International United Scientific and Social Population (IUSSP): 28 th - - PDF document

International United Scientific and Social Population (IUSSP): 28th International Population Conference (IPC) Assessment of the effect of climate change on self-care management of Type 2 diabetes; using Type 2 diabetes patients at Phiphidi Village located in Vhembe District in Thulamela Municipality in Limpopo Province of South Africa as a case study Author : Fhulufhedzani Nembambula Organisation: Statistics South Africa Year : 2017

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Abstract In South Africa, three-and-a-half million people are suffering from diabetes and there are many more that goes undiagnosed. On the other hand, climate changes are felt across the globe. Diabetes and climate change as inter-related elements are globally impacting human health at an accelerated rate, and are two urgent challenges facing the 21st century today. The study outlines the effect of climate change or more specific, extreme hot conditions on the self-care management of Type 2 diabetes. Type 2 diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose) which is the body's important source of fuel and also known as adult-onset or noninsulin- dependent diabetes. The study mainly focused on the self-care management of Type-2 diabetes (blood sugar levels, healthy eating, medication and physical activities) during extreme heat conditions. For the purpose of the study, randomly selected households were visited, using questionnaires to collect information about the effect of extreme heat condition on self-care management of Type-2 diabetes. Furthermore, climate information was collected using temperature trends data obtained from the South Africa Weather Service. The study will pave a way forward for the Limpopo Department of health in better assisting rural diabetic patients with the management of their diabetes during times

• f extreme heat conditions.

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Background Globally, more than 300 million people suffer from diabetes and it is estimated that by 2030 the number will reach half a billion. The implications are that families could be impoverished, labour productivity could be hampered and health systems could be overwhelmed. Globally, according to the International Diabetes Federation (IDF) (2011), diabetes are responsible for the deaths of 4.6 million people per year and furthermore, four out of five people suffering from diabetes are living in low to middle income countries. On the other hand, climate changes are felt across the globe. This is evident considering that sea levels are rising, tropical storms are causing damages along coastlines, fertile lands are battling floods or drought and the permafrost in the Polar Regions is melting. Diabetes and climate change as inter-related elements are globally impacting human health at an accelerated rate which are two critical challenges faced by the 21st century. The research was initiated when I worked as a diabetes medical sales

• representative. The one thing that stood out for me was that during extreme hot

conditions, diabetes patients struggled to self-care manages their condition especially when considering eating healthy food, regular exercising and taking their medications as prescribed. The aim of the study will outline the effect extreme hot conditions has on the self- care management of Type 2 diabetes. Type 2 diabetes is a chronic condition that affects the way the body metabolizes sugar (glucose) which is the body's important source of fuel and also known as adult-onset or noninsulin-dependent diabetes(Mayo Clinic,2017). The study focused on the self-care management of Type-2 diabetes considering blood sugar levels, healthy eating, taking medication as prescribed and physical activities. The outcome of the research will endeavour to answer the key question on how does extreme heat conditions affect the self-care management of Type 2 diabetes as a chronic condition.

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Research Methodology In Rajasekar et al. (2013) view, research is a logical and systematic search for new and useful information on a particular topic for finding solutions to scientific and social problems through objective and systematic analysis. Research methodology in essence is the study of the method of which the information is gained and could be quantitative, qualitative or both. Quantitative research is based on the measurement

• f quantity or amount results being a number or a set of numbers. Qualitative on the
• ther hand is non-numerical, descriptive, and exploratory which applies reasoning

and is concerned with qualitative phenomenon involving quality (Rajasekar et al.2013). The study includes both quantitative and qualitative research. It is qualitative in the sense that randomly selected households were visited, using a questionnaire (see Annexure A) to collect information on the effect hot conditions has on self-care management of Type 2 diabetes when taking into account blood sugar levels, healthy eating, taking of medication as prescribed and other challenges. It is quantitative based on the fact that climate change information was collected using temperature trends data obtained from the South Africa Weather Service. Furthermore, the Statistical Package for the Social Science (SPSS) was used to analyse the primary data collected using questionnaires. Lastly to illustrate the challenges faced by especially black rural diabetic patients. Phiphidi village located in the Vhembe District in Thulamela Municipality in Limpopo Province was used as a case study (see figure 1 and 2). Case studies excel at bringing to understand what is known through previous research or real-life events (Soy, 1997). Case studies contextualise the relationships between events or certain conditions. Basically, as summarised by Yin (1984 and 2009), case studies explains the contemporary phenomenon within its real life context.

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Figure 1: Map of South Africa

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Figure 2: Map of Limpopo Province showing Vhembe District and Thulamela Municipality and Thulamela Municipality Map. Literature Review Climate change as defined by the National Aeronautics and Space Administration (NASA) (2014) is a change in the usual weather found in a place which can be a change in how much rain a place usually gets in a year or a change in a place's usual temperature for a month or season. Climate change according to IDF (2011) is the biggest threat to human health and exacerbates existing health risks including increased morbidity and mortality from non-communicable diseases (NCDs) such as diabetes. The effects of climate change, including climatic extremes, may increase risk of diabetes in populations by curtailing physical activity, disrupting traditional food supplies, and increasing food

• insecurity. On the other hand, extreme climatic events such as heat waves increase

morbidity and mortality in people with underlying conditions such as diabetes, and damage healthcare infrastructure and its capacity to deliver essential care for people with diabetes (IDF, 2011).

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As mentioned, diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces (World Health Organisation (WHO), 2010). There are two types of diabetes, Type 1 diabetes which is characterized by a lack of insulin production and without daily administration of insulin can be fatal and Type 2 diabetes which results from the body’s ineffective use of insulin. According to WHO (2010) approximately 90 percent of people with diabetes around the world suffers from Type 2 diabetes. Type 2 diabetes develops when the body becomes resistant to insulin or when the pancreas stops producing enough insulin - the cause is unknown. The general assumption is that genetics and environmental factors, such as excess weight and inactivity, seem to be the contributing factors (Mayo, 2016). Furthermore, new research conducted by Waters(2017) suggests that if the state of fresh food supply which is essential for the diet of those diagnosed with diabetes is affected by climate change (high temperature) could lead to a rise in Type 2 diabetes. This is further emphasised by Orenstein (2011) stating that diabetes patients normally end up in emergency rooms during extreme hot conditions and as a result higher number of deaths occur during summer seasons. Therefore, according to WHO (2016), lifestyle measures shown to be effective in preventing or delaying the onset of Type 2 diabetes are: 1) maintaining a healthy body weight; 2) being physically active; 3) eating a healthy diet, 4) avoiding sugar and saturated fats intake; and 5) avoiding tobacco use as smoking increases the risk

• f diabetes as well as cardiovascular diseases. Moreover, eating well also helps to

manage blood glucose levels and body weight and exercising helps the insulin work more effectively, lowers blood pressure and reduces the risk of heart disease (Diabetes Australia, 2015). MedLinePlus (2017) to ensure that the management of diabetes especially during extreme hot conditions is maintained, it is essential to take the following precautions measures, namely 1) to stay hydrated, 2) to store medication properly, 3) to stay out

• f the heat, and 4) to know the signs of low blood sugar such as sweating and

shakiness or confusion.

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Analysis As mentioned earlier, the study included a quantitative and qualitative approach which was contextualised against Phiphidi village as a real-life event. The data on daily maximum and minimum temperatures were collected from the South African Weather Service’s meteorological station 0723664 6 - Thohoyandou WO and is illustrated in Graphs 1 and 2. Graph 1 shows the monthly daily maximum temperatures between the years 2013 to

• 2016. It is clear from the graph that the period September to April has the highest

daily maximum temperatures with an average of 29°C. Figure 1: Daily maximum temperature averages between 2013 and 2016 in Thohoyandou On the other hand, the daily minimum temperature between the years 2013 to 2016 is illustrated by Graph 2. It is clear from the graph that the period May to August have the lowest temperatures with an average of 11°C. Therefore it is safe to argue that extreme heat conditions would occur in the period between September to April.

23 24 25 26 27 28 29 30 Jan-April May-August Sept-December

Maximum Average Temperatures

Yearly Periods

Maximum Temperature Averages from the year 2013-2016 in Thohoyandou

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Figure 2: Daily minimum temperature averages between 2013 and 2016 in Thohoyandou The question posted was how do extreme heat conditions affect the self-care management of Type 2 diabetes as a chronic condition? To establish the relationship between extreme heat conditions as illustrated in the graphs above and the self-care management of diabetes, a questionnaire was administered. The questionnaire was based on experiences taking into account the self-care management of Type 2 diabetes as prescribed by the WHO as well as MedLinePlus. Taking into account the Census 2011 results, Phiphidi village comprises of 2,501 households of which 67 were randomly selected with a 10 percent error margin and a 90 percent level of confidence adopted from Qualtrics (2017).Findings from the questionnaires were analysed using SPSS frequency analysis. From the 67 households visited only 13 (19.4%) were diagnosed with Type-2 diabetes of which 10 (76, 9%) are female and 3 (23, 1%) are male. Findings from the analysis are: 1) Blood sugar levels: From the 13 patients with diabetes, only 3 (23 %) check their blood sugar levels while the other 10 (77 %) doesn’t check their blood sugar levels at all. The main reason is based on the fact that those checking their blood sugar levels have access to a Gluco-meter machine. However, although having access

5 10 15 20 25 30 35 Jan-April May-August Sept-December

Minimum Average Temperatures

Yearly Periods

Daily Minimum Temperature averages from the year 2013-2016 in Thohoyandou

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to a Gluco-meter machine, they only check blood sugar levels when they are not feeling well regardless of extreme heat condition. 2) Healthy eating: From the 13 patients with diabetes, 11 (85 %) consume food that makes it easy to reach an optimal blood sugar level. The reason is based on the fact that they produce fresh fruits and vegetables from their own backyard (home)

• gardens. Furthermore, they also consume a lot of water especially during extreme

heat condition. However, most of the patients also indicated that due to a lost in appetite during extreme heat conditions they tend to eat lots of sweets which is not optimum for blood sugar levels. 3) Physical activities: From the 13 patients with diabetes, 8 (62 %) through home chores participate in regular physical activities whereas 5 (38 %) do not do regular physical activity because they feel mostly tired during extreme heat conditions. 4) Medication: From the 13 patients with diabetes, only 4 (31 %) take their diabetes medication as prescribed whereas the other 9 (69 %) doesn’t take their diabetes medication as prescribed due to either over sleeping or plain laziness. Lastly, it seems that most of the patients don’t experience any other challenges when applying self-care management of their chronic condition during extreme heat conditions, however, it seems from their responses that there is a general increase in dizziness, hunger, tiredness and blurred vision during extreme heat conditions. Conclusion In conclusion, it is evident that most of Type 2 diabetes patients living in Phiphidi village have no knowledge on the effects of extreme heat conditions on the self-care management of diabetes as a chronic condition. Although, most of the Type 2 diabetes patients living in Phiphidi village understand the importance of good self- care, it seems that they lack the understanding why and when to regularly test for blood sugar levels, knowing what food to eat and not to eat and why it is important to take their medication as prescribed. It also seems that during extreme hot conditions, most patients’ experience dizziness, tiredness and an increase in hunger. Therefore it is safe to argue that patients suffering from Type 2 diabetes lack the knowledge and understanding in the self-care management of their condition especially during extreme heat condition. In that regard more awareness should be created to inform communities on the importance of self-care management of diabetes as a chronic

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condition especially during extreme heat conditions. The Phiphidi Health Centre should in advance check blood glucose levels every time patients come for medication collection. This will enable them to establish whether the medication is working or not especially during extreme heat conditions. Lastly, it might be helpful to encourage local businesses to sponsor Gluco-meter machines and strips as a means to assist needy diabetes patients.

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Appendix A Age : Gender : The following statements describe self-care activities related to your diabetes

• management. Thinking about your self-care

when there are climate change factors such as extremely hot temperatures and drought. Please specify the extent to which each statement applies to you. Applies to me very much Partially applies to me Doesn’t apply to me at all

• 1. Do you check blood sugar levels with

care and attention in extremely heat condition? ☐ 3 ☐ 2 ☐ 1

• 2. Does the food you choose to eat make it

easy to achieve optimal blood sugar levels in extremely heat conditions?

☐ 3 ☐ 2 ☐1

• 3. Do you take diabetes medication (e. g.

insulin, tablets) as prescribed in extremely heat conditions?

☐3 ☐2 ☐1

• 4. Do you occasionally eat lots of sweets or
• ther

foods rich in carbohydrates influenced by extremely heat condition?

☐3 ☐2 ☐1

• 5. Do you do regular physical activity to

achieve optimal blood sugar levels even in extremely heat condition?

☐3 ☐2 ☐1

• 6. What other challenges are you facing in

managing Type 2 diabetes when it is extremely hot /drought condition?

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References Diabetes Australia. (2015). The National Diabetes Services Scheme. www.diabetesaustralia.com.au/managing-type-2 http://medlineplus.gov/ency/patientinstructions/000086.htm Mayo clinic (2016).www.mayoclinic.org/doseases-conditions/type-2- diabates/home/ovc-20169860 NASA (2014). www.nasa.gov/audience/forstudents/K-4/stories/nasa- knows/what-is-climate-change-k4.html Orestein,B.W.(2017). How hot and cold weather affects your blood sugar. Qualtrics (2010). Sample Calculator Size. https://www.qualtrics.com/blog/calculating-sample-size/ Soy, Susan K. (1997). The case study as a research method. Unpublished paper, University of Texas at Austin Winters, C. (2017). Climate change may be linked to rise of Type 2 diabetes, Study says: Global Warming affects the body as well? www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms- causes/dxc-20169861 Yin, R. K. (1984). Case study research: Design and methods. Newbury Park, CA: Sage. Yin, R. K. (2009). Case study research: Design and methods (4th Ed.). Thousand Oaks, CA: Sage.