"Health Is Not Valued

CHAPTER 1
INTRODUCTION
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INTRODUCTION
“HEALTH IS NOT VALUED TILL SICKNESS COMES”
-THOMAS FULLER
Corona viruses are structurally wrapped viruses with a single RNA genome
that cause illness ranging from the common cold to more severe disease such as Middle
East Respiratory Syndrome (MERS- COV) and Severe Acute Respiratory Syndrome.
This novel Corona virus is a new strain that has not been previously identified in
humans1. COVID – 19 is the name of this new viral disease which was declared by
WHO on 11 February 2020, following guidelines previously developed with the world
organization for animal health and the food and agriculture organization of the united
nation (FAO). Common symptoms are fever, cough, and shortness of breath. COVID-19
cause severe health problem issues for adult over the age of 60 particularly fatal for
those 80 years also people having underlying health condition like Diabetes, heart
disease and other chronic illness. Regardless of the age all should take the precautious
the young and the healthy people seem to be less affected by COVID-19 than other
groups, they are still literally to be the carriers of the diseases. They can still be
contagious looking for local resources to support those vulnerable to COVID-19 can be
a great way to limit exposure during this time 2. There are several human corona viruses
currently known including the new corona virus SARS CoV-2, which is in December
2019 was identified as the pathogens responsible for causing the new corona virus
disease (COVID-19). On March 11,2020 according the WHO COVID-19 was stated as
a global pandemic and on July 17,2020 there were a total of 13,616,593 confirmed cases
with 585,727 deaths worldwide. Patients with DM are more likely to acquire infections,
especially influenza and pneumonia. Similarly, they are more susceptible to certain
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complications when infected with pathogens, as they undergo alterations in the pro-
inflammatory state and constriction of the essential immune reactions 3. On 2nd April
(02.04.2020), 827,419 confirmed cases are officially reported in more than 200
countries or territories with 40,777 deaths. We conducted a scoping review to provide a
brief summary of the general characteristics of COVID19, as well as a more detailed
description and critical assessment of the association between this new infectious
disease and diabetes4.
When people with diabetes develop a viral infection, it can be harder to treat
due to fluctuations in blood glucose levels and, possibly, the presence of diabetes
complications. There appear to be two reasons for this. Firstly, the immune system is
compromised, making it harder to fight the virus and likely leading to a longer
recovery period. Secondly, the virus may thrive in an environment of elevated blood
glucose. Like any other respiratory disease, COVID-19 is spread through air droplets
that are dispersed when an infected person talks, sneezes or coughs. The virus can
survive from a few hours up to a few days depending on the environmental conditions.
It can be spread through close contact with an infected person or by contact with air
droplets in the environment (on a surface for example) and then touching the mouth or
nose (hence the common advice circulating on hand hygiene and social distancing).
Corona viruses are enveloped, positive single-stranded RNA viruses widely
distributed in humans and animals worldwide. Although most human corona virus
infections are mild, major outbreaks of two beta-corona viruses, severe acute
respiratory syndrome corona virus (SARS-CoV) in 2002-2003 and Middle East
respiratory syndrome corona virus (MERS-CoV) in 2012, have caused deadly
pneumonia, with mortality rates of 10% for SARS-CoV and 36% for MERSCoV 5. In
December 2019, clusters of pneumonia cases of unknown aetiology emerged in
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Wuhan, Hubei Province, China. Deep sequencing analysis from lower respiratory tract
samples indicated a novel corona virus as the causative agent, which was named
Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), and the disease it
causes called COVID-19. Although SARS-CoV-2 has shown phylogenetic and
clinical similarities with SARS CoV, the novel corona virus appears to have a higher
transmissibility and lower case fatality rates. On 30 January 2020, the World Health
Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of
International Concern, and on March 11, the epidemic was upgraded to pandemic 6. In
this study, our aim is to assess the knowledge regarding self management behaviour
among type II diabetic patients in prevention of COVID-19 and give
recommendations on how to limit the spread of the disease.
BACKGROUND OF THE STUDY
Corona viruses disease 2019 (COVID-19) be a highly infectious disease. It is
caused by a novel viruses belonging to a family known as corona viruses. This virus
was first identified in the month of December 2019 in Wuhan, China Hubei province
since it’s the first identification it has spread globally. It was declared a public health
emergency of international concern on January 30, 2020 by WHO. Despite all effort
the virus continues to spread and WHO declared pandemic on March 11, 2020.The
high prevalence of diabetes globally makes it a frequent co-morbidity in patients with
corona virus associated disease 2019 (COVID-19). Though diabetes increases the risk
of infection in general, most studies have reported prevalence of diabetes almost
similar to that in general population in patients with COVID-19 9. A meta-analysis of
eight trials in China showed that diabetes was present in 8% of 46,248 patients with
COVID-19. Understandably, prevalence of diabetes in patients with COVID-19 varies
by region, age and ethnicity. In a letter published in the New England Journal of
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Medicine, they explained that diabetes, on the one hand, is associated with increased
risk of covid-19 severity and mortality with 20 to 30% of patients who died with the
infectious disease reported to have diabetes. The first case of COVID-19 in India,
which originated from China, was on 30 January 2020. India is currently has the
largest number of confirmed cases in Asia.10
Diabetes mellitus (DM) is a disease and an international health threat, the
severity of which has increased in the last twenty years. In 1985, 30 million people
suffered from diabetes, and by 2010 that figure increased to 285 million 11. According
to the latest global estimate from the International Diabetes Federation that number of
affected patients in 2019 stands at 463 million. It is estimated that by 2045, around
700 million people will suffer from diabetes. Diabetes is the leading cause of end
stage renal disease, adult-onset blindness, and non-traumatic lower extremity
amputations. Diabetic complications cause more disability, and at the extreme, life
threatening disorders12.
In early December 2019, the first pneumonia cases of an unknown origin
were identified in China. The pathogen has been identified as a novel enveloped RNA
beta corona virus. Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2)
pneumonia quickly became a newly recognized illness that was spreading rapidly
throughout Wuhan (Hubei province) to other provinces in China, and continues to
spread around the world. The World Health Organization (WHO) pronounced the
official name of SARS-CoV-2-induced disease as the corona virus disease 2019
(COVID-19). By April 28th 2020, the number of patients has risen sharply– 2,959,929
people are infected with this virus and the official death toll stands at 202,733. Fever,
dry cough, dyspnoea, fatigue, and lymphopenia are identified as the symptoms of
patients with COVID-19. Clinical manifestations are very similar to those of severe
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acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome
(MERS) It is mainly transmitted by droplets or direct contact, faeces and infected
through the respiratory tract. Due to novelty of disease, the factors affecting the
severity of status and death remain unknown. Nevertheless, it is assumed that patients
with underlying health conditions, people of older age, and delayed referral to a
hospital all contribute to the severity of the symptoms. Patients with underlying health
conditions such as high blood pressure and diabetes are considered as the high risk
group for catching the novel corona virus. Furthermore, it is considered that such
patients are more likely to suffer further complications and the risk of death from
COVID-19 is higher in this group13. COVID-19 also has indirect effects on people
with underlying health conditions. For instance, as COVID-19 continues overwhelm
many health care systems across the globe, large number of non-COVID-19 patients
are left without the necessary health care service they need due to their previous
conditions. Furthermore, many have been affected by the reduced physical activities
caused by the lockdowns introduced by most governments across the globe – which is
of specific importance for those who suffer from diabetes. All of these implications
should be considered problematic as they increase the risk of infections,
hospitalization, amputations, and possibly death in diabetes patients.
The increased rate of those suffering from diabetes combined with the
prevalence of COVID-19 suggests that the care for diabetic patients must be increased
in order to reduce any further complications and the risk of death. Due to a lack of
studies on the relationship between COVID19 and diabetes, it is difficult to suggests
how exactly that increased care should look like. Thus, in this paper, we aim to fill the
lacunae in the existing literature, and conduct a study that reviews current evidence
and provides guidelines for prevention and treatment of people affected by both
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COVID-19 and diabetes. This study aims to assess the current level of knowledge
regarding self management behaviour in prevention of COVID 19 among type II
diabetes mellitus. This is a descriptive study; a set of questionnaires is used as a tool to
analysis the level of knowledge regarding self management behaviour in prevention of
COVID-19 among type II DM patients. Findings from the study show that knowledge
regarding self management behaviour in prevention of COVID-19 among type II
diabetes mellitus is satisfactory. Yet a significant number of participants are lacking
confidence. The increased rate of those suffering from diabetes combined with the
prevalence of COVID-19 suggest that the care for diabetic patients must be increased
in order to reduce any further complication and risk of death14.
NEED OF THE STUDY
COVID-19 is caused by the corona virus SARS-CoV-2, which has spread
quickly more than 160 countries across the world. The spreading mechanism of the
virus is primarily by transmission of respiratory droplets between people. The people
with diabetes are more prone to COVID-19. Moreover, even in those with the
infection such as COVID-19, which lead to pneumonia, the chances of a secondary
bacterial infection complicating the viral pneumonia is there. Hence people with
diabetes should take particular precautions with respect to COVID-19, as they have a
slightly immune compromised state5. Nurses are aware of the challenges of delivering
high quality care at a time of pandemics and have demonstrated how they can improve
productivity with sustained high quality.
For instance, COVID-19 continues overwhelm major health care system across
the globe, a large number of non COVID-19 patients are left without the necessary
health care services they need due to their previous condition. Furthermore, many
have been affected by the reduced physical activities caused by the lockdown
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introduced by most governments across the globe – which is of specific importance
for those who suffer from diabetes15.All of this implications should be considered
problematic has thereby increase the risk of infections, hospitalization, amputations,
and possibly death in diabetes patients. Due to a lack of study on the relationships
between COVID-19 and diabetes, it is difficult to suggest how exactly that increased
care should look like. Thus it is indeed to assess the knowledge and provide
prevention guidelines regarding COVID-19 for people who suffering from diabetes
mellitus16.
STATEMENT OF PROBLEM
A study to assess the knowledge regarding self management behaviour among
type II diabetes mellitus patients in prevention of COVID-19 at selected area,
Alappuzha with a view to develop an information booklet.
OBJECTIVES
 To assess the knowledge regarding self management behaviour in prevention of
the COVID-19 among type II diabetes patients at selected area, Alappuzha.
 To find out the association between the knowledge regarding self management
behaviour in prevention of the COVID-19 among type II diabetes patients with
selected demographic variable.
 To develop an information booklet regarding self management behaviour in
prevention of the COVID-19 among type II diabetes patients.
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OPERATIONAL DEFINITIONS
Assess: To judge or decide the amount, value, quality or importance of something. In
this study assess; means to identify knowledge regarding self management behaviour
in prevention of COVID19 among type II diabetes patients at selected area Alappuzha.
Knowledge: Facts, information and skills acquired through experience or education,
the theatrical or practical understanding of a subject. In the study, knowledge means
awareness about self management behaviour in prevention of COVID19.
Self management behaviour: Is the ability to monitor and adjust one’s own
behaviour In this study, the self management behaviour means the use of mask,
maintain hygiene, proper hand washing and social distancing, self monitoring of
glucose level, physical activity, diet.
Type II diabetes mellitus patients: It refers to the clients diagnosed with type II
Diabetes mellitus (NIDDM) for more than 5 years, and residing at selected areas,
Alappuzha.
Information booklet: A small, thin book with paper covers, physically giving
information on a particular subject.
ASSUMPTION
Assumptions are the declarative statement about a phenomenon which are
largely believed to be true even in the absence of significant facts. In this study,
assumptions are: Type II diabetes patients will have some knowledge regarding self
management behaviour in prevention of corona virus.
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HYPOTHESES
Hypotheses were tested at 0.05 level of significance. There will be significant
association between the level of knowledge regarding self management behaviour
among type II diabetes patients in prevention of COVID-19 with selected
demographic variables.
CONCEPTUAL FRAMEWORK
General systems theory (GST) was outlined by Ludwig von Bertalanffy
(1968). Its premise is that complex systems share organizing principles which can be
discovered and modelled mathematically. Conceptual framework indicates how the
researcher views the concepts involved in the study especially the relationship among
concepts. The conceptual framework used in the study is Ludwig von Bertalanffy
General System Theory. The systems theory focuses on understanding the
organization as an open system that transforms inputs into outputs. System theory
provides approach to understanding, analyzing and thinking about organizations.
Systems theory views an organization as an organism made up of numerous parts
(subsystems) that must work together in harmony. Communication mechanisms must
be in place for organizational systems to exchange relevant information with its
environment. The basic elements of system theory are input, throughput, output,
process and feedback.
 Input is the energetic import which is processed to yield a productive outcome.
 Throughput is the work done on those resources used to produce a result.
 Output is the exist or change in existing system.
 Feedback is the information about a reaction to a product–Positive or Negative
feedback.
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FIGURE 1: Conceptual framework based on Ludwig von
Bertalanffy-General system theory
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CHAPTER 2
REVIEW OF LITERATURE
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REVIEW OF LITERATURE
A literature review is an evaluative report of information found in the literature
related to selected area of study. The review describes, summarizes, evaluates and
clarifies this literature. It gives a theoretical base for the research and helps to
determine the nature of the research.
[Queensland University, 1999]
The literatures related to the study are organized under the following headings:
 Studies on knowledge regarding COVID-19 among diabetes patients.
 Studies about prevention and management of COVID-19 among diabetes
patients.
 Studies on knowledge regarding COVID-19 among diabetes patients.
An article was published in PubMed regarding search to review and analyze
the data regarding the association between diabetes and COVID-19, pathophysiology
of the disease in diabetes and management of patients with diabetes that develop
COVID-19 infection on April 2020. Full texts of the articles say that there is evidence
of increased incidence and severity of COVID-19 in patients with diabetes. COVID-
19 could have effect on the pathophysiology of diabetes. Blood glucose control is
important not only for patients who are infected with COVID-19, but also for those
without the disease. Innovations like telemedicine are useful to treat patients with
diabetes in today's times.18
A cross sectional study was conducted in Taiwan between May 2020 and June
2020 to assess the risk factor which contributes to the severity and mortality of
COVID-19. A systemic random sampling strategy was carried out and the data was
collected through self-administered questionnaire of knowledge and attitude of
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general public regarding COVID 19. A total of 338 people had a mean score of
knowledge and attitude of 5 - 10 and 1- 4 respectively. They showed a good level of
knowledge and positive attitude. Approximately two third of the participants know
that diabetes, heart disease, elderly population etc can be the risk factors of
covid19.However the level of knowledge and attitude is lower than that expected for
their position level towards the virus. Additional education, intervention and campaign
are required for health care workers.19
A study was conducted to summarize the evidence about diabetes mellitus and
COVID - 19 outbreak through a systematic review and meta-analysis approach. A
literature review was implemented within databases of Scopus, PubMed, Science
direct, and Web of science (June 2020). Observational reviews, case-report, and case
series studies that assessed the diabetes in COVID-19 patients, were included. Data
extraction and assessment were guided by PRISMA checklist. Findings are some
studies suggest that there were no significant differences in symptoms between
patients who suffered from both diabetes and COVID-19 and those who only suffered
COVID-19. In the subsequent meta-analysis 14.5 % of the subjects were diabetic
patient. These clients have poor ARDS prognosis, severe symptoms, and the death
rate is higher among COVID-19 patients. The results of this study show that diabetes
is a risk factor – and contributes to the severity and mortality of patients with
COVID19. This paper also provides recommendations and guidelines which could be
useful for prevention and treatment of diabetic patients affected by COVID-19.20
A web-based-cross-sectional study was conducted among 1231 Yemeni HCPs
on July 2020 The COVID-19 related questionnaire was designed using Google forms
where the responses were coded and analyze during the Statistical Package for the
Social Sciences software package (IBM SPSS), version 22.0. Descriptive statistics and
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Pearson’s correlation coefficient test were also employed in this study. The results
further revealed that the majority of respondents had adequate knowledge, optimistic
attitude, moderate level of anxiety, and high-performance in preventive behaviours,
69.8, 85.10%, 51.0 and 87.70%, respectively, towards COVID-19.21
A descriptive study based on national databases in comparison with official
statistics announced by the World Health Organization, collected online, SQL
aggregated, and real-time access through a series of relevant questionnaires.
According to statistics, the incidence of diabetes in Iran is close to 11% of the
population over the age of 25. The results showed that about 9.5% of hospitalized.
Patients with Covid-19 were diabetics with 10%death cases subsequently. The cost of
hospitalization in this group showed a 12% higher rate, with 14.5% longer
hospitalization duration. According to the results, the mortality rate, treatment costs,
and average duration of hospitalization for diabetics involved with corona virus stay at
a higher level in relation to other cases. It necessitates a sophisticated solution to
control and monitor the situation to develop a special policy framework in the
management of emergencies in these type of patients.22
A survey was conducted in China, to find out whether the co-morbidities are a
predictor of mortality in COVID-19. And the findings are mortality seems to be about
threefold higher in people with diabetes compared with the general mortality of
COVID-19 in China. In addition to diabetes, the other common co-morbidities were
hypertension, in about 20% of cases, cardiovascular disease (16%), and lung
disease(6%). Indeed, people with diabetes are a high-risk group for severe disease.
Notably, diabetes was also a risk factor for severe disease and mortality in the
previous SARS, MERS (Middle East respiratory syndrome) corona virus infections
and the severe influenza A H1N1 pandemic in 2009.23
15
According to the available evidence, people with diabetes do not have a higher
susceptibility to SARS-CoV-2 infection. However, observations in the recent
COVID19 pandemic are comparable to those from other epidemics, with higher rates
of complications and mortality among patients with diabetes. Hypertension, diabetes,
coronary artery disease and cerebro-vascular disease were the main associations with
severe disease (present in 23.7%, 16.2%, 5.8% and 2.3%, respectively, of people
severely affected by COVID-19) and mortality rate (53.8%, 42.3%, 19.2% and 15.4%,
respectively, of people who died with the infection). Immuno-compromised state,
obesity and tobacco smoking are other risk factors for severe disease and death.24
The COVID-19 infection is a double challenge for people with diabetes.
Diabetes has been reported to be a risk factor for the severity of the disease and at the
same time patients have to control glucose in a situation with a decreased and more
variable food intake. COVID-19 is caused by the corona virus SARS-CoV-2 (severe
acute respiratory syndrome coronavirus-2), which has spread quickly to more than 160
countries across the world. The spreading mechanism of the virus is primarily by
transmission of respiratory droplets between people. The incubation time is on
average 6–8 days, followed by 1–2 weeks of symptomatic disease. It is characterized
by a wide spectrum of symptoms including coughing, fever, myalgia and respiratory
problems such as viral pneumonia, and respiratory failure. In worst cases, these can
lead to death. 25
16
 Studies about prevention and management of COVID-19 among diabetes patients.
A cohort study was conducted at district hospital, Italy on April 2020 to briefly
review the general characteristics of the novel corona virus (SARS-CoV-2) and provide
a better understanding of the corona virus disease (COVID-19) in people with diabetes,
and its management. Results shows that the clinical spectrum of COVID-19 is
heterogeneous, ranging from mild flu-like symptoms to acute respiratory distress
syndrome, multiple organ failure and death. Older age, type II diabetes mellitus and
other co-morbidities are reported as significant predictors of morbidity and mortality.
No conclusive evidence exists to support the discontinuation of angiotensin-converting
enzyme inhibitors (ACEI), angiotensin receptor blockers or thiazolidinediones because
of COVID-19 in people with diabetes. Caution should be taken to potential
hypoglycemic events with the use of chloroquine in these subjects. Patient tailored
therapeutic strategies, rigorous glucose monitoring and careful consideration of drug
interactions might reduce adverse reactions.26
A cohort study was conducted in Wuhan, China on February 2020 to shows the
origination of nCoV in connection to a seafood market in Wuhan, but specific animal
association has not been confirmed. The study aimed for the better understanding of
the epidemiology, causes, clinical diagnosis, prevention and control of the virus. And
the major findings are the nCoV has been identified as the cause of an outbreak of
respiratory illness in Wuhan, Hubei province, China beginning in December 2019.
This epidemic had spread to 19 countries with 11791 confirmed cases including 213
deaths as of January 31, 2020. The WHO declared it as a public health emergency of
international concern. Preventive measures such as masks, hand hygiene practices,
avoidance of public contact, case detection, contact tracing and quarantine are the
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recommended for reducing the transmission. To date, no specific antiviral treatment is
proven effective, hence infected people primarily relay on Symptomatic treatment and
supportive care. Studies provide evidence on prevention and control measures are
urgently needed to minimise the impact of the outbreak.27
A recent study from China during the COVID-19 pandemic has shown that
elderly subjects with type II diabetes mellitus experienced worsening of glycemic
control manifesting as higher fasting blood glucose. The impact of social distancing,
quarantine and lockdown on lifestyles would have probably led to worsening of
glucose control. Firstly, lockdown and social distancing meant for community
containment would have limited the physical activities of the people with DM.
Secondly, restriction in food supplies during the lockdown would have compelled
people with DM to alter their dietary habits that were earlier associated with good
glycemic control. Thirdly, procurement of anti-diabetic medications and glucose strips
would have been difficult amid the ongoing restrictions. Lastly, people with diabetes
mellitus would not have been able to visit their physicians for routine clinic followups;
hence, fine-tuning of anti-diabetic medications would not have been possible. This
would have led to sustained periods of hyperglycemia (and probably frequent episodes
of hypoglycemia that were not looked into in this study) which would have been left
unaddressed in the absence of in-clinic consultations.28
An observational study was performed on the impact of Diabetes Mellitus on
management and outcome of COVID-19 infection, June 2020.The study was designed
to compare treatment strategy and outcome for COVID-19 infection among patients of
diabetes mellitus and non-diabetics. A total of 1,048 admitted COVID-19 patients
were enrolled for the present study. COVID-19 patients were categorized into four
groups namely: group 1 of all diabetic patients, group 2 of all non-diabetic patients,
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group 3 had patients with isolated DM after exclusion of other co-morbidities and
group 4 included non-diabetic patients without other co-morbidities. And it was also
observed that COVID-19 patients with type II diabetic mellitus often required more
intensive treatments like lopinavir-ritonavir combination (p = 0.0142), convalescent
plasma (p = 0.0394), tocilizumab therapy (p = 0.0238) and other supportive treatment
like oxygen therapy (p = 0.0182) and non-invasive ventilation (p = 0.0394). As
compared to a non-diabetic group of patients. Diabetic mellitus patients exhibited
significantly lower recovery but higher mortality rates as compared to the non-diabetic
group (< 0.001). COVID-19 infected diabetics required more time for discharge from
hospital than the non- diabetic group (p = 0.007).29
Stefani Agustin Parapasan, Rossalia Artasya published an article in Journal
Penelitian Perawat Professional with an aim to provide information on the
management of COVID-19 patients with diabetes. The method used is literature
reviews from books, international journals, and websites. Literature sources were
searched through the NCBI and Google Scholar databases with the keywords
COVID19, SARS-Cov-2, diabetes mellitus, management of COVID-19 with diabetes,
management of COVID-19, management of diabetes. The literature obtained total 19
articles from 2017 to 2020. The results of the literature review show that diabetic
patients with COVID-19 must stick to the medication regimen that has been
prescribed, control glucose levels regularly, carry out screening, and live a healthy
lifestyle so that therapeutic goals can be achieved. A treatment strategy that focuses on
anti-inflammatory as a treatment for COVID-19 and keeps the host's immune response
in balance is the best treatment in eliminating COVID-19. Also, patients need to stick
to recommended drugs and control their blood glucose levels regularly during this
pandemic.30
19
PubMed and Google Scholar databases,02 April 2020 provide a better
understanding of the corona virus disease (COVID-19) in people with diabetes, and its
management. Results of the clinical spectrum of COVID-19 are heterogeneous,
ranging from mild flu-like symptoms to acute respiratory distress syndrome, multiple
organ failure and death. Older age, diabetes and other co-morbidities are reported as
significant predictors of morbidity and mortality. Chronic inflammation, increased
coagulation activity, immune response impairment, and potential direct pancreatic
damage by SARS-CoV-2 might be among the underlying mechanisms of the
association between diabetes and COVID-19. Caution should be taken to potential
hypoglycemic events with the use of chloroquine in these subjects. Patient tailored
therapeutic strategies, rigorous glucose monitoring and careful consideration of drug
interactions might reduce adverse outcomes. Suggestions are made on the possible
pathological mechanisms of the relationship between diabetes and COVID-19, and its
management. No definite conclusions can be made based on current limited evidence.
Further research regarding this relationship and its clinical management is warranted 31
World Health Organization reports that the corona virus disease 2019
(COVID-19) pandemic has emerged as one of the greatest challenges faced by
humankind in the recent past. People with diabetes and related co-morbidities are at
increased risk of its complications and of COVID-19-related death. Older age, multi-
morbidity, hyperglycemia, cardiac injury and severe inflammatory response are
predictors of poor outcome. Most patients experience a mild illness with COVID-19,
while people with diabetes are at increased risk of severe disease. Optimising
glycemic control and adopting measures to prevent disease spread are critical aspects.
The management of mild disease is supportive, while very many immuno-modulatory
and antiviral therapies are being investigated for the treatment of severe disease. Since
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mass population lockdowns are considered a key step in controlling disease spread, it
follows that, in addition to the direct vulnerability to severe COVID-19, people with
diabetes can be affected by limited access to healthcare, insulin, other medications and
blood glucose monitoring equipment. This review summarizes the current knowledge
and perceived challenges for prevention and management of COVID-19 in people
with diabetes32.
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CHAPTER 3
METHODOLOGY
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METHODOLOGY
RESEARCH METHODOLOGY
Research methodology is a way to systematically solve the research problem.
The various steps or strategies used for gathering and analyzing data in research
investigations are known as method of collection. Research methodology describes
research design, setting, population, sampling technique, development of tool, pilot
study and procedure for data collection and plan for data analysis. This chapter deals
with the methodology selected for the study.
RESEARCH APPROACH
A quantitative approach was used to assess the knowledge regarding the self
management behaviour among type II diabetes mellitus patients in prevention of
COVID-19.
RESEARCH DESIGN
Research design refers to the overall strategy utilized to carry out research that
defines a succinct and logical plan to tackle established research question through the
collection, interpretation, analysis, and discussion of data. Descriptive research design
was used in this study.
VARIABLE
Variables are anything that has quantity and quality that varies. Variables are
qualities or properties or characteristics of person, things or situations that change or
vary. In this study variable is :
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Research Variable:
Knowledge regarding self management behaviour in prevention of COVID-19.
SETTING OF THE STUDY
The study setting is the location in which the research is conducted. The study
was conducted in selected community areas in Alappuzha district.
POPULATION
A population can be defined as the total number of units from which the data
can be potentially collected. The population under the study were type II diabetes
mellitus patients at selected community area in Alappuzha.
SAMPLE
It is the subset of population selected to participate in a study. The sample of
the present study consists of 50 type II diabetes mellitus patients from selected areas.
SAMPLING TECHNIQUE
The sampling technique helps to draw a sample that will help to represent the
characteristics of the population from which the sample is drawn. The sample for the
study was selected by convenient sampling technique.
Inclusion Criteria:
1. Patients who are diagnosed with type II diabetes mellitus with long duration more
than 5 years.
2. All female and male patients with type II DM
Exclusion Criteria:
1. Patients who are not willing to participate in the study.
2. Recently diagnosed type II diabetes mellitus patients.
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TOOL/INSTRUMENTS
A tool is a device used to measure the concept of interest in a research project
that a researcher used to collect.
Development /selection of a tool
TOOL 1: Socio demographic variable:
It consists of questions regarding age, religion, family income etc.
TOOL 2:
Knowledge questionnaire in prevention of COVID19 which contains 32 questions
For the selection of items and preparation of tool, following steps were taken.
 Review of research and non research literature on the area.
 Opinion and suggestion from experts.
DESCRIPTION OF THE TOOL
The tool consists of two parts:
Section A: Socio demographic data
It consists of age, religion, family income etc.
Section B: Knowledge questionnaire regarding prevention of COVID19:
Total 32 objective type questions are prepared regarding self management
behaviour in prevention of COVID19 in different aspects.
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DATA COLLECTION PROCESS
Phase – 1
After getting approval from concerned authority for the study, demographic
data, and questionnaire are designed and prepared.
Phase – 2
The study conducted among type II diabetes mellitus patients in selected areas
of Alappuzha, District and during that time 50 samples are selected according to
convenient sampling techniques. In this phase researcher explain about study and its
purpose to samples and obtained informed consent for their participation. Then the
tool was administered.
PLAN FOR DATA ANALYSIS
The data obtained was planned to be analyzed by both descriptive and
inferential statistics on the objectives of the study. To compute the data, a master sheet
was prepared by the investigator.
The data would be analyzed in terms of descriptive statistics(frequency,
Percentage, Mean, Median, Standard deviation, and inferential statistics(chi-square
test)
Section 1: Data on baseline character was analyzed by frequency and percentage
would be presented in tables.
Section 2: Structured questionnaire to assess knowledge regarding prevention of
COVID-19. The knowledge regarding prevention of covid-19 among type2 diabetes
mellitus patients were analyzed.
Section 3: Association of knowledge of prevention of COVID 19 among type II
diabetes mellitus patients.
26
PILOT STUDY:
A small preliminary investigation of some general character as the major
study, which is designed to acquaint the researcher with problems that can be
corrected in preparation for the main research projects for collecting data is known as
a pilot study. A pilot study was conducted during the month of August. 5% of the
main study sample size has been taken for the pilot study. These 5% participants were
excluded from main study. The language of the tool was found to be clear and the
items in the tool were clearly understood by the subjects without ambiguity. Hence the
tool was found to be feasible and practicable for the study after the pilot study. The
researcher selected 5 type II diabetes patients in Alappuzha district who fulfilled the
inclusion criteria as samples for the study by using convenient sampling technique.
After a brief self introduction, the researcher explained the purpose of the study and
obtained consent from them. The researcher used structured questionnaire schedule to
collect the demographic data and also assessed the level of knowledge of the subjects
using the structured interview method. The time taken to interview a subject was
about 10 minutes and to complete the pilot study for 5 samples it took 1 hour. Data
collected were analyzed and the results indicated that there was a moderate level of
knowledge regarding prevention of COVID-19 among type II diabetes patients. The
subjects were comfortable and cooperated well during the study. Thus the feasibility
of the study was clearly known.
27
SETTING
RESEARCH RESEARCH Selected
POPULATI
APPROACH DESIGN community ON
Quantitative Descriptive area - Type II
approach design Alappuzha diabetes
district mellitus
patients
DATA TOOL
COMMUNICT
ANALYSIS Tool 1 -
ION OF
FINDINGS Descriptive Questionnair
Research
and e(to collect
reporting inferential demographic
statistics data)
28
CHAPTER - 4
ANALYSIS AND
INTERPRETATION
ANALYSIS AND INTERPRETATION
Analysis is the process of organizing and synthesizing data so as to answer
research question and test hypothesis. Analysis is a method of organizing data in such
a way that research question can be answered and hypothesis can be tested. Analysis is
29
the process of breaking a complex topic into smaller parts to gain better understanding
to it.
STATEMENT OF THE PROBLEM
OBJECTIVES OF THE STUDY
 To assess the knowledge regarding self management behaviour in prevention
of COVID-19 among type II diabetic patients at selected area, Alappuzha.
 To find out the association between the knowledge regarding self management
behaviour in prevention of COVID-19 among type II diabetes patients with
selected demographic variable.
 To develop an information booklet regarding self management behaviour in
prevention of COVID-19 among type II diabetic patients.
HYPOTHESIS
There will be significant association between the level of knowledge regarding
self management behaviour in prevention of COVID19 among type II diabetes
patients with selected demographic variables.
30
ORGANIZATION OF FINDINGS
Data is analyzed and presented under the following headings :
Section A: Distribution of subjects based on socio- demographic variables
Section B: Distribution of subjects based on the knowledge about prevention of
COVID -19 among type II diabetes mellitus patient.
SECTION A: DISTRIBUTION OF SUBJECTS BASED ON SOCIO-
DEMOGRAPHIC VARIABLES
The section deals with distribution of subjects based on socio demographic variables
like age, sex, religion, marietal status, type of family, area of residence, education,
occupation and income.
31
Table -1: Frequency and percentage distribution of subjects based on socio-
demographic variable
32
SI no. Variables Frequeny Percentage
1. Age
30-40 yrs 7 14%
41-50 yrs 8 16%
51-60 yrs 15 30%
61 yrs and above 20 40%
2 Sex
Male 22 44%
Female 28 66%
3 Religion
Hindu 15 30%
Christian 32 64%
Muslim 3 6%
Others 0 0
4 Marietal status
Married 32 64%
Unmarried 2 4%
Divorced 1 2%
Widow/widower 15 30%
5 Type of family
Joint family 7 14%
Nuclear family 40 80%
Extended family 3 6%
6 Area of residence
Rural 44 88%
Table 1
Urban 6 12%
7 Education shows that
Primary 19 38% out of 50

High school level 19 38%
samples
Higher secondary level 6 12%
Graduation & above 6 12% majority of
8 Occupation subjects
Employed 17 34%
20(40%)
Unemployed 4 8%
Home makers 22 44% were under
Retired 7 14%
33
9 Income
Below 5000 16 32%
5001-10000 18 36%
the age group of 61 years and above,15(30%) were under the age group of 51-60
years, 8(16%) were under the age group of 41-50 years and 7(14%) were under the
age group of 30-40 years. From total population 22(44%) are males and 28(66%) are
females. Majority of them were Christians 32(64%),15(30%) Hindus and 3(6%)
Muslims. Out of the 50 samples, majority were married 32(64%),
2(4%)unmarried,1(2%) divorced and 15(30%) widow/widower. Most of them lived in
a nuclear family 40(80%), 7(14%) joint family and3(6%)extended family Majority of
the samples is residing in rural area 44(88%) and 6(12%) in urban area. Out of 50
samples 19(38%) are having primary and 19(38%)high school level of
education,6(12%) are having higher secondary and6(12%) graduation & above level
of education. Most of the samples are homemakers 22(44%),17(34%)employed,
4(8%) unemployed and 7(14%) retired. Majority 18(36%) had monthly income
between Rs5001-10000, 16(32%) are below Rs5000 and 16(32%) Rs10001& above.
34
AGE
14%
40% 61 years and above

16% 51-60 years
41-50 years
30-40 years
30%
FIGURE (3): DIAGRAMATIC REPRESENTATION OF SOCIO-
DEMOGARPHIC STATUS ( AGE)
Table 1 shows that out of 50 samples majority of subjects 20(40%) were under the
age group of 61 years and above,15(30%) were under the age group of 51-60 years,
8(16%) were under the age group of 41-50 years and 7(14%) were under the age
group of 30-40 years.
35
FIGURE (4): DIAGRAMATIC REPRESENTATION OF SOCIO-
DEMOGARPHIC STATUS (INCOME)
Majority 18(36%) had monthly income between Rs5001 - Rs10000, 16(32%) are
below Rs5000 and 16(32%) Rs10001& above.
36
Section B: Distribution of subjects based on knowledge about prevention of
COVID-19 among type II diabetes mellitus patients.
Knowledge questionnaire on prevention of COVID-19 among type II
diabetes mellitus patients which contains 32 questions. Each correct answer was given
1 mark and 0 mark for wrong answer. Total score for knowledge questionnaire is 32
marks.
SCORING CRITERIA FOR KNOWLEDGE QUESTIONNAIRE
The scoring was done based on the maximum and minimal score gained by the
sample.
Max. Possible score= 32
SCORE INFERENCE
21-32 GOOD
11-20 AVERAGE
1-10 POOR
37
Table – 2: Frequency, Percentage distribution of knowledge of prevention of
COVID -19 among type II diabetes mellitus patients.
SLNO. LEVEL OF KNOWLEDGE FREQUENCY %
1 GOOD 42 84%
2 AVERAGE 8 16%
3 POOR 0 0
38
FIGURE (5): DIAGRAMATIC REPRESENTATION OF FREQUENCY,
PERCENTAGE DISTRIBUTION FOR KNOWLEDGE OF PREVENTION
ABOUT COVID 19 AMONG TYPE II DIABETES MELLITUS PATIENTS
Table 2 shows that all the 50 samples selected for the study showed a knowledge
score in good and average range. 42(84%) of samples had good level of knowledge
regarding prevention of COVID19 and 8(16%)had average knowledge. None of the
sample had good knowledge regarding prevention COVID19.
39
FIGURE 6: Frequency and percentage distribution of subjects based on
socio-demographic variable
OCCUPATION
25
22
20
17
15
10
7
4
5
0
Employed Unemployed Homemakers Retired
FIGURE 6(a): Frequency and percentage distribution of subjects based on
socio-demographic variable (Occupation)
Figure 6(a) shows that most of the samples are homemakers
22(44%),17(34%)employed, 4(8%) unemployed and 7(14%) retired.
40
EDUCATION
40%
30%
20%
10%
0%
on on y on
ar
ati ati d ati
uc u c on uc
ed l ed sec ed
y er f
ar h oo gh elo
P rim sc
hH
i lev
gh e
Hi bov
a
d
an
on
uati
ad
Gr
FIGURE 6(b): Frequency and percentage distribution of subjects based on
socio-demographic variables (education)
Figure 6(b) shows that out of 50 samples 19(38%) are having primary and
19(38%)high school level of education,6(12%) are having higher secondary
and6(12%) graduation & above level of education.
41
FIGURE (7): Diagrammatic presentation on frequency and percentage
distribution of prevention of COVID-19 among type II diabetes patients
45
45
40
35
30
25
20
15
10
3
2
5 0
0
Option A Option B Option C Option D
FIGURE (7a):Ffrequency and percentage distribution of samples based on
the level of knowledge regarding the effect of social isolation.
Figure (7a) shows that out of 50 samples 3(6%) were answered option A
(visiting relatives house), none of them answered option B (maintaining
contact with relatives and friends via meetings), 2(4%) had answered option C
(participate in spiritual meetings) and 45(90%) were answered option
D(maintaining contact with relatives and friends via telephone).
42
24
25
20 15
15
7
10
4
0
FIGURE (7b): Frequency and percentage distribution of samples based on
the level of knowledge regarding the duration of isolation if you have
confirmed COVID19.
Figure (7b) shows that out of 50 samples 7(14%) were answered
option A(7days), 4(8%) were answered option B(10days), 24(48%) were
answered option C(24days) and 15(30%) were answered option D(30days).
43
47
3
0
0
Option A
Option B
Option C
Option D
FIGURE (7c) :Frequency and percentage distribution of samples based on
the level of knowledge regarding the on practices if symptomatic.
Figure (7c) shows that out of 50 samples 47(94%) were answered
option A (notify local healthcare services), but then, none of them answered
option B (take self medication) and option C (interact with others) whereas
3(6%) were answered option D(never inform to others).
44
41
45
40
35
30
25
20
15
5
10 2 2
0
FIGURE (7d): Frequency and percentage distribution of samples based on
the level of knowledge regarding the measures to prevent the spread of
COVID19
FIGURE (7d) shows that out of 50 samples 5(10%) were answered
option A(clean your hands frequently and thorough),2 (4%) were answered
option B(avoid touching your eyes, mouth and nose), 2(4%) were answered
option C (cover your cough with the bend of elbow or tissue)and 45(90%)
were answered option D (maintain a distance of at least 1m from others).
45
50
45
45
40
35
30
25
20
15
10
5 3
1 1
0
FIGURE (7e):Frequency and percentage distribution of samples based on
the level of knowledge regarding the precautions to be taken while
travelling during the corona virus disease outbreak
FIGURE (7e) shows that out of 50 samples 1(2%) were answered
option A( maintain hand hygiene and food hygiene),1 (2%) were answered
option B(wear mask),3(6%) were answered option C(social distancing)and
45(90%) were answered option D(all the above).
46
Table : 3 Frequency and distribution of prevention of COVID-19 among type II
diabetes patients
N =50
Slno Questions Frequ %
ency
1 What is COVID19?
a.an infectious disease cause severe respiratory problems 50 100%
b.epileptic disorders 0 0
c.severe GI distress 0 0
d.mental retardation 0 0
2 Which microorganism cause COVID19 infection?
a.bacteria 0
b.virus 50 100%
c.fungi 0 0
d.protozoa 0 0
47
3 Which is the causative agent of COVID19?
a.Nippah 0 0
b.corona virus 50 100%
c.influenza virus 0 0
d.ebola virus 0 0
4 What is the mode of transmission of COVID19?
a.droplet 47 94%
b.soil 0 0
c.water 3 6%
d.food 0 0
5 What is the incubation period of COVID 19?
a.5 days 4 8%
b.10days 3 6%
c.14days 38 76%
48
d.28 days 5 10%
6 What is the most common symptom of COVID19?
a.fever,drycough,breathing difficulty 46 92%
b.alopecia,sore throat,blurred vision 0 0
c.seizure,vertigo,insomnia 1 2%
d.diarrhea,stomach ache,vomiting 3 6%
7 Which one is a risk factor for developing severe
COVID-19 ?
a.hyperglycemia 24 48%
b.family history 1 2%
c.hyperlipidemia 1 2%
d.malnutrition 24 48%
8 Who is at high risk to get infected with Covid-19 ?
a. Elderly above 65 yrs and above 12 24%
49
b.people with uncontrolled diabetes 2 4%
c.People with other pre-existing diseases 2 4%
d.All of the above 34 68%
9 Why diabetic patients are more prone to get covid-19?
a.due to insulin therapy 2 4%
b.due to the altered glucose level 10 20%
c.due to the immunocompromised state 35 70%
d.none of the above 3 6%
10 What are the measures to prevent the infection in
people with diabetes?
a.monitor glucose level 0 0
b.adaptive lifestyle 5 10%
c.continue regular medication 15 30%
d.all of the above 30 60%
11 What should you do if you have a contact with a
50
patient who is infected with COVID19?
a.never inform to others 1 2%
b.self quarantine for 7 days 6 12%
c.self quarantine for 14 days 43 86%
d.take medication without doctors prescripition 0 0
12 When a health provider or a clinical staff tests for
COVID19 after how many days they can return to
work?
a.next day onwards after recovery

11 22%
b. after 3 days have passed recovery

0 0
c.after 5 days have passed since recovery

16 32%
d.. after 1month have passed recovery

23 46%
13 Which is a step to reduce the effect of social isolation?
a.visiting relatives house

3 6%
b.maintaining contact with relatives and friends via

0 0
meetings
51
c.participate in spiritual meetings
2 4%
d.maintaining contact with relatives and friends via

45 90%
telephone
14 How long should you isolate yourself if you have
confirmed COVID19?
a.7days 7 14%
b.10days 4 8%
c.24days 24 48%
d.30days 15 30%
15 What will you do if you develop symptoms suggestive
of covid-19?
a.notify local healthcare services

47 94%
b.take self medication

0 0
c.interact with others

0 0
d.never inform to others

3 6%
16 What are the measures to prevent the spread of
COVID19?
a.clean your hands frequently and thoroughly

5 10%
52
b.avoid touching your eyes, mouth and nose
2 4%
c.cover your cough with the bend of elbow or tissue

2 4%
d.maintain a distance of atleast 1m from others

41 82%
e.all the above
17 What precautions to be taken while travelling during
the corona virus disease outbreak?
a.maintain hand hygiene and food hygiene 1 2%
b.wear mask 1 2%
c.social distancing 3 6%
d.all the above 45 90%
18 What do you mean by self isolation?
a.avoid going for shopping 0 0
b.avoid talking to others 0 0
c.stay home and away from others if you have 40 80%
covid-19 symptoms
d.avoid unnecessary travelling 10 20%
53
19 What do you mean by self-quarantine?
a.stay at home with family members 0 0
b.wearing mask while going out 0 0
c.stay at home and away from others if you have been 45 90%
exposed to covid- 19 symptoms
20 How can you protect yourself and to prevent the
spread of infection?
a.take self medication 0 0
b.avoid talking to others 3 6%
c.drink plenty of water 3 6%
d.maintain a distance of atleast 1m from others 44 88%
21 How to keep the children healthy during COVID19
outbreak?
a.instruct them to wear mask while playing outside 7 14%
54
b.teach the children to wash their hands 3 6%
c.reach out to friends via phone call or video chat 1 2%
d. all of the above 39 78%
22 How long does it take to develop symptoms after
exposure to COVID19 ?
a.1-7 days 14 28%
b.1-14days 21 42%
c.14-28days 12 24%
d.more than 28 days 3 6%
23 How long does the virus survive on the surface?
a.upto 12hrs 10 20%
b.upto24hrs 16 32%
c.upto 48hrs 9 18%
d.upto 72hrs 15 30%
What precautions to be taken while going for a

24
55
shopping?
a.keep atleast 1m distance from others

3 6%
b.avoid touching your eyes,mouthand nose

5 10%
c.sanitize the handles of shopping trolleys or baskets if

2 4%
possible before shopping
d.all of the above

40 80%
How to wash fruits and vegetables?

25
a.wash with clean water

14 28%
b.wash your hands thoroughly with soap and water and

33 66%
then wash vegetables thoroughly with clean water
c.wash with alcohol based sanitizer

0 0
d.none of the above

3 6%
26 What are the safety precaution to be taken at
workplace during COVID19?
a.disinfecting the workplace 8 16%
b.limit the number of workers 2 4%
c.promote crowd workplace 1 2%
56
d.both a and b 39 78%
27 What are the emergency warning signs for COVID19?
a.difficulty in breathing,persistent pain in the chest,bluish 43 86%
lips or face
b.respiratory distress,stiffness of joint,conjunctivitis 4 8%
c.backpain,confusion,fainting 0 0
d. none of the above 3 6%
28 What are the main difficulties faced by pregnant
women during the period of COVID19?
a.unavailability of nutritious food 2 4%
b.difficulty to access to medical care in person 10 20%
c.transportation difficulties 1 2%
d.All of the above 37 74%
29 How to manage diabetes during lock down?
a.adequate physical activity 2 4%
b.maintain eating pattern 1 2%
57
c.ensure good stock of required medications 2 4%
30 Which type of physical activity is needed for a
Diabetic patient?
a.aerobic exercise 30 60%
b.heavy lifting exercise 1 2%
c.hazardous /straneous activity 1 2%
What are the guidelines for foot care in diabetes

31
patients?
a.regular foot assessment 7 14%
b.clean using warm water 13 26%
c. moisturize your feet 1 2%
32 How can we make our hands safe?
58
a.wash with soap and water. 11 22%
b.wash with plain water 1 2%
c. wash with soap and water and scrub for atleast 20 36 72%
seconds.
d.wipe hand with tissue paper or cloths 2 4%
Table 4 : Association of knowledge of prevention of COVID-19 among
type II diabetes mellitus patients.
Sl no Socio Scoring X2 df Level of
demographic
significance
Good Average Poor
variable
1 Age 1.83 6 0.935
30yrs – 40yrs 7 0 0
41yrs – 50yrs 8 0 0
51yrs – 60yr 12 3 0
61yrs andabove 15 5 0
59
2 Sex 1.39 2 0.5
Male 20 2 0
Female 22 6 0
3 Religion 1.82 6 0.935
Hindu 14 1 0
Christain 26 6 0
Muslim 2 1 0
Others 0 0 0
4 Marietal status 0.28 6 1
Married 26 6 0
Unmarried 2 0 0
Divorced 1 0 0
Widow/widower 13 2 0
60
5 Family 0.58 4 0.965
Joint family 6 1 0
Nuclear family 33 7 0
Extended family 0 0 0
6 Area of residence 0.002 2 1
Rural area 37 7 0
Urban area 5 1 0
7 Education 1.87 6 0.931
Primary school 16 3 0
High school 14 5 0
Higher secondary 6 0 0
Graduation and 6 0 0
above
8 Occupation 3.82 6 0.70
61
Employed 16 1 0
Unemployed 4 0 0
Homemaker 17 5 0
Retired 5 2 0
9 Income 0.22 4 1
Below 5000 14 2 0
5001-10000 15 3 0
10001 and above 13 3 0
The association of the knowledge score with the selected demographic variables
was computed using chi-square. The chi square present in the table 4 shows that there
is no significant association between selected demographic variables with knowledge
level among type II diabetes patients
SUMMARY
This chapter deals with the analysis and interpretation of finding of the study.
Analysis was done using descriptive statistics. Tables and graphical representation of
the distribution of students were based on socio demographic data. Frequency and
percentage was used to analyze the sample knowledge. Chi square was used to
analyze the association of the knowledge with the selected demographic variables .
62
CHAPTER-5
RESULT
63
RESULT
The study is used to assess the knowledge of prevention and management of COVID-
19 among diabetes patients in Alappuzha district. We conducted the study in
Alappuzha district and we taken 50 samples for our study. The knowledge level of
diabetic patients that was assessed by giving questionnaire regarding the management
of COVID-19.The findings shows that out of 50 samples majority of subjects 20(40%)
where under in the age group of 61 years and above,15(30%) where under the age
group of 51-60 years, 8(16%) where under the age group of 41-50 years, 7(14%)
where under the age group of 30-40 years. From total population 22(44%) are males
and 28(66%) are females. Majority of them where Christian 32(64%),Hindu 15(30%)
and Muslim 3(6%).out of the 50 samples, majority were married 32(64%), unmarried
2(4%), divorced 1(2%) and widow/widower 15(30%).Most of them lived in a nuclear
family 40(80%), joint family 7(14%) and extended family 3(6%).Majority of the
samples had their permanent residential area in rural area 44(88%) and 6(12%) in
urban area. Out of 50 samples 19(38%) are having primary and high school level of
education,6(12%) are having higher secondary and graduation & above level of
education. Most of the samples are homemakers 22(44%),employed 17(34%),
unemployed 4(8%) and retired 7(14%).Majority 18(36%) had monthly income

64
between Rs. 5001-1000,16(32%) are below Rs. 5000 and Rs. 10001&above.The 50
samples selected for the study showed a knowledge score in good and average range.
42(84%)of samples had good level of knowledge regarding prevention of COVID19
and 8(16%)had average knowledge. Majority sample had good and some had average
knowledge regarding prevention of COVID-19.There is no significant association
between selected demographic variables with knowledge level among type II diabetes
patients.
CHAPTER 6
DISCUSSION
65
DISCUSSION
STATEMENT OF THE PROBLEM
This chapter discuss the result of present study and compare the findings with
other related study. The findings of the study are discussed based on the objectives of
the study.
OBJECTIVES
 To assess the knowledge regarding self management behaviour in prevention of
COVID-19 among type II diabetic patient at selected area, Alappuzha
 To find out the association between the knowledge regarding self management
behaviour in prevention of COVID-19 among type II diabetes patients with selected
demographic variable.
 To develop an information booklet regarding self management behaviour in
prevention of COVID-19 among type II diabetic patients.
66
DISTRIBUTION OF SUBJECT BASED ON DEMOGRAPHIC VARIABLES
This study is used to assess the knowledge level regarding self management
behaviour in prevention of COVID-19 among type II diabetic patients at selected area,
Alappuzha. 50 samples were taken for the study. The study was conducted by
questionnaire to assess the knowledge level of type II diabetes mellitus patients, along
with health education to improve knowledge.
The findings of the study are majority of the type II diabetes mellitus patients
are in the age group of 61 years and above 20 (40%), in gender majority are females
28(56%), religion of 32(64%) in Christian’s, marital status of 32(64%) in married,
family type of 40(80%) in nuclear, residential area of 44(88%) in rural, education of
19(38%) primary and 19(38%) in high school, occupation of 22(44%) in house-
makers, income of 18(36%) in 5001-10,000 and 16(32%) in below 5000 and 16(32%)
in 10001 & above.
67
ASSESS THE KNOWLEDGE LEVEL OF TYPE II DIABETES MELLITUS
PATIENTS IN SELF MANAGEMENT BEHAVIOUR OF PREVENTION OF
COVID-19.
Score level was
SL.NO SCORE
1 28
2 26
3 28
4 20
5 17
6 26
7 25
8 26
9 26
10 22
11 22
12 24
13 24
14 21
15 23
16 24
17 13
68
18 23
19 23
20 24
21 23
22 26
23 25
24 23
25 24
26 22
27 24
28 23
29 24
30 27
31 22
32 23
33 20
34 23
35 22
36 25
37 12
38 24
39 24
40 25
41 22
42 21
43 23
44 23
45 18
46 22
47 20
48 25
49 14
50 23
69
SUMMARY
COVID-19 is a novel respiratory virus reported to be transmitted by animal-to-
human and human-to-human interaction. The viral outbreak is a pandemic resulting in
human deaths in enormous numbers. The development of the epidemic follows an
exponential growth in cases. COVID-19 causes a variety of symptoms in people who
are infected, and not all people infected with COVID-19 will have the same
symptoms. Fever, dry cough, shortness of breath, fatigue or body aches are some of
the most common symptoms appearing 2–14 days after the exposure, however, some
people have experienced headache, abdominal pain, diarrhoea and sore throat as well,
although some patients may not develop symptoms until later. Initial studies found
increased severity of corona virus disease 2019 (COVID-19), caused by infection of
severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), in patients with
diabetes mellitus. Furthermore, COVID-19 might also predispose infected individuals
to hyperglycaemia.
This study is used to assess knowledge level regarding the self care
management behaviour in prevention of Covid-19 among type II diabetes mellitus
patients at selected area, Alappuzha. The research variable was knowledge regarding
self Care Management behaviour in prevention of covid-19.50 samples had taken for
the study through convenient sampling. The tool developed and used for data
collection was structured questionnaire. The content validity of the tool was
established by three experts. The tool was reliable and feasible. The study was
70
conducted by giving questionnaire to assess the knowledge level of type II diabetes
mellitus patients. We gave health education regarding the prevention and Management
of covid-19 among type II diabetes mellitus patients. The study was effective and
satisfactory. Gathered data were analyzed and interpreted.
CONCLUSION
The study pointed out some important concern about the understanding of COVID-19
pandemic among Indians. Diabetes and COVID-19 are health treated conditions that
spread in whole of the world. Diabetes patients are more of other people in danger of
severity of COVID-19 and mortality, and consisted of 14.5% of COVID-19 patients.
Best function is prevention and then usage of evidence-based treatments. There is a
clear need for training programme with respect to locale specific scenario targeted to a
specific cluster of population emplaning upon their respective lifestyle, to improve the
knowledge and compliance about risk and preventions. The role of media, physician,
government & non-governmental organizations and religious groups is extremely
important in creating awareness about the various aspects of spread, prevention,
treatment of the disease by means of interesting programme, poems, songs, cartoons,
talks, among others, to facilitate confidence of people to let them protect themselves,
follow their economic activities and care COVID-19 patients. Creating awareness by
innovative ways should be adopted as one of the best practices to combat the spread of
pandemic. Presentations on TV, social media in local people’s friendly language,
online and live competitions with continuous guidelines are required. There is a need
to elaborate the Indian socio cultural aspects so that society start appreciating and
voluntarily following social distancing. This should improve the confidence of people
to let them protect themselves not only from the present pandemic but also from all
other unforeseen infections, provide care to patients, contribute towards country’s
71
economic build-up by maintaining livelihood resilience with continued presence and
productivity at workplace. This should improve the confidence of people to let them
protect themselves and care COVID-19 patients.
LIMITATIONS
1. The study was limited to type 2 diabetes mellitus with long duration more than 5
years at selected area of Alappuzha district.
2. The study was confined to a small sample group at the selected areas of Alappuzha
due to lack of time.
3. The study is limited only to type 2 diabetes mellitus patients who are willing to
participate and available during the conduct of the study.
72
REFERENCE
BOOK REFERENCE
1. Viral pandemics from small pox to Covid-19, Rae-Ellen W. Kavey and Allison B,
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2. Covid 19: Global pandemic, societal response, ideological solution Volume - 1
Edited by J. Michael Ryan.
3. Corona virus Disease in 2019, medical virology from pathogenesis to disease
control, Shailendra K Saxena Editor, Springer Publications.
4. Ananthanarayan and Panickers Textbook of Microbiology, 10th edition Editor,
Reba Kanungo, Elsevier Publications India Pvt Ltd.
5. Suresh K Sharma, Nursing research and Statistics - 3rd edition, Elsevier
Publications India Pvt Ltd.
6. Stastistical Methods for survival Data Analysis, 3rd Edition, Elisa T. Lae, John
Wenyu Wang
73
JOURNAL REFERENCE
7. World Health Organization; Ministry of Health and WHO respond to first case
of COVID19 in Laos, News release Vientiane Capital, 2020.
8. World Health Organization; Naming the Coronavirus disease (COVID-19) and
the virus that causes it, 2020.
9. NWHN Staff; How Does COVID-19 Affect Different Age Groups?, 2020.
10. Anna Lucy Tavares de Oliveira, Luiz Felipe, Lage Souza Camilo, Ravena
Rieelly Araújo Moura, Letícia Karoline Braga, Cassia Regina Gontijo Gomes;
COVID-19 and diabetes: a review literature, Volume 5, 2020.
11. Akhtar Hussain, Bishwajit Bhowmik and Nayla Cristina do Vale Moreira,
COVID-19 and diabetes: Knowledge in progress, Elsevier Publications India
Pvt Ltd.2020.
12. International Diabetes Federation; COVID-19 and diabetes, 2020.
13. Francesco Di Gennaro, Damiano Pizzol, and Lee Smith, Corona virus Disease
(COVID19) Current Status and Future Perspectives: A Narrative Review,2020.
14. World Health Organization; COVID-19 Public Health Emergency of
International Concern (PHEIC) Global research and innovation forum, 2020.
15. Heng Li, Shang-Ming Liu, [...], and Chao-Ke Tang, International Journal of
Antimicrobial Agents, Corona Virus Disease 2019 (COVID-19): current status
and future perspectives, Elsevier Publications India Pvt Ltd, 2020.
74
16. Rithesh Guptha, Akthar Hussain and Anoop Misra, European journal of
clinical nurtrition, Diabetes and COVID-19: evidence, current status and
unanswered research questions,74, 2021.
17. Jawad A. Al-Lawati, Oman Medical Journal, Diabetes Mellitus: A Local and
Global Public Health Emergency!, OMSB Publishers, 2020.
18. Mahendra Pal, Gemechu Berhanu, [...], and Venkataramana Kandi, Cureus
journal of medical science, Severe Acute Respiratory Syndrome Coronavirus-2
(SARS-CoV-2): An Update, 2020.
19. Alireza Abdi, Milad Jalilian, [...], and Zeljko Vlaisavljevic, Diabetes Research
and Clinical Practice, Diabetes and COVID-19: A systematic review on the
current evidences, Elsevier Publications India Pvt Ltd, 2020.
20. Susan L. Norris, MD, MPH, Michael M. Engelgau, MD, MSC and K.M.
Venkat Narayan, MD, MPH, Effectiveness of Self-Management Training in
Type 2 Diabetes, American diabetes Association, 2020.
21. Sasmita Poudel Adhikari, National Library of Medicine, Epidemiology, causes,
clinical manifestation and diagnosis, prevention and control of Corona Virus
Disease 2019 (COVID-19) during the early outbreak period: a scoping review,
PubMed, 2020.
22. Tayrine Ordonio Filgueira, Angela Castoldi1, Lucas Eduardo R. Santos,
Geraldo José de Amorim1, Matheus Santos de Sousa Fernandes, Weydyson de
Lima, Nascimento Anastácio, Eduardo Zapaterra Campos, Tony Meireles
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Santos and Fabrício Oliveira Souto, Frontiers in Immunology Inflammation,
The Relevance of a Physical Active Lifestyle and Physical Fitness on Immune
Defense: Mitigating Disease Burden, With Focus on COVID-19
Consequences, 2021.
23. Rahmatollah Moradzadeh, Javad Nazari and Saeed Amini, Knowledge,
Attitudes, and Practices Toward Corona Virus Disease 2019 in the Central
Area of Iran: A Population Based study/Frontiers in Public Health, Dec 8 2020.
24. Alireza Abdi, Milad Jalilian, Pegah Ahmadi Sarbarzeh, Zeljko Vlaisavljevic,
Diabetes and COVID-19: A systematic review on the current evidences,
PubMed.gov, 2020.
25. Maryam Moghaddamsamira, Examining the condition of Diabetic Patients in
the face of Covid-19, Journal of Health and Medical Research, 2020.
26. Ala'a B Al-Tammemi, Amal Akour, LaithAlfalah, Is it Just About Physical
Health? An Internet-Based Cross-Sectional Study Exploring The Pyschological
Impacts of COVID-19 Pandemic On University Students in Jordan Using
Kessler Psychological Distress Scale, Frontier in Psychology, 2020.
27. Tingxuan Yin, Yuanjun Li, Zhijun Luo, Prevalence of co-morbidity in Chinese
patients with COVID-19: systematic review and meta-analysis of risk factors,
BMC infectious diseases, 2021.
28. Matteo Apicella, Maria Cristina Campopiano, Michele Mantuano, Laura
Mazoni, Albertro Coppeli /COVID-19 in people with diabetes: understanding
the reasons for worse outcomes, Plux X Metric, 2020.
76
29. Akhtar Hussain, Bishwajit Bhowmik, and Nayla Cristina do Vale Moreira,
COVID-19 and diabetes: Knowledge in progress, Elsevier Publications India
Pvt Ltd, 2020.
30. Sten Madashad, COVID-19 Infection in People with Diabetes, American
Diabetic Association, 2020.
31. Govind Rankawat, Sudhir Bhandari, Ajeet Singh, Vishal Gupta and Bhupendra
Patel, Impact of Diabetes Mellitus onManagement and Outcome of COVID-19
Infection, International Journal of Research on Internal Medicine, Volume 1,
Issue 1. 2020.
32. Prasad Katulanda, Harsha A Dissanayake, […] David R. Matthews. Prevention
and management of COVID-19 among patients with diabetes: an appraisal of
the literature, Springer publications,2020.
33. Manish Kaushik1, Divya Agarwal, Anil K Gupta, Post graduate medical
journal, Cross-sectional study on the role of public awareness in preventing the
spread of COVID-19 outbreak in India, 2020.
NET REFERENCE
34. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/
technicalguidance/naming-the-coronavirus-disease-(covid-2019)-and-the-
virusthat-causes-it.
35. https://nwhn.org/how-does-covid-19-affect-different-age-groups/
36. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144611/
37. https://diabetesvoice.org/en/news/covid-19-and-diabetes/
77
39. https://www.who.int/publications/m/item/covid-19-public-health-
emergencyofinternational-concern-(pheic)-global-research-and-innovation-
forum
41. https://www.nature.com/articles/s41430-020-0652-1
45. https://care.diabetesjournals.org/content/24/3/561
46. https://pubmed.ncbi.nlm.nih.gov/32183901/
47. https://www.frontiersin.org/articles/10.3389/fimmu.2021.587146/full
48. https://ciowiki.org/wiki/General_Systems_Theory_(GST)#:~:text=General
%20system s% 20theory%20(GST)%20was,in%20all%20fields%20of
%20science
51. https://www.researchsquare.com/article/rs-29439/v1
52. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30238-2/
fulltext
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peoplewithdiabetes/
56. https://www.frontiersin.org/articles/10.3389/fimmu.2021.587146/full
78
57. www.scireslit.com
59. http://jurnal.globalhealthsciencegroup.com/index.php/JPPP/article/view/146
61. https://link.springer.com/article/10.1007/s00125-020-05164-x
ANNEXURE
79
ANNEXURE 1
LETTER REQUESTING PERMISSION FROM PRINCIPAL
From
Research Group 2
Third year BSc Nursing
St Thomas College of Nursing, Kattanam
To
The Principal
Respected Madam,
Subject : Requesting permission to conduct research study.
We, the third year B.Sc.Nursing students [Research Group 2] are conducting a
research project as a part of our curriculum requirement.
Topic: A study to assess the knowledge regarding self management behaviour
among type II diabetes mellitus patient in prevention of COVID19 at selected
area, Alappuzha with a view to develop an information booklet.
We have selected the study settings in selected community area Alappuzha with 50
samples of type II diabetes mellitus patients. So, we would like to request you to
kindly grand us permission to conduct the study in selected community area
Alappuzha.
Thanking you Yours faithfully

Kattanam Ms. Anju S Thankachan
16/08/2020 Ms. Anugraha K John
Ms. Gopika Harikumar
Ms.Manju Devan
Ms Riya Mary Varghese
Ms. Sneha C Paul
80
ANNEXURE 2
LETTER REQUESTING EXPERTS OPINION TO ESTABLISH CONTENT
VALIDITY
From
Research Group 2
Third year BSc Nursing
To
Mrs/ Mr.
Respected Madam,
Subject: Requesting the expert’s opinion and suggestions to establish content validity
of the research tool.
We, the Third year B.Sc Nursing students of St.Thomas College of Nursing, has selected
the below mentioned topic for the research project, as a partial fulfillment for B.Sc
Nursing degree.
Topic: “A study to assess the knowledge regarding self management behaviour
among type II diabetes mellitus patients in prevention of COVID19 at selected area,
Alappuzha with a view to develop an information booklet.”
Here we have enclosed:
Socio demographic data: Tool to assess knowledge regarding self care management in
prevention of COVID19
We request you to go through the items and give your suggestions and opinions to develop
content validity of the tool. Kindly suggest modifications, if any in the remark column.
Thanking you
Place:Kattanam Yours sincerely
Date:19/08/2020 Research Group2
81
ANNEXRE 3
CONTENT VALIDITY CERTIFICATE
I hereby certify that, I have validated the tool of III year B.Sc. Nursing students of St.
Thomas college of Nursing, Kattanam, who has undertaken a study on “Assess the
knowledge regarding self management behaviour among type II diabetes mellitus
patients in prevention of COVID19 at selected area, Alappuzha with a view to develop
an information booklet.
Place:
Date : Signature of expert
82
LIST OF EXPERTS FOR CONTENT VALIDATION
1. Mrs. Smitha Jose (Assistant Professor)
2. Mrs. Monisha Mohan (Assistant Professor)
3. Mr. Chikku S (Assistant professor)
83
I hereby certify that, I have validated the tool of III year B.Sc. Nursing students of St.
an information booklet.”
Place: Kattanam. Signature of expert:
Date : 21-08-2020 Mrs.Smitha Jose
Assistant professor
84
I hereby certify that, I have validated the tool of III year B.Sc.Nursing students of St.
Place: kattanam Signature of expert:
Date:27/08/2020 Mrs.Monisha Mohan
Assistant professor
85
I hereby certify that, I have validated the tool of III year B.Sc.Nursing students of St.
Place: kattanam Signature of expert:
Date : 26/08/2021 Mr. Chikku.S
Assistant professor
86
ANNEXURE 4
Checklist for validation of tool
CONTENT VALIDITY
TOOLNO: 1 – SOCIO DEMOGRAPHIC DATA
Kindly go through the content and place the[√]mark against questionnaire and
following column ranging from good, satisfactory and need to change.
Qn. Socio demographic Good Satisfactory Need to Remarks
No. variables change
1 Age
2 Sex
3 Religion
4 Marital status
5 Type of Family
6 Area of residence
7 Education
8 Occupation
87
9 Income
10 Duration of diabetes
11 Hospitalization
experience
TOOLNO:-2 GENERAL QUESTIONS
Kindly go through the content and place the [√]mark against questionnaire and
following column ranging from good, satisfactory and need to change.
88
Q.no Good Satisfactory Need to Change Remarks
1.
2.
3.
4.
5.
6.
7.
8.
9.
ANNEXURE 5
RESEARCH TOOL
STATEMENT: A study to assess the knowledge regarding self management
behaviour among type 2 diabetes mellitus patients in prevention of covid-19 at
selected community area, Alappuzha with a view to develop an information booklet
Tool:1 Questionnaire to collect the socio demographic data
Instructions:
• Give answer to all questions.
89
• Go through the questions.
• Select most appropriate option
1. Age
a. 30yrs-40yrs
b. 41 yrs-50yrs
c. 51yrs-60yrs
d. 61 yrs and above
2. Sex
a. Male
b. Female
3. Religion
a. Hindu
b. Christian
c. Muslim
d. Others
4. Marital status
a. Married
b. Unmarried
c. Divorced
d. Widow or Widower
5. Type of family
a. Joint family
b. Nuclear family
c. Extended family
90
6. Area of residence
a. Rural Area
b. Urban Area
7. Education
a. Primary
b. High school level
c. Higher secondary level
d. Graduation and above
8. Occupation
a. Employed
b. Unemployed
c. Homemakers
d. Retired
9. Income
a. Rs. below 5000
b. Rs. 5001-10000
c. Rs. 10001and above
GENERAL QUESTIONS
1. Do you get a regular medical check-up?
a. Yes
b. No
2. When was the last visit to your doctor for a check-up?
a. 1 week ago
b. 1 months ago
c. 3 months ago
91
d. 6 months ago
3. What is the recent blood sugar value?
a. 30-80mg/dl
b. 70-110mg/dl
c. 110-160mg/dl
d. 60-180mg/dl
4. Are you on medication?
a. Yes
b. No
5. Which type of treatment you are taking for
managing your diabetes?
a. Oral hypoglycemic drugs
b. Insulin therapy
c. Combination of both
d. Managing with diet and exercise
e. Any other
6. Was anybody in your family diagnosed
for Covid-19?
a. Yes
b. No
7. Whether anybody in your family has any
symptoms of covid-19
a. Yes
b. No
92
8. Whether they have taken any treatment?
a. Yes
b. No
9. What treatment you gave at home?
a. Proper self isolation
b. Never inform to others
c. Proper medication intake and follow up
d. None of the above
10. Are antibiotics effective in preventing or
treating COVID 19 ?
a. Yes
b. No
11. Is there a vaccine, drug or treatment for covid-19?
a. Yes
b. No
Tool II: STRUCTURED QUESTIONAIRE TO ASSESS THE KNOWLEDGE
REGARDING SELF MANAGEMENT BEHAVIOUR IN PREVENTION OF
COVID-19 AMONG TYPE II DM PATIENTS
1. What is COVID19?
a. An infectious disease cause severe
respiratory problems
b. Epileptic disorders
c. Severe GI distress
93
d. Mental retardation
2. Which microorganism cause COVID19 infection?
a. Bacteria
b. Virus
c. Fungi
d. Protozoa
3. Which is the causative agent of COVID19?
a. Nippah
b. Corona virus
c. Influenza virus
d. Ebola virus
4. What is the mode of transmission of COVID19?
a. Droplet
b. Soil
c. Water
d. Food
5. What is the incubation period of COVID 19?
a. 5 days
b. 10days
c. 14days
d. 28 days
6. What is the most common symptom of COVID19?
a. Fever, dry cough, breathing difficulty
b. Alopecia, sore throat, blurred vision
94
c. Seizure, vertigo, insomnia
d. Diarrhea, stomach ache, vomiting
7. Which one is a risk factor for developing
severe COVID-19 ?
a. Hyperglycemia
b. Family history
c. Hyperlipidemia
d. Malnutrition
8. Who is at high risk to get infected with Covid-19 ?
a. Elderly above 65 yrs and above
b. People with uncontrolled diabetes
c. People with other pre-existing diseases
d. All of the above
9. Why diabetic patients are more prone to get covid-19?
a. Due to insulin therapy
b. Due to the altered glucose level
c. Due to the immuno-compromised state
10. What are the measures to prevent the infection
in people with diabetes?
a. Monitor glucose level
b. Adaptive lifestyle
c. Continue regular medication
d. All of the above
11. What should you do if you have a contact with
95
a patient who is infected with COVID19?
a. Never inform to others
b. Self quarantine for 7 days
c. Self quarantine for 14 days
d. Take medication without doctors prescription.
12. When a health provider or a clinical staff tests for
COVID19 after how many days they can return to work?
a. Next day onwards after recovery
b. After 3 days have passed recovery
c. After 5 days have passed since recovery
d. After 1 month have passed recovery
13. Which is a step to reduce the effect of social isolation?
a. Visiting relatives house
b. Maintaining contact with relatives and friends
via meetings
c. Participate in spiritual meetings
d. Maintaining contact with relatives and friends
via telephone
14. How long should you isolate yourself if you
have confirmed COVID19?
a. 7days
b. 10days
c. 24days
d. 30days
96
15. What will you do if you develop symptoms
suggestive of covid-19?
a. Notify local healthcare services
b. Take self medication
c. Interact with others
d. Never inform to others
16. What are the measures to prevent the spread
of COVID19?
a. Clean your hands frequently and thoroughly
b. Avoid touching your eyes, mouth and nose
c. Maintain a distance of at least 1m from others
d. All the above
17. What precautions to be taken while travelling
during the corona virus disease outbreak?
a. Maintain hand hygiene and food hygiene
b. Wear mask
c. Social distancing
d. All the above
18. What do you mean by self isolation?
a. Avoid going for shopping
b. Avoid talking to others
c. Stay home and away from others if you have
covid-19 symptoms
d. Avoid unnecessary travelling
19. What do you mean by self-quarantine?
97
a. Stay at home with family members
b. Wearing mask while going out
c. Stay at home and away from others if you have
been exposed to covid- 19 symptoms
20. How can you protect yourself and to prevent
the spread of infection?
a. Take self medication
b. Avoid talking to others
c. Drink plenty of water
d. Maintain a distance of at least 1m from others
21. How to keep the children healthy during
COVID19 outbreak?
a. Instruct them to wear mask while playing outside
b. Teach the children to wash their hands
c. Reach out to friends via phone call or video chat
d. All of the above
22. How long does it take to develop symptoms
after exposure to COVID19
a. 1-7 days
b. 1-14days
c. 14-28days
d. More than 28 days
23. How long does the virus survive on the surface?
98
a. Upto 12hrs
b. Upto24hrs
c. Upto 48hrs
d. Upto 72hrs
24. What precautions to be taken while going for a shopping?
a. Keep atleast 1m distance from others
b. Avoid touching your eyes,mouthand nose
c. Sanitize the handles of shopping trolleys or
baskets if possible before shopping
d. all the above
25. How to wash fruits and vegetables?
a. Wash with clean water
b. Wash your hands thoroughly with soap
and water and then wash vegetables
thoroughly with clean water
c. Wash with alcohol based sanitizer
26. What are the safety precaution to be
taken at workplace during COVID19?
a. Disinfecting the workplace
b. Limit the number of workers
c. Promote crowd workplace
d. Both a and b
27. What are the emergency warning signs for COVID19?
99
a. Difficulty in breathing, persistent pain in the
chest, bluish lips or face
b. Respiratory distress, stiffness of joint, conjunctivitis
c. Backpain, confusion, fainting
28. What are the main difficulties faced by
pregnant women during the period of COVID19?
a. Unavailability of nutritious food
b. Difficulty to access to medical care in person
c. Transportation difficulties
d. All of the above
29. How to manage diabetes during lock down?
a. Adequate physical activity
b. Maintain eating pattern
c. Ensure good stock of required medications
d. All of the above
30. Which type of physical activity is needed
for a Diabetic patient?
a. Aerobic exercise
b. Heavy lifting exercise
c. Hazardous /strenuous activity
31. What are the guidelines for foot care
100
in diabetes patients?
a. Regular foot assessment
b. Clean using warm water
c. Moisturize your feet
d. All of the above
32. How can we make our hands safe?
a. Wash with soap and water.
b. Wash with plain water
c. Wash with soap and water and scrub for
at least 20 seconds.
d. Wipe hand with tissue paper or cloths
ANNEXURE - 6
ഗവേഷണ ഉപകരണം
നിർദ്ദേശങ്ങൾ
 എല്ലാ ചോദ്യങ്ങള്‍ക്കും ഉത്തരം നല്‍കുക
 എല്ലാ ചോദ്യങ്ങളും ശ്രദ്ധാപൂര്‍വ്വം വായിക്കുക
 ഏറ്റവും അനുയോജ്യമായ ഉത്തരം തിരഞ്ഞെടുക്കുക
101
I. സാമൂഹിക ജനസംഖ്യ ഡാറ്റ ശേഖരിക്കുന്നതിനുള്ള
ചോദ്യാവലി
1. വയസ്സ്
എ. 30- 40 വയസ്സ്
ബി. 41-50 വയസ്സ്
സി. 51- 60 വയസ്സ്
ഡി. 61 വയസ്സിനുമുകളില്‍
2. ലിംഗം
എ.. പുരുഷന്‍
ബി. സ്ത്രീ
3. മതം
എ.. ഹിന്ദു
ബി. ക്രിസ്ത്യൻ
സി. മുസ്ലിം
ഡി. മറ്റുള്ളവർ
4. വിവാഹം
എ.. വിവാഹിതര്‍
ബി. അവിവാഹിതർ
സി. ബന്ധം വേര്‍പിരിഞ്ഞവർ
ഡി. വിധവ/വിഭാര്യന്‍
102
5. കുടുംബം
എ. കൂട്ടുകുടുംബം
ബി. അണുകുടുംബം
സി. വിസ്തൃതമായ കുടുംബം
6. താമസസ്ഥലം
എ. ഗ്രാമപ്രദേശം
ബി നഗരപ്രദേശം
7. വിദ്യാഭ്യാസ യോഗ്യത
എ. പ്രാഥമിക വിദ്യാഭ്യാസം
ബി. ഹൈസ്കൂൾ
സി. ഹയര്‍സെക്കന്‍ഡറി
ഡി. ബിരുദം/ ഉന്നത വിദ്യാഭ്യാസം
8. തൊഴില്‍
എ..ജോലിയുള്ളവര്‍
ബി. തൊഴില്‍രഹിതർ
സി. ഗൃഹഭരണം
ഡി. വിരമിച്ചവർ
103
9. വരുമാനം
എ. 5000 രൂപയിൽ കുറവ്
ബി. 5001-10000
സി. 10001 രൂപയിൽ കൂടുതല്‍
II A. പൊതുചോദ്യങ്ങള്‍
1. കൃത്യമായ ആരോഗ്യ പരിശോധനകള്‍ നടത്താറുണ്ടോ?
എ. ഉണ്ട്
ബി. ഇല്ല
2. നിങ്ങള്‍ അവസാനമായി വൈദ്യപരിശോധനക്കായി
ഡോക്ടറെ സന്ദര്‍ശിച്ചതെന്ന്‍?
എ. ഒരാഴ്ചക്ക് മുന്‍പ്
ബി. ഒരു മാസത്തിനു മുന്‍പ്
സി. 3 മാസങ്ങള്‍ക്ക് മുന്‍പ്
ഡി. 6 മാസങ്ങള്‍ക്ക് മുന്‍പ്
3. നിങ്ങളുടെ സമീപകാലത്തെ രക്തത്തിലെ പഞ്ചസാരയുടെ
അളവ് എത്ര?
എ. .30-80 മി.ഗ്രാം/ഡെ.ലി
ബി. 70-110 മി.ഗ്രാം/ഡെ.ലി
സി. 110-160 മി.ഗ്രാം/ഡെ.ലി
104
ഡി. 160-180 മി.ഗ്രാം/ഡെ.ലി
4.നിങ്ങള്‍ പ്രമേഹരോഗത്തിനു മരുന്നുകൾ
ഉപയോഗിക്കുന്നുണ്ടോ?
5. നിങ്ങള്‍ ആശുപത്രിയിൽ അഡ്മിറ്റായിട്ടുണ്ടോ?
6. പ്രമേഹ പരിചരണത്തിനായി ഏതു ചികിത്സയാണ്
ഉപയോഗിക്കുന്നത്?
എ. വായിലൂടെ കഴിക്കുന്ന മരുന്നുകള്‍
ബി. ഇൻസുലിൻ ചികിത്സ
സി. രണ്ടിന്‍റെയും മിശ്രിതം
ഡി. ആഹാര ക്രമീകരണവും ആഹാരവും
ഇ. മറ്റുള്ളവ
7. നിങ്ങളുടെ കുടുംബത്തില്‍ ആര്‍ക്കെങ്കിലും കോവിഡ്-19
സ്ഥിതികരിച്ചിട്ടുണ്ടോ?
105
8. നിങ്ങളുടെ കുടുംബത്തിൽ ആര്‍ക്കെങ്കിലും കോവിഡ്-19
രോഗ ലക്ഷണങ്ങളുണ്ടോ?
9. ഉണ്ട് എങ്കിൽ ചികിത്സ സ്വീകരിച്ചിട്ടുണ്ടോ?
10. ഏത് ചികിത്സയാണ് വീട്ടില്‍ നല്‍കുന്നത്?
എ. സ്വയം മാറി താമസിക്കുക
ബി. ആരെയും അറിയിക്കാതിരിക്കുക
സി. കൃത്യമായി മരുന്നുകള്‍ കഴിക്കുക
ഡി. ഇവയൊന്നുമല്ല
11. കോവിഡ്-19 ന്‍റെ ചികിത്സയ്ക്കായി ആന്‍
റിബയോട്ടിക്കുകൾ ഉപയോഗിക്കുന്നത് ഫലപ്രദമാണോ?
എ. അതെ
ബി. അല്ല
12. കോവിഡ്-19 തടയാനായി എന്തെങ്കിലും
വാക്സിനുകളോ,മരുന്നുകളോ ഉണ്ടോ?
106
IIB. പ്രമേഹം & കോവിഡ്-19
1. എന്താണ് കോവിഡ്-19?
എ. കടുത്ത ശ്വാസകോശ സംബന്ധമായ
പ്രശ്നങ്ങളുണ്ടാക്കുന്ന പകര്‍ച്ചവ്യാധി.
.ബി. അപസ്മാരം
സി. ദഹന വ്യവസ്ഥയിലെ രോഗം
ഡി. മാനസിക രോഗം
2. ഏതു സൂക്ഷ്മാണുവാണ് കോവിഡ്-19 രോഗത്തിനു
കാരണമാകുന്നത്?
എ. ബാക്ടീരിയ
ബി. വൈറസ്
സി. ഫംഗസ്
ഡി. പ്രൊട്ടോസോവ
3. കോവിഡ്-19 രോഗത്തിന്‍റെ രോഗകാരി ഏതാണ്‌?
എ. നിപ്പ വൈറസ്
ബി. കൊറോണ വൈറസ്
സി. ഇന്‍ഫ്ലുവന്‍സ വൈറസ്
107
ഡി. എബോള വൈറസ്
4. ഏതു രീതിയിലുടെയാണ്‌ കോവിഡ്-19 പകരുന്നത്?
എ. വായുവിലൂടെ
ബി. മണ്ണിലൂടെ
സി. വെള്ളത്തിലൂടെ
ഡി. ഭക്ഷണ പദാര്‍ത്ഥങ്ങളിലൂടെ
5. വൈറസ് ശരീരത്തില്‍ പ്രവേശിച്ചിട്ട് രോഗലക്ഷണങ്ങൾ
കണ്ടുതുടങ്ങാൻഎടുക്കുന്ന കാലയളവ്?
എ. 5 ദിവസം
ബി. 10 ദിവസം
സി. 14 ദിവസം
ഡി. 28 ദിവസം
6. കോവിഡ്-19 ന്‍റെ പ്രധാന രോഗലക്ഷണങ്ങൾ
എന്തൊക്കെ?
എ. പനി,വരണ്ട ചുമ, ശ്വാസതടസ്സം
ബി. മുടികൊഴിച്ചില്‍,തൊണ്ടവേദന,മങ്ങിയ കാഴ്ച
സി. അപസ്മാരം,തലകറക്കം,ഉറക്കമില്ലായ്മ
ഡി. വയറിളക്കം,വയറുവേദന,ഛര്‍ദ്ധി
7. താഴെ പറയുന്നവയില്‍ ഏതാണ്‌ കോവിഡ്-19
ഉണ്ടാകാനുള്ള പ്രധാന ഘടകം?
എ. കുടുംബ പാരമ്പര്യം
108
ബി. കോളസ്ട്രോള്‍
സി. പോഷകാഹാരക്കുറവ്
8. കോവിഡ്-19 രോഗമുണ്ടാകാൻ ഏറ്റവും സാധ്യത
കൂടിയ ആളുകള്‍ ആരൊക്കെ?
എ. 65 വയസ്സിനു മുകളിൽ പ്രായമുള്ളവർ
ബി. പ്രമേഹ രോഗികള്‍
സി. മറ്റു രോഗങ്ങളുള്ളവര്‍
ഡി. മേല്‍പ്പറഞ്ഞവയെല്ലാം
10. എന്തുകൊണ്ടാണ് പ്രമേഹ രോഗികളില്‍ കോവിഡ്-19
വരാന്‍ സാധ്യത കൂടുതല്‍?
എ ഇൻസുലിൻ ചികിത്സമൂലം
ബി. രക്തത്തില്‍ ഗ്ലുക്കോസിന്‍റെ അളവിലുണ്ടാകുന്ന

വ്യതിയാനം
സി. രോഗപ്രതിരോധശേഷി ഇല്ലാത്ത അവസ്ഥ
10. എന്തൊക്കെ മാര്‍ഗ്ഗങ്ങളാണ് പ്രമേഹ രോഗികളിൽ
അണുബാധ തടയാനായി സ്വീകരിക്കേണ്ടത്?
എ. രക്തത്തിലെ ഗ്ലുക്കോസിന്‍റെ അളവ് പരിശോധിക്കുക
ബി. ശരിയായ ജീവിത ശൈലി
109
സി. പതിവ് മരുന്നുകള്‍ കൃത്യമായി കഴിക്കുക
ഡി. ഇവയെല്ലാം
11. കോവിഡ്-19 രോഗിയുമായി സമ്പര്‍ക്കത്തിലേര്‍പ്പെട്ടാൽ
നിങ്ങള്‍ എന്താണ് ചെയ്യുന്നത്?
എ. ആരെയും അറിയിക്കാതിരിക്കുക
ബി. 7 ദിവസം ക്വാറന്‍റീനില്‍ കഴിയുക
സി. 14 ദിവസം ക്വാറന്‍റീനില്‍ കഴിയുക
ഡി. വൈദ്യ നിര്‍ദേശമില്ലാതെ മരുന്ന് കഴിക്കുക
12. ആരോഗ്യപ്രവര്‍ത്തകര്‍ക്ക് കോവിഡ്-19
സ്ഥിതികരിച്ചശേഷം എത്ര ദിവസത്തിനുള്ളില്‍ ജോലിയിൽ
പ്രവേശിക്കാം?
എ. രോഗശമനത്തിന്‍റെ പിറ്റേ ദിവസം മുതൽ
ബി. രോഗശമനത്തിന്‍റെ 3 ദിവസത്തിനു ശേഷം
സി. രോഗശമനത്തിന്‍റെ അഞ്ചാം ദിവസം മുതൽ
ഡി. രോഗശമനത്തിന്‍റെ ഒരു മാസത്തിനു ശേഷം

13. എങ്ങനെ സാമുഹിക ഒറ്റപ്പെടലിന്‍റെ പ്രഭാവം
കുറയ്ക്കാം?
എ. ബന്ധു വീടുകള്‍ സന്ദര്‍ശിക്കുന്നതു വഴി
ബി. കുടുംബാംഗങ്ങളുമായി യോഗം നടത്തുന്നത് വഴി
110
സി. പ്രാര്‍ത്ഥന യോഗങ്ങളിൽ പങ്കെടുക്കുന്നതു വഴി
ഡി. ടെലിഫോണിലുടെ ബന്ധുക്കളുമായി ബന്ധം

നിലനിര്‍ത്തുന്നതു വഴി
14. കോവിഡ്-19 സ്ഥിതികരിച്ചാൽ എത്ര ദിവസം നിങ്ങൾ
സ്വയം ഐസൊലെറ്റ് ചെയ്യപ്പെടും?
എ. 7 ദിവസം
ബി. 10 ദിവസം
സി. 24 ദിവസം
ഡി. 30 ദിവസം
15. നിങ്ങള്‍ക്ക് കോവിഡ്-19 ന്‍റെ രോഗലക്ഷണങ്ങൾ കണ്ടു
തുടങ്ങിയാല്‍ എന്താണ് ചെയ്യുക?
എ. ആരോഗ്യ പ്രവര്‍ത്തകരെ അറിയിക്കും
ബി. ഡോക്ടറുടെ നിര്‍ദ്ദേശമില്ലാതെ മരുന്നുകൾ കഴിക്കും
സി. മറ്റുള്ളവരുമായി സംമ്പര്‍ക്കം പുലര്‍ത്തും
ഡി. ആരെയും അറിയിക്കില്ല.

16. കോവിഡ്-19 തടയാനായി എന്തൊക്കെ മാര്‍ഗ്ഗങ്ങൾ
സ്വീകരിക്കാം?
എ. കൈകള്‍ ഇടയ്ക്കിടെ വൃത്തിയായി കഴുകുക
ബി.കണ്ണ്‍
,മൂക്ക്,വായ്‌ ഭാഗങ്ങളില്‍ സ്പര്‍ശിക്കാതിരിക്കുക
111
സി. മറ്റുള്ളവരില്‍ നിന്ന്‍1 മീ. അകലം പാലിക്കുക.
ഡി. ഇവയെല്ലാം.
17. എന്തെല്ലാം മുന്‍കരുതലുകലാണ് കോവിഡ് കാലത്ത്
യാത്ര ചെയ്യുമ്പോള്‍ സ്വീകരിക്കേണ്ടത് ?
എ. ഭക്ഷണ ശുചിത്വവും കൈകളുടെ ശുചിത്വവും

പാലിക്കുക
ബി. മാസ്ക് ധരിക്കുക
സി. സാമുഹിക അകലം പാലിക്കുക.
18. എന്താണ് സ്വയം ഐസൊലെറ്റ് ചെയ്യുന്നത് കൊണ്ട്
ഉദ്ദേശിക്കുന്നത്?
എ. ഷോപ്പിങിനു പോകുന്നത് ഒഴിവാക്കുക
ബി. മറ്റുള്ളവരുമായി സംസാരിക്കുന്നത് ഒഴിവാക്കുക
സി. കോവിഡ്-19 ലക്ഷണങ്ങളുള്ളപ്പോള്‍ ആരുമായും

സമ്പര്‍ക്കത്തിലെര്‍പ്പെടാതെ വീട്ടില്‍ തന്നെ ഇരിക്കുക.
ഡി. അനാവശ്യമായ യാത്രകള്‍ ഒഴിവാക്കുക

19. എന്താണ് ക്വാറന്‍റീന്‍ കൊണ്ട് ഉദ്ദേശിക്കുന്നത്?
എ. കുടുംബാംഗങ്ങളോടൊപ്പം വീട്ടിലിരിക്കുക.
ബി. പുറത്തു പോകുമ്പോള്‍ മാസ്ക് ധരിക്കുക
112
സി. കോവിഡ്-19 ലക്ഷണങ്ങൾ കണ്ടു തുടങ്ങിയാൽ
ആരുമായും സമ്പര്‍ക്കത്തിലെര്‍പ്പെടാതെ വീട്ടിലിരിക്കുക.
ഡി. ഇവയൊന്നുമല്ല.
20. കോവിഡ്-19 രോഗം പകരുന്നത് ഏതു മാര്‍ഗ്ഗത്തിലുടെ
നിങ്ങള്‍ക്ക് തടയാനാകും?
എ. ഡോക്ടറുടെ നിര്‍ദ്ദേശമില്ലാതെ മരുന്നുകൾ കഴിക്കുക.
ബി. മറ്റുള്ളവരുമായി സംസാരിക്കുന്നത് ഒഴിവാക്കുക
സി. ധാരാളം വെള്ളം കുടിക്കുക.
ഡി. മറ്റുള്ളവരില്‍ നിന്ന്‍1 മീ. അകലം പാലിക്കുക.
21. കോവിഡ്-19 സമയത്ത് കുട്ടികളെ എങ്ങനെ
ആരോഗ്യത്തോടെ നിലനിര്‍ത്താം?
എ.. പുറത്തു കളിയ്ക്കാന്‍ പോകുമ്പോൾ മാസക്

ധരിക്കാന്‍ നിര്‍ദ്ദേശിക്കുക
.
ബി. കൈകള്‍ കഴുകാന്‍ കുട്ടികളെ പഠിപ്പിക്കുക
സി. ഫോണ്‍ കോള്‍/വിഡിയോ സന്ദേശങ്ങള്‍ വഴി

സുഹൃത്തുക്കളുമായി ബന്ധപ്പെടുക.
22. ഒരാള്‍ക്ക് കൊറോണ വൈറസുമായി സമ്പര്‍ക്കം വന്നാ
ൽ രോഗലക്ഷണങ്ങള്‍ കണ്ടു തുടങ്ങാന്‍ എത്ര
സമയമെടുക്കും?
113
എ. 1-7 ദിവസം
ബി. 1-14 ദിവസം
സി. 14-28 ദിവസം
ഡി. 28 ദിവസത്തേക്കാൾ കൂടുതൽ
23. എത്ര നാള്‍ ഒരു പ്രതലത്തിൽ കൊറോണ വൈറസ്
നിലനില്‍ക്കും?
എ. 12 മണിക്കൂർ വരെ
ബി. 24 മണിക്കൂർ വരെ
സി. 48 മണിക്കൂർ വരെ
ഡി. 72 മണിക്കൂർ വരെ
24. ഷോപ്പിംഗിന് പോകുമ്പോള്‍ എന്തൊക്കെ മുന്‍കരുതൽ
സ്വീകരിക്കാം?
എ. മറ്റുള്ളവരില്‍ നിന്ന്‍1 മീ. അകലം പാലിക്കു
ബി.കണ്ണ്‍
,മൂക്ക്,വായ്‌ ഭാഗങ്ങളിൽ സ്പര്‍ശിക്കാതിരിക്കുക
സി. ഷോപ്പിംഗിനു മുന്‍പായി കഴിയുമെങ്കിൽ ഷോപ്പിംഗ്
ട്രോളികളും,ബാസ്ക്കറ്റുകളും അണു വിമുക്തമാക്കുക
25. എങ്ങനെയാണു പച്ചക്കറികളും,പഴങ്ങളും
കഴുകേണ്ടത്?
114
എ. വൃത്തിയുള്ള വെള്ളത്തില്‍ കഴുകുക
ബി. കൈകള്‍ സോപ്പുപയോഗിച്ചു കഴുകിയ ശേഷം

പച്ചക്കറികളും,പഴങ്ങളും വൃത്തിയുള്ള വെള്ളത്തിൽ
കഴുകുക.
സി. സാനിറ്റൈസർ ഉപയോഗിച്ച് കഴുകുക
26. എന്തൊക്കെ മുന്‍കരുതലുകളാണ് കോവിഡ് കാലത്ത്
ജോലിസ്ഥലങ്ങളില്‍ സ്വീകരിക്കേണ്ടത്?
എ. ജോലിസ്ഥലം അണു വിമുക്തമാക്കുക
ബി. ജോലിചെയ്യുന്നവരുടെ എണ്ണം പരിമിതപ്പെടുത്തുക.
സി. കൂട്ടംകൂടിയുള്ള ജോലിസ്ഥലങ്ങള്‍ പ്രോത്സാഹിപ്പിക്കുക
ഡി. എ & ബി
27. എന്തൊക്കെയാണ്‌ കോവിഡ്-19 രോഗത്തിന്‍റെ പ്രധാന
മുന്നറിയിപ്പ് അടയാളങ്ങള്‍?
എ. ശ്വാസതടസ്സം,നെഞ്ചില്‍ സ്ഥിരമായ വേദന,നീല നിറം
കലര്‍ന്ന ചുണ്ടും മുഖവും
ബി. ശ്വാസതടസ്സം,ചലിക്കുവാന്‍ പ്രയാസമുള്ള സന്ധികൾ,
നേത്രാണുബാധ
സി. നടുവേദന,വിഭ്രാന്തി,തലകറക്കം
115
28. എന്തൊക്കെ ഗുരുതരമായ പ്രശ്നങ്ങളാണ് കോവിഡ്
കാലയളവില്‍ ഗര്‍ഭിണികൾ നേരിടേണ്ടി വരുന്നത്?
എ. പോഷകാഹാരങ്ങളുടെ ലഭ്യതക്കുറവ്
ബി. വൈദ്യസഹായം ലഭിക്കുന്നതിനുള്ള ബുദ്ധിമുട്ട്
സി. യാത്ര സൗകര്യങ്ങളുടെ ബുദ്ധിമുട്ട്
29. എങ്ങനെ ലോക്ക്ഡൗണ്‍ കാലയളവിൽ പ്രമേഹത്തെ
പരിഹരിക്കാം?
എ. മതിയായ വ്യായാമം
ബി. ശരിയായ ഭക്ഷണരീതി
സി. ആവശ്യമുള്ള മരുന്നുകള്‍ കൈവശമുണ്ടെന്ന്

ഉറപ്പുവരുത്തുക
30. ഏത് തരത്തിലുള്ള വ്യായാമരീതിയാണ്‌ പ്രമേഹ
രോഗികളില്‍ ആവശ്യം?
എ. രക്തത്തിലെ പ്രാണവായുവിന്‍റെ അളവ് കൂട്ടാനുള്ള

വ്യായാമം
ബി. ഭാരമേറിയ വ്യായാമം
സി. അപകടകരവും ബുദ്ധിമുട്ടുള്ളതുമായ വ്യായാമം
116
31.ഏതാണ് പ്രമേഹ രോഗികളിലെ
പാദസംരക്ഷണത്തിനുള്ള മാര്‍ഗ നിര്‍ദ്ദേശ o?
എ. ചിട്ടയായുള്ള പാദപരിശോധന
ബി. ചൂടുവെള്ളത്തില്‍ പാദം വൃത്തിയാക്കുക
സി. പാദങ്ങള്‍ നനയ്ക്കുക
32. എങ്ങനെ നമ്മുക്ക് കൈകളെ സുരക്ഷിതമാക്കാം?
എ. സോപ്പും,വെള്ളവും ഉപയോഗിച്ച് കഴുകുക
ബി. പച്ചവെള്ളത്തില്‍ കൈ കഴുകുക
സി. സോപ്പും,വെള്ളവും ഉപയോഗിച്ച് 20 സെക്കന്‍റെ കൈ
കഴുകുക
ഡി. തുണി കൊണ്ടോ ടിഷ്യു കൊണ്ടോ കൈ തുടയ്ക്കുക
117
ANNEXURE 7
ANSWER KEY: Structured questionaire to assess the knowledge regarding self
management behaviour in prevention of COVID-19 among type II dm patients
1. A 17. D
2. B 18. C
3. B 19. C
4. A 20. D
5. C 21. D
6. A 22. B
7. A 23. D
8. D 24. D
9. C 25. B
10. D 26. D
11. C 27. A
12. B 28. D
13. D 29. D
14. B 30. A
15. A 31. D
16. D 32. C
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ANNEXURE-9
ആരോഗ്യ പഠനം :-
പ്രമേഹരോഗികൾക്ക് ഇടയിലെ കോവിഡ് -19 പ്രതിരോധ
മാർഗങ്ങൾ
119
ആമുഖം
പുതുതായി കണ്ടെത്തിയ കൊറോണ
വൈറസ് മൂലമാണ് കോവിഡ്-19 എന്ന അണുബാധ
ഉണ്ടാകുന്നത്.
അണുബാധയുണ്ടാകുന്നവരിൽ സാധാരണയായി
ശ്വാസകോശ-സംബന്ധ ലക്ഷണങ്ങളാണ് കാണപ്പെടുന്നത്.
തീവ്രപരിചരണങ്ങൾ കൂടാതെ തന്നെ ഈ രോഗം
ഭേദമാകുന്നതാണ്. എന്നാൽ പ്രായമായവരിലും, മറ്റ്
രോഗങ്ങൾ അഥവാ പ്രമേഹം, ഹൃദയസംബന്ധ രോഗങ്ങൾ,
പ്രതിരോധശേഷി കുറവുള്ള രോഗികൾ എന്നിവരിൽ ഈ
രോഗം ഒരു വെല്ലുവിളി ഉയർത്തുന്നു. കൂടാതെ മറ്റുപല
ഗുരുതര അവസ്ഥയിലേക്കും നയിക്കുന്നു.
രക്തത്തിലുള്ള ഗ്ലൂക്കോസിന്റെറ അളവ് സാധാരണ
നിലയിൽ ശരീരത്തിന് നിലനിർത്താൻ പറ്റാത്ത
അവസ്ഥയാണ് പ്രമേഹം. രക്തത്തിലെ ഗ്ലൂക്കോസിന്റെ്
അളവ് ഉയരുന്നത് അപകടകരവും, പ്രതിരോധശേഷി
കുറയ്ക്കുന്നവയുമാണ്.
120
നിർവചനം:-
"പുതുതായി കണ്ടെത്തിയ കൊറോണ വൈറസ് മൂലം
ഉണ്ടാവുന്ന അണുബാധയാണ് കൊറോണ വൈറസ്
രോഗം".
- ലോകാരോഗ്യ സംഘടന(WHO)
"COVID-19 എന്നാൽ കൊറോണ വൈറസ് മൂലം
ശ്വാസകോശത്തിന് ഉണ്ടാകുന്ന രോഗമാണ്,"COVID-19
രോഗബാധയുള്ളവരുമായുള്ള സമ്പർക്കം(തുപ്പൽ)/വൈറസ്
ഉള്ള വസ്തുക്കൾ തൊടുന്നത് ഇവയിലൂടെയാണ് വൈറസ്
നമ്മുടെ ശരീരത്തിൽ പ്രവേശിക്കുന്നത്".
പനി, ചുമ, ശ്വാസം മുട്ടൽ എന്നിവയാണ് പ്രധാന
രോഗലക്ഷണങ്ങൾ. രോഗം കൂടുതല്‍ ആകുന്ന അവസ്ഥയില്‍
ന്യൂമോണിയ എന്ന രോഗം ഉണ്ടാകുന്നു. ഇത് രോഗതീവ്രതയെ
വർധിപ്പിക്കുന്നു.
രോഗകാരി:-
121
കൊറോണവൈറസ് (SARS-COV2).
വൈറസ് ശരീരത്തിൽ പ്രവേശിച്ച് ആദ്യ ലക്ഷണങ്ങൾ
പ്രകടമാകാൻ എടുക്കുന്ന സമയം:-
2-4 ദിവസങ്ങൾ.
പകരുന്ന വിധങ്ങൾ:-
1. ശാസകോശം വഴി :
രോഗബാധയുള്ള ആളുകളുടെ തുപ്പൽ/ചുമ
എന്നിവയിലൂടെ പുറത്തുവരുന്ന സ്രവം, തുപ്പൽ
വഴിയാണ് ഈ രോഗം പ്രധാനമായും ബാധിക്കുന്നത്.
2. സമ്പർക്കം വഴി :
രോഗിയുമായി അടുത്ത് ഇടപഴകുകയും
സംസാരിക്കുകയും ചെയ്യുന്നത് വഴി.
3. ഏയ്റോസോൾ :
ചുമ തുമ്മൽ എന്നിവ വഴി വായുവിലേക്ക് പടരുന്ന
കണികകൾ വഴി.
രോഗലക്ഷണങ്ങൾ :-
 പനി
122
 വിറയൽ
 ശ്വാസതടസ്സം
 ക്ഷീണം
 ശരീരവേദന
 തലവേദന
 തൊണ്ടവേദന
 ജലദോഷം
 ചർദ്ദി
 വയറിളക്കം
രോഗം വരാൻ സാധ്യത കൂടിയവർ:-
 ക്യാൻസർ
 പ്രമേഹം
 ശ്വാസകോശ രോഗങ്ങൾ
 ഹൃദയസംബന്ധ രോഗങ്ങൾ
 ശരീരഭാരം കൂടിയവർ
 അനീമിയ/വിളര്ച്ച
 കുട്ടികൾ
 വയോധികർ
 പ്രതിരോധശേഷി കുറഞ്ഞവർ
123
പ്രമേഹം
അസാധാരണമായ ഇൻസുലിൻ ഉൽപ്പാദനം, ദുർബലമായ
ഇൻസുലിൻ ഉപയോഗം അല്ലെങ്കിൽ ഇവ രണ്ടുമായി
ബന്ധപ്പെട്ട ഉപചയ പ്രവർത്തനത്തെ ബാധിക്കുന്ന
രോഗമാണ് പ്രമേഹം. പ്രമേഹം മൂലം രക്തത്തിലുള്ള
ഗ്ലൂക്കോസിന്റെ അളവ് അമിതമായി ഉയരുകയും
ശരീരത്തിന് നിയന്ത്രിക്കാൻ കഴിയാതെ വിധം വരികയും
ചെയ്യുന്നു.
ടൈപ്പ് 2 ഡയബറ്റിസ്(രണ്ടാംതരം പ്രമേഹം )
ഇവ ഒന്നിൽ കൂടുതൽ സവിശേഷതകൾ കാണിക്കുന്നു
ഇൻസുലിൻ ഉൽപാദനം കുറയുകയും ഗ്ലൂക്കോസിന്റ
ഉല്പ്പാ ദനം കൂടുകയും ചെയ്യുന്നു.
രക്തത്തിലെ സാധാരണ ഗ്ലൂക്കോസിന്റെന അളവ്:-
FBS : 80-110 mg/lt
PBS : 8-140 mg/lt
RBS : 80-110 mg/lt
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എന്തുകൊണ്ടാണ് പ്രമേഹരോഗികളിൽ കോവിഡ്
വരാനുള്ള സാധ്യത കുടുതൽ ?
വൃദ്ധർ, പ്രമേഹം പോലുള്ള രോഗങ്ങൾ ഉള്ളവർ
എന്നിവർക്ക് കോവിഡ്-19 എന്ന രോഗസാധ്യത വളരെ
കൂടുതലാണ്.
രക്തത്തിലുള്ള ഗ്ലൂക്കോസിന്റെ അളവിലുള്ള വ്യതിയാനം
മൂലവും മറ്റു പ്രമേഹ സങ്കീർണതകൾ മൂലവും ചികിത്സ
വളരെ പ്രയാസകരമാകുന്നു .
ഇതിന് രണ്ട് കാരണങ്ങളാണ് പ്രധാനമായുള്ളത്,
1. പ്രമേഹ രോഗികളിൽ വൈറസിനെതിരെ പോരാടാനുള്ള
പ്രതിരോധശേഷി കുറവ്.
2. ഗ്ലൂക്കോസിന്റെ അളവ് കൂടിയ രക്തത്തിൽ വൈറസ്
കൂടുതലായി വളരുന്നു.
ചികിത്സാരീതികൾ
പ്രമേഹ നിയന്ത്രണത്തിന്റെ പ്രാഥമിക ലക്ഷ്യം രക്തത്തിലെ
ഗ്ലൂക്കോസിന്റെ അളവ് കഴിയുന്നത്ര സാധാരണ
നിലയിലാക്കുക എന്നതാണ്.
ഇൻസുലിൻ തെറാപ്പി
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ഒന്നിലധികമോ ദിനംപ്രതിയോ ഉള്ള ഇൻസുലിൻ
കുത്തിവയ്പ്പുകൾ ഗ്ലൂക്കോസിന്റെ അളവിനെ
നിയന്ത്രിക്കുന്നു.
പ്രധാനമായും നാലുതരം :-
(1) റാപ്പിഡ് ആക്ടീവ്
(2) ഷോര്ട്ട് ആക്ടിങ്
(3) ഇന്റ്ര്മി്ഡിയേറ്റ് ആക്ടിങ്
(4) ലോങ്ങ് ആക്ടിങ്
ഓറൽ മരുന്നുകൾ(ഗുളികകൾ)
 ബിഗ്മാനൈഡ്സ്
 സൾഫോണായിൽയൂരിയസ്
 ആൽഫാഗ്ലുക്കോസിഡേസ് ഇൻഹിബിറ്റർസ്
 തെയാസോളിഡിനോഡൈന്സ്
 ഡൈ പെപ്ടിഡയിൽ പെപ്റ്റിഡേസ് ഇൻഹിബിറ്റർസ്
 ഡോപ്പാമിൻ റിസപ്പ്ടെർ അഗോണിസ്റ്
 സോഡിയം ഗ്ലുക്കോസ്, കോ ട്രാൻസ്‌പോർട്-2
 കോമ്പിനേഷൻ ഓറൽ ഇൻഹിബിറ്റർസ് തെറാപ്പി
ഇൻസുലിൻ കൂടാതെയുള്ള കുത്തിവെപ്പുകൾ
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 ഗ്ലുക്കഗൺ പോലുള്ള പെപ്റ്റൈഡ്-1 റിസെപ്പ്റ്റര്
അഗോനിസ്റ്റ്.
 അമൈലിന്‍ആന്റസഗോണിസ്റ്റ്
മറ്റുള്ള നിയന്ത്രണങ്ങൾ :-
 ഭക്ഷണക്രമീകരണവും ശാരീരിക പ്രവർത്തനവും
രക്തത്തിലെ ഗ്ലൂക്കോസ് അളവ് കുറയ്ക്കുന്നതിനുള്ള
ആദ്യപടിയാണ്പരിഷ്കരിച്ച ഭക്ഷണക്രമവും ശാരീരിക
പ്രവർത്തനവും.
 സ്വയം പരിചരണം :-
ലക്ഷണങ്ങൾ പ്രകടമാകുമ്പോൾ എന്തെല്ലാം ചെയ്യണം
 അടുത്തുള്ള ആരോഗ്യകേന്ദ്രത്തിൽ അറിയിക്കുക..
 സ്വയം ക്വാറന്റൈനിൽ പ്രവേശിക്കുക, 14 ദിവസം,
മറ്റുള്ളവരുമായി സമ്പർക്കത്തിൽ ഏർപ്പെടാതിരിക്കുക.
 വീട്ടുകാരുമായി ബന്ധമില്ലാത്ത ശുചിമുറിയും,
കിടപ്പുമുറിയും ഉപയോഗിക്കുക.
 വിശ്രമിക്കുക.
 ധാരാളം വെള്ളം കുടിക്കുക.
 പോഷകാഹാരങ്ങൾ കഴിക്കുക.
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 രോഗി സ്പർശിച്ച സ്ഥലങ്ങൾ നിശ്ചിത ഇടവേളയില്
വൃത്തിയാക്കുക / അണുവിമുക്തമാക്കുക.
 മറ്റുള്ളവരെ ഫോൺ ഇന്റവർനെറ്റ് എന്നീ മാര്ഗ്ഗം വഴി
ബന്ധപ്പെടുക.
 ചുമയ്ക്കുമ്പോഴും തുമ്മുമ്പോഴും വായും, മൂക്കും മൂടുക.
 കൈകൾ സോപ്പുപയോഗിച്ചോ, സാനിറ്റൈസർ
ഉപയോഗിച്ചോ ഇടവിട്ട് കഴുകുക.
 സമൂഹത്തിൽ പടരുന്ന വ്യാജവാർത്തകളെപറ്റിയും
അറിവുകളെപ്പറ്റിയും ബോധവാന്മാ്രാകുക.
 പുറത്തു നിന്നുള്ള ഭക്ഷണം കഴിവതും ഒഴിവാക്കുക.
 പച്ചക്കറികളും പഴങ്ങളും ശരിയായ രീതിയിൽ കഴുകി
വൃത്തിയാക്കിയ ശേഷം മാത്രം ഉപയോഗിക്കുക.
പ്രമേഹ ഭക്ഷണം :-
 പഴങ്ങൾ (ഉണങ്ങിയ പഴങ്ങൾ, ചക്കപ്പഴം, മാമ്പഴം, ഓമയ്ക്ക,
വാഴപ്പഴം എന്നിവ ഒഴിവാക്കുക)-
 പച്ചക്കറികൾ
 ഗോതമ്പ്/ആട്ട
 തവിടുള്ള അരി
 ഓട്സ്
 ഇലവർഗ്ഗങ്ങൾ
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 ഒരിക്കലും ഭക്ഷണം ഒഴിവാക്കാതിരിക്കുക ചെറിയതോതിൽ
ഇടവിട്ടുള്ള ഭക്ഷണക്രമം തിരഞ്ഞെടുക്കുക.
 ദിവസേനയുള്ള വ്യായാമം ശരീരഭാരം നിയന്ത്രിക്കുവാനും,
ഗ്ലൂക്കോസിന്റെ അളവ്നിലനിർത്താനും സഹായിക്കുന്നു
കോവിഡ്-19 ചികിത്സാരീതികൾ :-
കോവിഡ് പരത്തുന്ന കൊറോണ വൈറസിനെതിരെ
വാക്സിനുകളോ, മരുന്നുകളോ ഇല്ല. അതിനെപ്പറ്റിയുള്ള
ഗവേഷണങ്ങൾ ഇപ്പോഴും നടന്നുകൊണ്ടിരിക്കുന്നു.
പരിചരണ മാർഗങ്ങൾ :-
 പനി, തുമ്മൽ, ജലദോഷം എന്നീ പ്രധാനമായ ആദ്യ
ലക്ഷണങ്ങൾക്ക് ആന്റിപൈററ്റിക്സ്, അനാള്ജെകസിക്
(വേദനസംഹാരി) എന്നിവ നൽകുന്നു.
 ഡോക്ടർ നിർദ്ദേശിച്ച പ്രകാരമുള്ള മരുന്നുകൾ മാത്രം
കഴിക്കുക. സ്വയം ചികിത്സ ഒഴിവാക്കുക.
 എന്തെങ്കിലുംഅണുബാധയുണ്ടെങ്കിൽ
ആൻറിബയോട്ടിക്സും നിർദ്ദേശിക്കപ്പെടുന്നു.
നിയന്ത്രണ മാർഗങ്ങൾ:-
 കോവിഡിനെതിരെയുള്ള വാക്സിൻ ലഭ്യമല്ല
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മറ്റുള്ള നിയന്ത്രണമാർഗ്ഗങ്ങൾ
 ഇടവിട്ട് കൈകൾ സാനിറ്റൈസറോ, (ആൾക്കഹോൾ
ബേസിഡ്) സോപ്പോ ഉപയോഗിച്ച് വൃത്തിയാക്കുക.
 സാമൂഹിക അകലം പാലിക്കുക, പരസ്പരം 6 അടി അകലം
പാലിക്കുക.
 കഴിവതും വീട്ടിൽ തന്നെ ഇരിക്കുക, തിരക്കുള്ള
സ്ഥലങ്ങളും, ആൾക്കൂട്ടങ്ങളും ഒഴിവാക്കുക.
 പൊതുസ്ഥലങ്ങളിൽ നിർബന്ധമായും മാസ്ക്
ഉപയോഗിക്കുക. രണ്ട് ലയർ ഉള്ള തുണിയുടെ മാസ്ക്കോ,
സിംഗിൾ യൂസ് മാസ്ക്കോ ഉപയോഗിക്കണം.
 ഉപയോഗ ശേഷം മാസ്ക് കത്തിച്ചുകളയുകയോ, വീണ്ടും
ഉപയോഗിക്കുന്നവയെ സോപ്പുപയോഗിച്ച് കഴുകി
വെയിലത്ത് ഉണക്കി ഉപയോഗിക്കുക . കൃത്യമായ തോതിൽ
സൂര്യപ്രകാശം ലഭ്യമല്ലെങ്കിൽ ഇസ്തിരിയിൽ തേച്ച് ഉണക്കി
ഉപയോഗിക്കുക .
 ഒരിക്കലും കണ്ണിലും, മൂക്കിലും മുഖത്തും കൈകള്‍കൊണ്ട്
സ്പർശിക്കാതിരിക്കുക. അണുക്കൾ ഉള്ള പ്രതലത്തിൽ തൊട്ട
കൈകളില്‍നിന്ന് ഇത്പകരുന്നതിന് ഇടയാക്കും.
 ഒരു പ്രതലത്തിൽ 2 മണിക്കൂർ മുതൽ 9 ദിവസം വരെ ഇവ
അതിജീവിക്കുന്നു
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 സ്ഥിരമായി അല്ലെങ്കിൽ പൊതുവായി എല്ലാവരും
സ്പർശിക്കുന്ന സ്വിച്ച്, മേശവാതിൽ, താഴ്, പൂട്ട്‌എന്നിവ
തുടച്ച് അണുവിമുക്തമാക്കുക.
 പൊതുസ്ഥലങ്ങളിൽ തുമ്മുമ്പോഴോ ചുമയ്ക്കുമ്പോഴോ
വായും മൂക്കും പൊത്തുക, മാസ്ക് ഉപയോഗിക്കുക.
 സാമൂഹിക അകലം പാലിക്കുക. ഫോണുകള്‍വഴി
ബന്ധപ്പെടുക.
 പൊതുസ്ഥലങ്ങളിൽ തുപ്പാതിരിക്കുക .
സാധാരണ രീതിയിലുള്ള മുൻകരുതലുകൾ:-
കച്ചവട സ്ഥലങ്ങളിൽ എടുക്കേണ്ട മുൻകരുതലുകൾ
 മാസ്ക് ധരിക്കുകയും കൈകൾ വൃത്തിയാക്കുകയും ചെയ്യുക.
 സ്വയമായി സാധനങ്ങൾ എടുക്കുവാനുള്ള സഞ്ചി കരുതുക.
ഉപയോഗ ശേഷം കഴുകി ഉപയോഗിക്കുകയോ, കത്തിച്ചു
കളയുകയോ ചെയ്യുക.
 സാമൂഹിക അകലം പാലിക്കുക.
 കഴിവതും തനിയെ പോകാൻ ശ്രമിക്കുക.
 സ്വന്തമായി സാനിറ്റൈസർ കരുതുക. ഏതെങ്കിലും വസ്തുവിൽ
സ്പർശിച്ചത്തിനു ശേഷം ഇടവിട്ട് കൈകൾ വൃത്തിയാക്കുക.
 കഴിയുമെങ്കിൽ നേരിട്ട് സാധനങ്ങൾ വാങ്ങുന്നത് ഒഴിവാക്കുക.
 കൈകൾ തമ്മിൽ സ്പർശനത്തിൽ വരാതിരിക്കുക.
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 സാങ്കേതികമായ രീതിയിൽ പണം അടയക്കുക, നേരിട്ടുള്ള
ഇടപാടുകൾ കഴിവതും ഒഴിവാക്കുക.
 ആവശ്യമായ ദിവസങ്ങൾക്ക് മുൻപേ തന്നെ ഓൺലൈനായി
ഓർഡർ ചെയ്യുക.
 തിരിച്ച് വീട്ടിൽ പ്രവേശിക്കുന്നതിന് മുന്പ് കുളിച്ചു
വൃത്തിയാകുകയും, വസ്ത്രങ്ങൾ മാറ്റുകയും ചെയ്യുക.
 പ്രതലങ്ങളിൽ സ്പർശിച്ചതിന് ശേഷം കൈകൾ
വൃത്തിയാക്കുക. 2 മണിക്കൂർ മുതൽ 9 ദിവസം വരെ
പ്രതലങ്ങളിൽ വൈറസ് അതിജീവിക്കുന്നു.
 കണ്ണുകളിലും മൂക്കിലും സ്പർശിക്കാതെ ഇരിക്കുക.
 പുറത്തുനിന്നുള്ള ആഹാരം ഒഴിവാക്കുക.
 പച്ചക്കറികളും പഴങ്ങളും കഴുകി മാത്രം ഉപയോഗിക്കുക.
ജോലിസ്ഥലങ്ങളിലേ നിയന്ത്രണ മാർഗങ്ങൾ :
 മാസ്ക് ധരിക്കുക.
 ഇരിപ്പിടങ്ങൾ സാമൂഹിക അകലം പാലിച്ച് ക്രമീകരിക്കുക.
 മറ്റു പ്രധാന രോഗങ്ങളുള്ളവർ ഗർഭിണികൾ എന്നിവരെ
കഴിവതും സ്ഥാപനങ്ങളിൽ വരുന്നതിൽനിന്നും
ഒഴിവാക്കുക
 ശരീരതാപനില പരിശോധന നിർബന്ധമാക്കുക.
 പ്രവേശന സ്ഥലങ്ങൾ സാനിറ്റൈസർ ലഭ്യത ഉറപ്പുവരുത്തുക.
132
 ഉപയോഗിച്ച തുണി ടിഷ്യു എന്നിവ കൃത്യമായി
നശിപ്പിക്കുക.
 ചുമയ്ക്കുമ്പോഴും തുമ്മുമ്പോഴും ശുചിത്വം പാലിക്കുക.
 കൈകള്‍ഇടവിട്ട്‌വൃത്തിയാക്കുക.
 ജോലിക്കാരിൽ ഏതെങ്കിലും രീതിയിലുള്ള ലക്ഷണങ്ങൾ
പ്രകടമായവർ‍ സ്വയം ക്വാറന്റൈനിൽ തുടരുവാനുള്ള അവധി
നൽകുക.
 നേരിട്ടുള്ള ചർച്ചകൾ ഒഴിവാക്കി സാമൂഹ്യ മാധ്യമങ്ങൾ വഴി
നടപ്പിലാക്കുക.
 കഴിവതും വീട്ടിലിരുന്ന് ജോലി ചെയ്യുന്ന രീതിയെ
പ്രോത്സാഹിപ്പിക്കുക.
 ജോലി സ്ഥലങ്ങളിലെ പൊതുപരിപാടികളും, ചർച്ചകളും
ഒഴിവാക്കുക
ഉപസംഹാരം
വളരെ വേഗത്തിൽ പടർന്നു പിടിക്കുന്ന ഒരു
പകർച്ചവ്യാധിയാണ് കോവിഡ്-19. അപകട സാധ്യത
കൂടുതലുള്ളവർ കൃത്യമായ മുൻകരുതലുകൾ
എടുത്തിരിക്കണം ദിനംപ്രതി നൂറിലധികം ഗവേഷണങ്ങൾ
ഇതിന്റെ നിയന്ത്രണ മാർഗങ്ങളെപ്പറ്റി നടക്കുന്നു. ഓരോ
വ്യക്തികളും തങ്ങളുടെ കടമ മനസ്സിലാക്കി സ്വയംപരിചരണ
133
മാർഗങ്ങൾ എടുക്കുകയും, സർക്കാർ നിർദേശങ്ങൾ
അനുസരിക്കുകയും ചെയ്തു ഒരുമിച്ച് ചങ്ങലയെ മുറിക്കുക.
134

"Health Is Not Valued

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"Health Is Not Valued

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CHAPTER 1

“HEALTH IS NOT VALUED TILL SICKNESS COMES”

countries or territories with 40,777 deaths. We conducted a scoping review to provide a

brief summary of the general characteristics of COVID19, as well as a more detailed

disease and diabetes4.

Corona viruses are enveloped, positive single-stranded RNA viruses widely

respiratory syndrome corona virus (SARS-CoV) in 2002-2003 and Middle East

respiratory syndrome corona virus (MERS-CoV) in 2012, have caused deadly

December 2019, clusters of pneumonia cases of unknown aetiology emerged in

Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), and the disease it

causes called COVID-19. Although SARS-CoV-2 has shown phylogenetic and

Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of

among type II diabetic patients in prevention of COVID-19 and give

recommendations on how to limit the spread of the disease.

BACKGROUND OF THE STUDY

Corona viruses disease 2019 (COVID-19) be a highly infectious disease. It is

high prevalence of diabetes globally makes it a frequent co-morbidity in patients with

of infection in general, most studies have reported prevalence of diabetes almost

similar to that in general population in patients with COVID-19 9. A meta-analysis of

COVID-19. Understandably, prevalence of diabetes in patients with COVID-19 varies

largest number of confirmed cases in Asia.10

Diabetes mellitus (DM) is a disease and an international health threat, the

stage renal disease, adult-onset blindness, and non-traumatic lower extremity

In early December 2019, the first pneumonia cases of an unknown origin

throughout Wuhan (Hubei province) to other provinces in China, and continues to

official name of SARS-CoV-2-induced disease as the corona virus disease 2019

(MERS) It is mainly transmitted by droplets or direct contact, faeces and infected

with underlying health conditions. For instance, as COVID-19 continues overwhelm

should be considered problematic as they increase the risk of infections,

hospitalization, amputations, and possibly death in diabetes patients.

studies on the relationship between COVID19 and diabetes, it is difficult to suggests

regarding self management behaviour in prevention of COVID 19 among type II

diabetes mellitus. This is a descriptive study; a set of questionnaires is used as a tool to

analysis the level of knowledge regarding self management behaviour in prevention of

regarding self management behaviour in prevention of COVID-19 among type II

diabetes mellitus is satisfactory. Yet a significant number of participants are lacking

in order to reduce any further complication and risk of death14.

NEED OF THE STUDY

COVID-19 is caused by the corona virus SARS-CoV-2, which has spread

virus is primarily by transmission of respiratory droplets between people. The people

infection such as COVID-19, which lead to pneumonia, the chances of a secondary

productivity with sustained high quality.

problematic has thereby increase the risk of infections, hospitalization, amputations,

A study to assess the knowledge regarding self management behaviour among

type II diabetes mellitus patients in prevention of COVID-19 at selected area,

Alappuzha with a view to develop an information booklet.

 To assess the knowledge regarding self management behaviour in prevention of

the COVID-19 among type II diabetes patients at selected area, Alappuzha.

behaviour in prevention of the COVID-19 among type II diabetes patients with

selected demographic variable.

 To develop an information booklet regarding self management behaviour in

prevention of the COVID-19 among type II diabetes patients.

Assess: To judge or decide the amount, value, quality or importance of something. In

in prevention of COVID19 among type II diabetes patients at selected area Alappuzha.

Knowledge: Facts, information and skills acquired through experience or education,

the theatrical or practical understanding of a subject. In the study, knowledge means

awareness about self management behaviour in prevention of COVID19.

glucose level, physical activity, diet.

information on a particular subject.

Assumptions are the declarative statement about a phenomenon which are

management behaviour in prevention of corona virus.

Hypotheses were tested at 0.05 level of significance. There will be significant

association between the level of knowledge regarding self management behaviour