Self-care management practices, glycemic control, and associated challenges among adolescents with type 1 diabetes mellitus in Dar es salaam, Tanzania. Dissertation
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Date
2025
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Kairuki University
Abstract
Introduction: Type 1 diabetes mellitus is among the leading non communicable diseases of public health importance worldwide. According to the International Federation of Diabetes atlas report, there were 8.75 million people living with T1DM worldwide in the year 2022, and out of these individuals, 1.52 million were those under 20 years of age. In Tanzania, approximately 6,915 youth under the age of 20 have T1DM. Despite improvement in diabetes care, maintaining optimal glucose levels in adolescents with T1DM remains challenging, with many exhibiting poor glycemic controls. Therefore, this study aimed at assessing self care management practices, glycemic control, and associated challenges among adolescents with T1DM.
Rationale: This study stems from the critical need to understand and address the challenges faced by adolescents with Type 1 diabetes mellitus in Dar es Salaam, Tanzania. Given the complexities of managing Type 1 diabetes mellitus during adolescence, especially in developing countries, this research is crucial to identify areas where support is most needed.
Objective: The broad objective of this study was to assess self-care management practices, glycemic control, and associated challenges among adolescents with type 1 diabetes mellitus in Dar es Salaam, Tanzania.
Methods: This was a cross-sectional study employing mixed-methods, sequential explanatory design comprising both quantitative and qualitative data collection methods. The standard questionnaire and Self Care Inventory-Revised Version of 2009 were used to gather quantitative data from 155 study participants. Qualitative data were gathered through focus group discussions to investigate challenges to self-care management. Data were analyzed using SPSS version 27, with continuous variables presented as mean ± standard deviation. Categorical responses were expressed in frequencies and percentages, with glycaemic control categorized as good (≤7.5% HbA1c) or poor (>7.5% HbA1c), and participants in each category reported proportionally. The thematic analysis method was used to analyze the qualitative data.
Results: Among the 155 adolescents with Type 1 Diabetes recruited into the study, 51.6% were females. The majority of participants (62.6%) were aged 1519 years, and 37.4% were in the 11-14 years age group. Regarding self-care management practices, the overall weighted average was 3.6 out of 5 equivalent to 72%. High adherence was reported for insulin use and clinic attendance, with over 80%, while recording blood glucose results, keeping food records, carrying quick-acting sugar to treat low blood glucose, exercise, and adjusting insulin dosage were among the most challenging practices. The majority of participants,
122 (78.7%), had poor glycaemic control, while only 33 (21.3%) had good glycemic control.
Conclusion: This study showed the self-care management practices among the 155 study participants with varying levels of adherence. The overall weighted average score for self-care management practices was 3.6 out of 5, indicating moderate adherence to recommended self-care behaviours. However, only a third of study participants had good glycaemic outcomes despite moderate overall adherence to self-care practices. The qualitative analysis revealed multiple interconnected challenges that adolescents with Type 1 Diabetes mellitus face in managing their condition. Seven areas stood out: Insulin management challenges; Blood glucose monitoring difficulties; Dietary management barriers; Exercise-related concerns; Healthcare system challenges
and the perceptions of Type 1 Diabetes mellitus. These findings reveal a complex interplay between technical, psychosocial and systemic barriers that require comprehensive, multifaceted interventions addressing not only clinical education but also healthcare system improvements, social stigma reduction, and ageappropriate developmental support.
Recommendations: To improve glycaemic control among adolescents with Type 1 Diabetes mellitus:
i. There is an urgent need for targeted interventions designed specifically for this population. These interventions should address the multifactorial nature of poor glycaemic control by incorporating age-appropriate education, family-centered care approaches, peer support programs, and enhanced healthcare system capacity for adolescent diabetes management.
ii. To conduct further studies, especially involving study participants in rural areas to ensure generalizability countrywide, as well as including family and healthcare providers to explore their perspectives.
Description
A dissertation report submitted in partial fulfillment of the requirements for the degree of Master of Medicine in Paediatrics and Child Health
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Citation
Malasa, Leonard J. 2025. Self-care management practices, glycemic control, and associated challenges among adolescents with type 1 diabetes mellitus in Dar es salaam, Tanzania. Dissertation. Kairuki University