ___/  ___ (participant's 
Signature (Date) 
Or Thumbprint) 
If the participant cannot read the form themselves, a witness must sign here. 
I, ____________________ was present while the purpose, 
I' Il:~~, 18 well as the risks and benefits were read to the participant. All questions were 
answered and the participant has voluntarily agreed to participate as a subject in this study. 
--'--'--
(\.,.: ;'S ~i;nature (Date) 
Or Thumbprint) 
Interviewer's Statement and Signature 
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I, certify that the pwpose, 
procedures as well as the risks and benefits associated with participating in this study have been 
explained to the above individual in the English 1 Ga 1 Twi 'local language. The individual has 
freely agreed to participate in the study. 
__' __1 _ _ (Signature of interviewer) ( Date) 
Appendix 2: Questionnaire on risk factors and complications among diabetics at Maamobi 
General Hospital 
TOPIC: RISK FACTORS AND COMPLICATIONS AMONG DIABETICS AT 
MAAMOBI GENERAL HOSPITAL. 
Participant No ........... . Date ..............•.. 
Personal Profile 
1. Signature .............................. " .... . 
2. \'!c .. .......................... . 
3. 3. Sex: I.Male 2.Female 
4. Educational Level: I.None 2. Primary 3.Secondary 4.Tertiary 
5. Occupation: l.Employed 2.Unemployed 3.Pensioner 
6. T:11c n:Employment: l.Public servant 2. Informal sector 3.Selfemployed 
7. Religion: 1. Christian 2.Muslim 3. Traditional 
Others Specify ................ . 
8. Marital status: I.single 2. Married 3. Separated 4. Divorced 5. Widowed 
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F,' '" 'ly History 
9, Does any member of your family have Diabetes Mellitus? Yes [] No [ ] Don't know[ 
][ 
10. If yes, how do you relate to the person? ................................................... . 
II. Do your family know about your diabetes Yes [ ] No [] Don't know[ ] 
12. If yes, do you receive any support from them? Yes [] No[] 
Medical History 
13. What type of diabetes do you have? 1). Type 1[ ] 2). Type 2 [] 
1·\. Tfc"" l":1g have you been diagnosed with diabetes? 
1).l-2yrs [] 2) .2-5years [] 3). >5 years [] 
15. Do you currently use any form of diabetic medication? Yes [ ] No [] If yes 
which of these do you use? 1. Oral antidiabetics [] 2.Insulin [] 3.Diet [] 
'~:~'. 'f: r" take any of the drugs. 
A .Mctfonnin[] b. Thiazolidinediones [] c .Sulfonylureas (Daonil)[ ] d. Peptic analogues[ ] 
e .Alpha glucosidase inhibitors[ ] 
Risk factors 
Smoking status 
17. Do you smoke tobacco? Yes [] No [] 
I ~ :' '. ; ~, Y. ong have you been smoking? ........................................... . 
How many cigarettes on average do you smoke per week? ...... , ....... ,. ...... 
Alcohol consumption 
18. Do you take alcohol? Yes [] No [] 
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If yc~, how long have you been using it? .. ,. ...... ,. ......................... ,. .... . 
How often do you take alcohol on average per week? ,.,.,..,. ... ,.,.,. .. 
Exercise 
19.Do you exercise regularly? Yes No 
If yes,how long do you exercise? ..................... . 
How often do you exercise per week?,. ... ,. ... ,. ................... . 
Diet 
:'.11.H()w oftcn do you eat the following foods? Tick where appropriate 
a. Fruits. Often [ ] Sometimes[ ] Never[ ] 
b. Vegetables. Often[ ] Sometimes[ ] Never[ ] 
c. Fats and Oils. Often[] Sometimes[ ] Ncver[ ] 
Grains and Cereals. Often[ ] Sometimes[ ] Never[ ] 
e. Protein. Often[ ] Sometimes[ ] Never[] 
Complications 
21. Do you have complications as a result of diabetes? Yes [ ] No[ ] 
\\':. . '-:omplications Tick where appropriate 
1. Diabetic foot disease [ ] 
2 .Diabetic retinopathy [ J 
3 .Diabetic nephropathy (Kidney) [ ] 
4 .Er.::ctile dysfunction [J 
5 .Cardiovascular disease (Heart disease) [ ] 
22. Do you have any of these diseases? Hypertension [] Cardiac Disease [] 
If others, state type.,..,.,. ....... ,.,. .... ,. ..... ,..,.,. ............ ,.,.,.,. ... ,..,. ......... ,.,. .. ,. ................ . 
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When was these diseases diagnosed? ....................................................................... . 
Are you on any medication for any of these diseases? ........................ ................................ . 
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GHANA HEALTH SERVICE ETlIlCS REVIEW COMMITI'EE 
In CQ.fe o/reply the rl,. ..~.=!:. .. '" Research &. Development Division numbertmddole of/his tE'·~~ Ghana Health Service 
Lelf", ,,",KId be quoted 15 ( (*-\) I: P.O. BoxMB 190 
.. ~ ~:/~'!2J3-302-681 109 
.............. co..m Fax + 233-302-68S414 
MyRef. G/lSlRDDIERc/AdmlniAppI  ,>oS; Email: ghserc@gmol• . com 
Your Ref. No. 
Biah Nancy Apcwc 
University of Ghana 
School of Public Health 
Legon, Accra 
The Ghana Hcalth Service Ethics Review Committee has reviewed and given approval for tho implementation of 
your Study Protocol. 
GHS-ERC Number GBS-ERC: 86/02117 
Project Title Diabetes Mellitus: Risk Factors and Complications in Patients Attending Maamobi 
General Hospital 
Approval Date IS'" Mav. 2017 
Expiry Date 14'" May. 2018 
GHS-ERC Decision Annroved 
Thi¥ npproval rcquires the rollowing from the Principal Investigator 
• Subm iss ion of yearly progress report of the study to the Ethics Review Committee (ERC) 
• Renewal of ethical approval irthe study lasts for more than 12 months, 
• Reporting of all serious adverse events related to this study to the ERC within three days verbally and 
seven days in writing. 
• Submission of a final report ancr completion of the study 
• Informing ERC if study cannot be implemented or is discontinued and reasons why 
• Informing the ERC and your sponsor (where applicable) before any publication orthc researeh findings. 
Please note that any modification of the study without ERC approval orthe amendment is invalid. 
The ERC may observe or cause to be observed procedures and records of the study during and after 
implemcntation. 
Kindly quote Ihc protocol identification number in all future correspondence in rell!tionlo this approved protocol 
SIGNE~R:'C~~~ERMAN""""""""'''''' 
(GHS-ERC CHAIRPERSON) 
Ce: The Director, Research'" Development Division. Ghana Health Service, Ac:eru