Background

Diabetes mellitus is a global disease with an extreme effect on the quality of life of affected patients. In the past, South Africans diagnosed with diabetes mellitus were predominantly from the affluent urban community. Now, due to westernisation of the rural community, it is fast becoming prevalent in the rural African population. The increase in the number of peripheral clinics postapartheid has provided essential health care to the masses. There has been an increase in screening for diabetes and easier access to treatment for outlying communities. An important point of consideration is the knowledge that diabetic patients have of their disease. This is an integral component for attaining optimal disease control. Knowledge of diabetes can thus prevent the impending chronic co-morbidities of diabetes mellitus, which impact significantly on the quality of life of the diabetic patient. It would thus be valid to assess the understanding of the primary healthcare patient of his or her disease state and the complications that may arise. This study was therefore aimed at clinics in the KwaZulu-Natal region, where 56,9% of the people live in rural areas, with an estimated 65% literacy rate and unemployment standing at over 50%. The patients at the rural clinics, who have limited access to the health care enjoyed by urban and private patients, would be of particular interest

Methods

This was a descriptive study involving 181 patients attending three primary healthcare clinics in KwaZulu- Natal (designated A, B and C). The clinics that were selected either bordered on or were in a rural area. The patients were chosen by convenience sampling. All patients visiting the diabetic clinic were chosen on a voluntary basis. Informed consent was obtained from each patient. The patients could be either type 1 or type 2 diabetics. A two-part patient questionnaire was designed. Section A investigated basic patient history (demographics and disease state), while section B was a basic knowledge test on diabetes mellitus. Section A investigated patient age, race, residence, number of years post-diagnosis and the type of diabetic medication being taken. Diabetes knowledge was assessed with a modified version of the Michigan Diabetes Research and Training Centre's Brief Diabetes Knowledge Test. A total of 13 multiple-choice questions were used, covering key areas in diabetic management, including hypoglycaemic symptom identification, plasma glucose level awareness, knowledge of diet, the possible chronic co-morbidities of diabetes, foot care, exercise, etc. Patients answering seven of the 13 questions correctly were considered as having passed the test.

Results

A total of 121 of the 181 patients (66.9%) passed the diabetic knowledge test (p<0.05). There was a higher pass in the female group than in the male group, with 69.8% of the female population passing compared to 60% of the male. The overall data across the three clinics indicate a better pass by the Indian than the African population, with 75.9% of the Indian patients passed in comparison to 52.2% of the African patients.

Conclusion

It should be emphasised that a difference in knowledge scores illustrates a lack of history in the particular group and is a legacy of apartheid, during which there were inequalities in education, health services and all other spheres of life. Further correlations were established regarding diabetes knowledge and age, number of years post-diagnosis of diabetes, counselling received and type of diabetic medication used. There is a problem with regard to the understanding of diabetes by the African population. The majority of the African study population, who were type 2 diabetics and older than forty, grew up during the apartheid era and consequently lacked the benefit of appropriate heath care and education. We therefore need to ensure that our healthcare providers are continuously trained and provided with the essentials in order to comprehensively care for diabetic patients. Furthermore, follow up evaluations should be performed on a regular basis in the clinical environment and re-training administered where appropriate.