Health seeking practices before seeking medical consultation with qualified

health care providers among diabetic patients visiting Allied

Hospital,Faisalabad.

Submitted by:

Iqra Tariq(Roll no.11)

Ammara Sana(Roll no.15)

Khadija Mushtaq(Roll no.22)

Batch A1

(4th year MBBS)

Session 2016-2021

Supervised by:

Dr.Tahir Ismail

Department of Community Medicine

Faisalabad Medical University,Faisalabad.

Health seeking practices before seeking medical consultation with qualified
health care providers among diabetic patients visiting Allied Hospital FSD.

Introduction/Literature Review:
Diabetes is one of the metabolic disorders which causes chronic hyperglycemia
either because of decreased insulin secretion,decreased insulin action or both. 9

It has emerged as an epidemic all over the world with 170% rise in the cases of diabetes
in developing countries as compared to 47%rise in the developed countries .1

The prevalence of diabetes has increased globally both in urban and rural
areas. Pakistan having an area of 881,913 km2(including Azad Kashmir and Gilgit Baltistan) 13 with an
approximate population of 219,241,649 as of Friday, February 14, 2020 and as the 5 th most populous
country15 has great epidemiologic and economic transitions such as growing urbanization. These
transitions has led to sedentary and stressful lifestyle, increased inactivity,increased calories intake and
eating more, consuming less behavior. These factors has contributed to the increased prevalence of
Diabetes Mellitus12.

According to IDF Diabetes Atlas 9th edition2019, approximately 463 million adults(20-
79yr) were living with diabetes and by 2045;it will rise to 700 million and it caused 412 million deaths
worldwide.5 According to WHO diabetes is the 7th most common cause of death in 2016 worldwide 14. The
current prevalence of diabetes in Pakistan is 11.77%. In Males it is 11.20%,in Femaleit is 9.19%.The
prevalence is higher in males than in females. Mean prevalence of diabetes in Sindh province is 16.2% in
males and 11.70% in females; in Punjab,it is 12.14% in males and 9.83% in females; in Balochistan,it is
13.3%im males and 8.9%in females and in Khyber Pakhtunkhwa(KPK),it is 9.2% in males and 11.60% in
females. In Urban areas the prevalence is 14.18% and 10.34% in Rural areas 11.

Data suggests that many diagnosed diabetic patients use remedies other than
consulting with qualified health care providers and taking conventional medical treatments based on
economic, physical, psychological, and social considerations 4.. These remedies include Greek,
homeopathy, Ayurveda,biochemy,Reiki,Traditional Chinese medicine and some household remedies,
herbal treatments, going to Hakeems,spiritual healing, massage therapy, meditation etc. 3,6

Unfortunately,majority of the people using these practices don’t know that diabetes is a syndrome that
requires comprehensive medical treatment plan for related disorders like dysregulation of glucose,lipids
and blood pressure homeostasis.These practices have been prevailing for several deacdes,people think
that these are free from any sort of side effects and are most beneficial.but in actual, they do not have
sufficient data on their safety and effectiveness 7. Some of these remedies may prove effective for
sometime but without proper medical consultation diabetes may lead to the development of serious
complications like:

 Cardiovascular diseases like hypertension,angina,heart attack,stroke and atherosclerosis.

  Neuropathies like Alzheimers disease,Dementia.
 Nephropathies.
 Retinopathy.
 Slow wound healing leading to ulcers.
 Diabetic foot syndrome ultimately resulting in toe,foot or leg amputation.
 Increased bacterial and fungal infections
 Gestational diabetes is a condition which has its own large number of complications like
premature deaths2,8,10.
This study aims to find the treatments or methods people use after being
diagnosed with diabetes to correct their symptoms or sugar level.The methods which stops
them for seeking proper medical treatments which results in the development of serious
complications as mentioned above.

Objectives:
 to find the health seeking practices among diabetic patients other than and before consultation
with qualified health care providers.

Methodology:

1. Study Design:
A survey using a cross sectional study design will be employed. Our sampling frame will
be diabetic patients diagnosed according to WHO criteria and confirmed by repeat
testing.
2. Study setting:
Survey will be conducted in 3 medical units of Allied Hospital, Faisalabad, a tertiary care
hospital in Faisalabad, a densely populated city of Pakistan.
3. Study duration:
Data collection for this study will be carried out during the time period of one and a half
month from 01-03-2020 to 15-04-2020. We will be visiting medical units, selecting
population, collecting data, analysing data and compiling results in this duration.
4. Sample size and Sampling method:
Target population for this study will be diabetic patients of Pakistan since the
conventional and non-medicinal health seeking practices of diabetic patients of Pakistan
will be studied. Sample for this study will be the diagnosed patients of diabetes mellitus
seeking medical treatment in medical units of Allied Hospital Faisalabad. 30 patients will
be interviewed and made to fill the questionnaire.
Simple random sampling technique will be used.
 5. Inclusion and exclusion criteria:
Only above 18 years of age diabetic patients diagnosed according to WHO criteria and
confirmed by repeat test and admitted to medical unit wards will be included in the
study. Among them, data of only patients using remedies before medical treatment will
be included in study.
Patients having any co-morbid condition beside diabetes mellitus will not be included in
study. No patient will be included in this study against his will.
6. Operational definitions:
Diabetes: is having a blood glucose level of greater than or equal to 126 milligrams per
decilitre (mg/dL) after an eight-hour fast (not eating anything), or by having a non-fasting
glucose level greater than or equal to 200 mg/dL along with symptoms of diabetes, or a
glucose level of greater than or equal to 200 mg/dL on a two-hour glucose tolerance test, or an
A1c greater than or equal to 6.5%.
7. Data collection procedure:
Data will be collected after written and duly signed consent from respective medical unit
incharges. Coordination with staff responsible for indoor admissions procedure will be
done to get information about number of diabetic patients admitted and their details
(like bed numbers). Patients will be personally approached and interviewed for checking
their eligibility according to inclusion criteria and for taking the informed consent from
them in written. A questionnaire will be filled for each patient based on information
provided by them in interview.
8. Data analysis plan:
We will be analysing the collected data using SPSS. We will get the frequencies of each
type of health seeking practice used by patients before turning to proper medical
consultation with qualified healthcare provider. We will also get the percentage
prevalence or popularity of each practice. We will present this data making a pie chart.

Ethical Considerations:
Written free informed consent will be taken from patients before including them to
study. The names and identities of patients will be preserved and guarded. No patient
will be forced to participate in study against his will.

Refrences:
1.
Bhatti, F., NaseemAkhtar, Rasheed, U. & humayun, S., 2011. Prevalence and risk factors for diabetes
mellitus in a selected urban population of a city in Punjab. Journal of Pakistan Medical
Association(JPMA).

2.Brutsaert, E. F., 2019. MSD Manual Professional Version. [Online]

Available at: https://www.msdmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-
mellitus-and-disorders-of-carbohydrate-metabolism/complications-of-diabetes-mellitus
[Accessed 17 feburary 2020].

3.Egede, L. E., Ye, X., Zheng, D. & D.Silverstein, M., 2002. The Prevalence and Pattern of Complementary
and Alternative Medicine Use in Individuals With Diabetes. Diabetes Care, 25(2), pp. 324-329..

4.Gokuldas V. Sawant, P. R. K., 2016. A study of knowledge, practices and treatment seeking behaviour
among diabetic patients. International Journal of Community Medicine and Public Health, 3(3).

5.International Diabetes Federation, 2019. International Diabetes Federation. [Online]

Available at: https://www.idf.org/aboutdiabetes/what-is-diabetes/facts-figures.html?
fbclid=IwAR1vWjMOHykWO7mpMviM1sBSk5GGIXz10bp98_CAdrxeHA55nND1KEOumTM
[Accessed 14 feburary 2020].

6.Kamran, M., Khan, Z. & Ismail, M., 2019. Complementary and Alternative Medicines Use in Diabetes
Mellitus: A Descriptive Cross-Sectional Study in Pakistan. World Journal of Pharmaceutical Sciences ,
7(3), pp. 142-151.

7.Kesavadev, J., 2017. Efficacy and safety concerns regarding Complementary and Alternative Medicine
use among diabetes patients. Journal Of Pakistan Medical Association(JPMA), 67(2).

8.Khan, A. & Junaid, N., 2017. Prevalence of diabetic foot syndrome amongst population with type 2
diabetes in Pakistan in primary care settings. Journal Of Pakistan Medical Association.

9.Kharroubi, A. T. & Darwish, H. M., 2015 . Diabetes mellitus: The epidemic of the century. World J
Diabetes, p. 850–867.

10.Mayoclinic, n.d. mayoclinic. [Online]

Available at: https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-
20371444?fbclid=IwAR1jF4YUZm8P9-M-WlUDyal0TtWcoFq1sfGB_ucwGbPbjbFMnXX-8K4zUyY
[Accessed 14 feburary 2020].
11.Meo, S. A., Zia, I., bukhari, I. A. & Arain, S. A., 2016. Type 2 diabetes mellitus in Pakistan: Current
prevalence and future forecast. Journal of the Pakistan Medical Association.

12.SA, M., Zia, I., Bukhari, I. A. & Arain, S. A., 2016. Type 2 diabetes mellitus in Pakistan: Current
prevalence and future forecast. Journal of the Pakistan Medical Association, pp. 1637-1642 .

13.wikipedia, 2020. wikipedia,the free encyclopedia. [Online]

Available at: https://en.wikipedia.org/wiki/Geography_of_Pakistan?fbclid=IwAR0kz16lY-
_qe_hu4G30QiGdKgH3rqikRXHyF-wThMmug-G-2xHNocQk-W0.
[Accessed 14 feburary 2020].

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15.Worldometer, n.d. Worldometer. [Online]

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