Research: Brief Report Brunei Int Med J.

2015; 11 (5): 247-250

Diabetes awareness in Kampong

Kapok, Brunei Maura district,
Brunei Darussalam
Shi Ying TAN, Afifah Amirah Hakimah SHAZLI, Azirah ABD WAHAB, Adib A RAHMAN,
Fazean IDRIS
Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah (PAPRSB) Institute of Health Sciences,
Universiti Brunei Darussalam, Brunei Darussalam

INTRODUCTION MATERIALS AND METHODS

Diabetes Mellitus (DM) is the third leading cause of and above participated in the health screening,
deaths in Brunei Darussalam after cardiovascular discussion and presentation sessions.
1
disease and cancer. Approximately 12.5% of the
Bruneian population have DM (95% type 2) and Data Collection. Participants were screened for
2
27.2% of them are obese. DM is a precursor to their body mass index (BMI), blood pressure (BP)
3
other serious health complications. DM can lead and random blood glucose and completed a ques-
to functional limitations, disability and productivity tionnaire that addressed their knowledge and atti-
4
which consequently results in economical strains. tudes on DM. They were then divided for small
Notably, the number of children diagnosed with DM groups discussion, followed by an interactive talk
5
is escalating in Brunei. According the Internation- which addressed the risk factors, detections, signs
al Diabetes Foundation, approximately half of DM and symptoms, long-term complications and pre-
3
patients were unaware of their disease. The Min- vention of DM. Participant completed the same
istry of Health, Brunei Darussalam has devoted questionnaires to assess any changes in knowledge
some efforts in addressing early identification of and attitude after the intervention.
DM such as ‘Program Mukim Sihat’ and public
health promotional awareness talks. A community Research Instruments. BMI categories were de-
outreach project with the theme “Diabetes Aware- termined using the Centers for Disease Control and
6
ness” was aimed to educate the community on Prevention (CDC) guidelines. BP categories were
diabetes prevention and management through classified according to the National High Blood
7
healthy lifestyle approaches. During this pro- Pressure Education Programme. The knowledge
gramme, a survey was conducted to assess the questionnaire was adapted from "Diabetes
8
awareness of DM at the grass root level. Knowledge Questionnaire". The attitude question-
naire was adapted from an attitude survey by The
MATERIALS AND METHODS Montana-Wyoming Tribal Leaders Council. 9

Study Design, Population and Sample. The

study was conducted in Kg. Kapok, one of the vil- Statistical Analysis. Data was computed using
lages in Mukim Serasa, Brunei Muara district. Vil- Microsoft Excel for Windows for simple mathemati-
lagers were invited and those aged 18 years old cal calculations.

Correspondence author: Shi Ying TAN Ethical Considerations. This project was ap-
PAPRSB Institute of Health Sciences,
University Brunei Darussalam, Jalan Tungku Link, proved by Department of Health Services, Ministry
BE 1410,Brunei Darussalam, of Health and PAPRSB Institute of Health Sciences,
Tel: +673 8162155
E mail: [email protected] UBD in September 2014.
 Tan et al. Brunei Int Med J. 2015; 11 (5): 248

RESULTS Table 1: Demographics of subjects.

In total 60 of more than 150 attendants were re-
n (%)
cruited. 33.9% (n=20) screened were overweight Male Female Total

and 32.2% (n=19) were obese. 49.0% (n=27) had Body Mass Index categories

hypertension (HT). 93% (n=56) had normal ran- Underweight (<18.0) 0 (0.0) 0 (0.0) 0 (0.0)

Healthy (18.0-25.0) 9 (33.3) 11 (34.4) 20 (33.9)

dom blood sugar readings, and one participant had
Overweight (25.1-29.9) 12 (44.4) 8 (25.0) 20 (33.9)
a random blood glucose of 13.2 mmol/L, who was
Obese (≥ 30.0) 6 (22.2) 13 (40.6) 19 (32.2)
referred to the diabetic nurse educator. 11.7%
27 (100.0) 32 (100.0) 59 (100.0)
(n=7) were on medications for diabetes. However, Blood pressure categories

despite the treatment, two of them were found to Normal (<120/<80) 7 (28.0) 11 (36.7) 18 (32.7)

have borderline high random blood glucose levels Pre-HT (120-139/80-89) 0 (0.0) 10 (33.3) 10 (18.2)

HT Stage 1 (140-159/90-99) 12 (48.0) 7 (23.3) 19 (34.5)

(10.7 and 10.9 mmol/L). Participants’ demographic
HT Stage 2 (≥160/≥100) 6 (24.0) 2 (6.7) 8 (14.5)
is shown in Table 1.
25 (100.0) 30 (100.0) 55 (100.0)

During small groups’ discussion, partici-

pants were able to identify the risk factors of DM sweet food may cause DM. There was a slight de-
and were aware that diabetes could be inherited. crease in knowledge with regards to dizziness as a
There several misconceptions; consequences; fre- sign of both low and high blood sugar respectively.
quent pyrexia, and dyspnoea (which could possibly
resulted in asthma), males are more prone, stress After the intervention, there were also im-
could induce and sleeping less can prevent DM. provement in the attitudes; awareness of long-term
complications, recognised that blood sugar had to
There was a significant increase in be kept as close to normal to prevent the complica-
knowledge and positive attitude towards the man- tions and importance of self-initiative and self-care.
agement of diabetes (Tables 2 and 3). After the In contrast, majority (77.8%, n=42) still thought
intervention, awareness of the importance of that Type 2 DM is more serious and dangerous
healthy diet and lifestyle, in addition to the im- compared to Type 1 DM. A majority (94.4%, n=51)
portance of medications, importance of weight loss thought that insulin injections were given to more
especially if overweight, eating too much sugar and serious cases.

Table 2: Pre- and post-questionnaire questions on knowledge about diabetes.

Pre-Questionnaire (n=39) Post-Questionnaire (n=54)

Agree Neutral Disagree Agree Neutral Disagree

n (%) n (%) n (%) n (%) n (%) n (%)
1: Eating too much sugar and sweet foods may
34 (87.2) 2 (5.1) 3 (7.7) 52 (96.3) 1 (1.9) 1 (1.9)
cause diabetes
2: The usual cause of diabetes is lack of insulin in
27 (69.2) 10 (25.6) 2 (5.1) 46 (85.2) 1 (1.9) 7 (12.9)
the body
3: If I am diabetic, my children have a higher chance
26 (66.7) 9 (23.1) 4 (10.3) 40 (74.1) 6 (11.1) 8 (14.8)
of being diabetic
4: There are 2 main types of diabetes: Type 1 & Type 2 29 (74.4) 8 (20.5) 2 (5.1) 51 (96.2)a 1 (1.9)a 1 (1.9)a
5: Diabetes can't be managed just by looking after
25 (64.1) 6 (15.4) 8 (20.5) 14 (25.9) 3 (5.6) 37 (68.5)
a healthy diet & healthier lifestyle
6: Medication is more important than diet
25 (64.1) 5 (12.8) 9 (23.1) 20 (37.0) 6 (11.1) 28 (51.9)
and exercise to control diabetes
7: Weight loss is not important in treating obese
22 (56.4) 3 (7.7) 14 (35.9) 9 (16.7) 1 (1.9) 44 (81.5)
diabetic patient
8: Diabetes can cause loss of feeling in my hands,
31 (79.5) 4 (10.3) 4 (10.3) 51 (94.4) 1 (1.9) 2 (3.7)
fingers and feet
9: Dizziness is a sign of low blood sugar 31 (79.5) 4 (10.3) 4 (10.3) 38 (70.4) 9 (16.7) 7 (12.9)

10: Dizziness is a sign of high blood sugar 27 (69.2) 5 (12.8) 7 (17.9) 35 (64.8) 7 (12.9) 12 (22.2)
 Tan et al. Brunei Int Med J. 2015; 11 (5): 249

Table 3: Respondents’ knowledge level, attitudes and perceptions towards

hyperlipidaemia and its management.

Pre-Questionnaire (n=39) Post-Questionnaire (n=54)

Agree Neutral Disagree Agree Neutral Disagree

n (%) n (%) n (%) n (%) n (%) n (%)

1. People who need to take insulin to treat their diabetes have a more
29 (74.4) 9 (23.1) 1 (2.6) 51 (94.4) 3 (5.6) 0 (0.0)
serious disease

2. There is not much use in trying to have good blood sugar control
24 (61.5) 7 (17.9) 8 (20.5) 24 (44.4) 8 (14.8) 22 (40.7)
because the complications of diabetes will happen anyway

3. People whose diabetes is treated by just a diet do not have to worry

28 (71.8) 8 (20.5) 3 (7.7) 31 (57.4) 6 (11.1) 17 (31.5)
about getting many long-term complications
4. Keeping the blood sugar close to normal can help to prevent the
29 (74.4) 8 (20.5) 2 (5.1) 50 (92.6) 2 (3.7) 2 (3.7)
complications of diabetes

5. Type 2 diabetes is a more serious disease than Type 1 30 (76.9) 8 (20.5) 1 (2.6) 42 (77.8) 6 (11.1) 6 (11.1)

6. Looking after diabetes on your own not as important than be looked

22 (56.4) 5 (12.8) 12 (30.8) 19 (35.2) 3 (5.6) 32 (59.3)
after by health professionals

7. Support from family & friends are important in dealing with diabetes 34 (87.2) 4 (10.3) 1 (2.6) 50 (92.6) 3 (5.6) 1 (1.9)

DISCUSSION DISCUSSION
It was alarming to note that more than half of the participants (77.8%, n=42) thought that Type 1
participants (66.1%) were not in the healthy BMI DM is more serious than Type 2 DM, possibly be-
range and almost half had HT (49.0%). This was an cause we did not emphasise and elaborate much on
upsetting phenomenon as both overweight and HT these topics during the session.
are risk factors for Type 2 DM. Some participants
thought that males are more susceptible to DM, In addition, there were several aspects
which corresponded to an exploratory study done that could be improved on. We screened only half
among Hmong population in the United States. 10 of the targeted participants due to limited time and
Another common misconception included excessive manpower. Hence, we would recommend a longer
sugar intake can cause DM. 11, 12This belief was also time for the implementation of activities. Further-
present in our community, as demonstrated in our more, with interactive sessions, overrun and delays
knowledge question 1, where 96.3% (n=52) of the with subsequent sessions contributed to failure to
participants chose "Eating too much sweet and sug- obtain more samples. Having a larger venue is rec-
ary foods may cause diabetes". Another reason for ommended where more participants can benefit
it is probably due to the ambiguity of the question. from the discussions and provide more time for
For instance, Type 1 DM is caused by genetics and questions where further misconceptions can be
other factors that might trigger the disease. Life- addressed, depending on availability of manpower.
style changes were found to increase the risk for
developing Type 2 DM but genetic factors also play In conclusion, this successful campaign
a major role in Type 2 DM. Hence, participants may helped raise the community awareness on health,
be confused as they thought eating sweet foods principally on DM. The intervention provided in-
may cause diabetes. In addition, "stress could sightful information and created opportunities to
cause diabetes" was also a common belief in a clarify any uncertainties regarding DM and enabled
study done in Saudi Arabia (n=514/1,030). 11 These the community to acquire a better understanding
misconceptions were immediately corrected by the on diabetes prevention and management even
diabetes nurse educator who was present for the when already diagnosed with the condition. It was
event. our intention that the participants would impart
their newfound, refined knowledge on DM to their
We noted that participants were unable to friends as well as relatives and trigger the commu-
distinguish dizziness as a sign for both high and low nity to be more concerned and proactive about
blood sugar levels. Furthermore, a large number of their health.
 Tan et al. Brunei Int Med J. 2015; 11 (5): 250

ACKNOWLEDGEMENTS 7: Jones DW, Hall JE. Seventh report of the Joint

We thank the diabetes nurse educator, nutritionists and
National Committee on Prevention, Detection, Eval-
dieticians from Ministry of Health, Brunei Darussalam. Our
gratitude also extend to a number of lecturers and col- uation, and Treatment of High Blood Pressure and
leagues, as well as Hers Kitchen Cooking Class for making evidence from new hypertension trials. Hyperten-
our event a successful one.
sion. 2004; 43:1-3.
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