Project – Community Awareness and Prevention Practices Regarding Diabetes Mellitus among Adults: A Study of Selected Communities in Enugu North Local Government Area, Enugu State

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Diabetes mellitus is a chronic metabolic disease characterized by elevated blood glucose levels resulting from defects in insulin secretion, insulin action, or both. It is an important public health problem because prolonged hyperglycaemia can damage blood vessels and nerves and subsequently contribute to cardiovascular disease, kidney failure, visual impairment, neuropathy, foot complications and premature mortality. The global burden of diabetes has increased substantially, with the World Health Organization (WHO) reporting that the number of people living with diabetes increased from about 200 million in 1990 to 830 million in 2022. The burden has also been increasing rapidly in low- and middle-income countries, where health systems may have fewer resources for prevention, early detection and long-term management. WHO emphasizes that type 2 diabetes can often be prevented or delayed through healthy eating, regular physical activity, maintenance of a healthy body weight and avoidance of tobacco use (World Health Organization [WHO], 2024).

Diabetes mellitus has become particularly relevant to public health in Nigeria because the disease is occurring alongside changing lifestyles, urbanization, increasing overweight and obesity, physical inactivity and dietary changes. A systematic review and meta-analysis by Uloko et al. (2018) estimated an overall pooled prevalence of diabetes mellitus of 5.77% in Nigeria and identified unhealthy dietary habits, older age, urban residence, physical inactivity and obesity among important risk factors. More recently, a systematic review by Adeloye et al. (2024) involving 60 studies and 124,876 participants estimated a pooled prevalence of type 2 diabetes of 7.0% in Nigeria and identified family history, physical inactivity, urban living, elevated body mass index, infrequent vegetable consumption and abdominal obesity as significant risk factors. These findings demonstrate that diabetes prevention cannot be restricted to treatment of diagnosed patients; it must also involve improving awareness and encouraging preventive practices among adults who may not yet have developed the disease (Uloko et al., 2018; Adeloye et al., 2024).

Community awareness is an important component of diabetes prevention because individuals’ knowledge of the disease can influence their recognition of risk factors, symptoms, complications and preventive behaviours. Awareness, however, does not necessarily mean adequate knowledge or appropriate health behaviour. Osiberu et al. (2021), in a community-based study of 500 adults in two communities in Ibadan, Nigeria, found that 89.6% of respondents had previously heard about diabetes, but only 31.8% demonstrated adequate knowledge and only 28% had ever had their blood glucose measured by a doctor or other health professional. The researchers concluded that high awareness could coexist with important knowledge gaps and poor screening practices. This distinction is significant because merely knowing that diabetes exists may not be sufficient to motivate adults to adopt healthier diets, engage in physical activity, maintain healthy body weight or undergo appropriate screening (Osiberu et al., 2021).

Prevention practices regarding diabetes mellitus encompass several behaviours that can reduce the risk of developing type 2 diabetes or facilitate early detection. These include consuming a balanced diet, reducing excessive intake of free sugars and unhealthy fats, eating adequate fruits and vegetables, engaging in regular physical activity, maintaining a healthy body weight, avoiding tobacco use and obtaining appropriate health checks. WHO (2024) recommends at least 150 minutes of moderate-intensity physical activity per week for adults as part of broader efforts to reduce non-communicable disease risk. WHO also emphasizes that healthy diets and regular physical activity are central to preventing or delaying type 2 diabetes. Physical activity is particularly relevant because insufficient activity is associated with increased risk of type 2 diabetes and other chronic diseases (WHO, 2024).

The gap between awareness and actual preventive behaviour is an important public health concern in Nigeria. Evidence from Nigerian communities suggests that individuals may possess some awareness of diabetes without adequately understanding its risk factors or consistently adopting preventive measures. Ndibuagu, Arinze-Onyia and Chime (2016), in a study of 296 residents of a rural community in Enugu State, found low levels of knowledge concerning the nutritional causes, symptoms, risk factors and complications of diabetes. Only 30.7% of respondents knew that diabetes could be prevented, while 30.1% knew that careful dietary practices could help prevent the disease, 19.9% identified regular exercise as a preventive measure, and 29.7% knew about regular blood-sugar testing as a preventive or early-detection practice. These findings are particularly relevant to the present study because they demonstrate that significant knowledge and prevention gaps have previously been observed among residents of Enugu State (Ndibuagu et al., 2016).

The importance of community-level awareness and preventive practices is further demonstrated by evidence from Enugu and other parts of southeastern Nigeria. Ndibuagu et al. (2016) compared diabetic and non-diabetic residents in a rural Enugu community and found that the diabetic respondents had considerably better knowledge of diabetes than non-diabetic respondents, including knowledge concerning types, prevention, risk factors, symptoms and complications. However, the existence of knowledge differences does not eliminate the need for preventive education among adults who have not been diagnosed with diabetes. Similarly, a study of adults in Enugu South Local Government Area reported substantial knowledge of diabetes among respondents but also identified socio-cultural and demographic factors associated with knowledge and attitudes toward diabetes and hypertension. These findings suggest that community awareness is shaped not only by exposure to health information but also by age, education, socioeconomic circumstances, cultural practices, family history and other characteristics of the population (Ndibuagu et al., 2016; Nwafor et al., 2024).

Enugu North Local Government Area provides an important setting for investigating community awareness and diabetes prevention practices among adults. The area is part of Enugu metropolis and contains a mixture of residential and commercial activities, with residents engaged in occupations and socioeconomic activities that may influence access to health information and preventive healthcare services. Research conducted in Enugu North has shown that adult residents use health facilities within the local government area, while broader evidence from Enugu State demonstrates that diabetes is already an important concern in the population. A recent study involving diabetes patients receiving care in Enugu State included health facilities in Enugu North and other parts of the state, demonstrating the continued relevance of the area to diabetes-related research and healthcare delivery. However, evidence from patients receiving treatment cannot be assumed to represent the awareness and preventive practices of the general adult community population, making community-based investigation necessary (Onwujekwe et al., 2014; Nwankwo et al., 2026).

Community awareness is therefore an essential component of a comprehensive diabetes prevention strategy. Health education can help adults understand modifiable risk factors, recognize possible symptoms, appreciate the importance of screening and make informed decisions concerning diet, physical activity and other health behaviours. Nigerian evidence has shown that diabetes awareness can be relatively high while appropriate knowledge and screening practices remain inadequate. Furthermore, WHO emphasizes that communities, health systems and policies all have important roles in creating environments that support healthy behaviours, early detection and access to preventive care. Consequently, assessing what adults in selected communities actually know about diabetes and what preventive practices they undertake can provide useful evidence for developing targeted community health education and prevention programmes (Osiberu et al., 2021; WHO, 2026).

1.2 Statement of the Problem

Diabetes mellitus is increasingly recognized as a major non-communicable disease challenge in Nigeria. The growing prevalence of type 2 diabetes has been associated with modifiable factors such as physical inactivity, unhealthy dietary practices, overweight and obesity, urban living and other lifestyle-related factors. Although many of these risk factors can be modified through individual and community-level interventions, prevention requires adults to possess adequate information and translate such information into appropriate health practices. The increasing burden of diabetes therefore raises concerns about whether community members possess sufficient awareness of the disease, its risk factors, warning signs, complications and available preventive measures (Adeloye et al., 2024; WHO, 2024).

A major concern is the possible gap between having heard about diabetes and possessing sufficient knowledge to prevent it. Osiberu et al. (2021) found that although almost nine out of ten adults in their Ibadan community study had previously heard about diabetes, only 31.8% were considered knowledgeable and only 28% had ever undergone blood-glucose measurement by a health professional. Similarly, research conducted in a rural community in Enugu State found substantial gaps in knowledge concerning diabetes prevention, dietary measures, exercise, risk factors and screening. Such findings indicate that general awareness of the name of a disease does not necessarily translate into the knowledge and behaviour required for effective prevention. If similar gaps exist among adults in Enugu North, individuals who consider themselves healthy may remain unaware of their risk and may not engage in appropriate preventive practices (Osiberu et al., 2021; Ndibuagu et al., 2016).

Another problem concerns the adoption of preventive practices among adults. Evidence indicates that regular physical activity, healthy dietary behaviour and appropriate screening can contribute to diabetes prevention and early detection, yet these behaviours may be influenced by socioeconomic circumstances, education, occupation, culture, access to healthcare and individual perceptions of risk. In eastern Nigeria, a study of patients with type 2 diabetes found that although 95.6% were aware of self-monitoring of blood glucose, only 60.7% practiced it at some frequency, while 39.3% did not practice self-monitoring at all; lack of finance was reported as the predominant reason for non-practice. Although that study involved people already diagnosed with diabetes, it illustrates the broader challenge of translating health knowledge into sustained preventive or self-care behaviour in the Nigerian context (Uchenna et al., 2016).

The specific problem addressed by this study is therefore the limited community-level evidence concerning the relationship between awareness and prevention practices regarding diabetes mellitus among adults in selected communities in Enugu North Local Government Area. Previous research has examined diabetes knowledge in rural communities in Enugu State and knowledge, attitudes and sociocultural factors in Enugu South, while other studies have focused on diagnosed patients attending health facilities. These studies provide valuable evidence, but their findings cannot automatically be generalized to adults living in selected communities in Enugu North. Consequently, there is a need to determine the level of community awareness, assess the preventive practices adopted by adults, examine the relationship between awareness and prevention practices, and identify factors that may hinder effective diabetes prevention. The findings may provide community-specific evidence useful for strengthening health education, screening promotion and lifestyle-based diabetes prevention activities in Enugu North Local Government Area (Ndibuagu et al., 2016; Nwafor et al., 2024; Osiberu et al., 2021).

1.3 Purpose of the Study

The main purpose of this study is to examine community awareness and prevention practices regarding diabetes mellitus among adults in selected communities in Enugu North Local Government Area of Enugu State.

Specifically, the study seeks to:

1. determine the level of awareness of diabetes mellitus among adults in selected communities in Enugu North Local Government Area;
2. assess the level of diabetes mellitus prevention practices among adults in selected communities in Enugu North Local Government Area;
3. examine the relationship between community awareness and prevention practices regarding diabetes mellitus among adults in selected communities in Enugu North Local Government Area; and
4. identify the major factors influencing diabetes mellitus prevention practices among adults in the selected communities.

1.4 Research Questions

The following research questions will guide the study:

1. What is the level of awareness of diabetes mellitus among adults in selected communities in Enugu North Local Government Area?
2. What is the level of diabetes mellitus prevention practices among adults in selected communities in Enugu North Local Government Area?
3. What relationship exists between community awareness and prevention practices regarding diabetes mellitus among adults in selected communities in Enugu North Local Government Area?
4. What are the major factors influencing diabetes mellitus prevention practices among adults in the selected communities?

1.5 Research Hypothesis

The following null hypothesis will be tested at the 0.05 level of significance:

H₀: There is no significant relationship between community awareness and prevention practices regarding diabetes mellitus among adults in selected communities in Enugu North Local Government Area of Enugu State.

1.6 Significance of the Study

The study is expected to be beneficial to the following groups:

Adults and Community Residents: The findings may increase understanding of diabetes mellitus, particularly its risk factors, symptoms, complications and preventive measures. The study may also draw attention to the importance of healthy dietary practices, physical activity, weight management and appropriate health screening.

Community Health Workers: Community health workers may use the findings to identify areas of inadequate knowledge and misconceptions among adults. The information may assist them in designing more targeted health education and community outreach activities.

Primary Healthcare Providers: The findings may provide evidence that can assist primary healthcare facilities in strengthening diabetes awareness, risk assessment, screening referrals and preventive health education within surrounding communities.

Enugu State Ministry of Health: The study may provide community-level information that can support planning and implementation of non-communicable disease prevention programmes, particularly those targeting diabetes and other lifestyle-related conditions.

Public Health Practitioners: The findings may help public health practitioners understand the extent to which awareness is translated into actual preventive behaviour. This may assist in developing interventions that move beyond information dissemination toward sustained behavioural change.

Researchers and Students: The study may serve as reference material for future research on diabetes mellitus, community health education, health awareness, lifestyle-related diseases and prevention practices in Enugu State and Nigeria.

1.7 Scope of the Study

The study is delimited to community awareness and prevention practices regarding diabetes mellitus among adults in selected communities in Enugu North Local Government Area of Enugu State.

The study will focus on adults aged 18 years and above residing in the selected communities. The content scope will cover awareness of the meaning and types of diabetes mellitus, symptoms, risk factors, complications, prevention and early detection. It will also examine preventive practices such as healthy dietary behaviour, reduction of excessive sugar intake, consumption of fruits and vegetables, regular physical activity, weight management, avoidance of tobacco use, reduction of harmful lifestyle practices and willingness to undertake blood-glucose screening.

The geographical scope is limited to selected communities within Enugu North Local Government Area. The study will focus on community-dwelling adults rather than exclusively on patients already diagnosed with diabetes. Consequently, findings will primarily reflect the awareness and preventive practices of adults within the selected communities and should not automatically be generalized to all adults in Enugu State.

1.8 Operational Definition of Terms

Awareness: The extent to which an adult has heard of and possesses basic information about diabetes mellitus, including its meaning, symptoms, risk factors, complications and preventive measures.

Community: A geographically defined group of people living within a particular locality and sharing certain social, environmental or administrative characteristics.

Diabetes Mellitus: A chronic metabolic disease characterized by elevated blood glucose resulting from inadequate insulin production, impaired insulin action or a combination of both.

Diabetes Prevention: Actions undertaken by individuals, families, communities or health systems to reduce the risk of developing diabetes, particularly type 2 diabetes, or to facilitate early detection and reduction of complications.

Prevention Practices: Specific behaviours adopted by adults to reduce their risk of diabetes mellitus. These include healthy eating, regular physical activity, weight control, avoidance of tobacco, appropriate health checks and blood-glucose screening.

Adult: For the purpose of this study, a person aged 18 years or above who resides in one of the selected communities in Enugu North Local Government Area.

Community Awareness: The collective level of knowledge and understanding of diabetes mellitus among adults within the selected communities, including knowledge of its causes or risk factors, symptoms, complications and prevention.

Screening: The process of checking an apparently healthy person for an increased likelihood of having a disease or condition, such as diabetes, through appropriate health assessment or blood-glucose testing.

1.9 Organisation of the Study

The study will be organized into five chapters.

Chapter One presents the introduction, background to the study, statement of the problem, purpose of the study, research questions, research hypothesis, significance of the study, scope of the study, operational definition of terms and organisation of the study.

Chapter Two will review relevant literature on diabetes mellitus, community awareness, knowledge of diabetes risk factors and symptoms, diabetes prevention practices, theoretical perspectives and empirical studies related to the subject.

Chapter Three will present the methodology of the study. It will cover the research design, area of the study, population of the study, sample size and sampling technique, instrument for data collection, validity of the instrument, reliability of the instrument, method of data collection and method of data analysis.

Chapter Four will present the analysis and interpretation of data obtained from the respondents. The research questions will be answered using appropriate descriptive statistics, while the null hypothesis will be tested at the 0.05 level of significance.

Chapter Five will present the discussion of findings, conclusion, recommendations, limitations of the study, implications of the findings and suggestions for further studies.

Project – Community Awareness and Prevention Practices Regarding Diabetes Mellitus among Adults: A Study of Selected Communities in Enugu North Local Government Area, Enugu State