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Assessment of Mother's Knowledge Regarding Management of Children with

Diabetes Mellitus Type 1

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Assessment of Mother's Knowledge Regarding Management of Children with
Diabetes Mellitus Type 1

Zainab Abidzaid Abid AL-Hadrawy, Murtadha Ghanim Adai , Ph.D., Nursing,

University Of Kufa, Faculty Of Nursing, Iraq.

Mobile / 07724836513, e-mail/ zainab.abedzaid@/@uokufa.edu.iq

ABSTRACT:

Diabetes is considered one of the world main health problems. it's one of the major causes of morbidity
and mortality. It's complication leads to the rise in disability, reduced life anticipate and many health care expenses to
the community. A Descriptive A Descriptive cross-sectional design is used through the present study in order to :
assess the mother's knowledge regarding the management of their children with diabetes mellitus type 1 . and to
determine the relationship between the mothers' knowledge and their socio- demographic characteristics. The period
of the study is from 20th September 2016 until August 20th , 2017. A non-probability ( purposive sample) of the study
consisted of ( 100 ) mothers with their diabetic children. Those who visit Al- Sadder Medical city / Al- Najaf Center for
Diabetes and Endocrine, are included in the study sample. The data are collected through using a well-designed
questionnaire that consist of (2) parts: Part I consists of socio demographic Characteristics of diabetic children
containing (4) items. In addition to Part I consists of socio-demographic characteristics of mothers; it contains (7)
items. Part 2 consists of Information about the mothers knowledge regarding the management of children with Diabetes
Mellitus type 1 containing (11) domains . Reliability of the questionnaire is determined by using the Alpha Cronbach’s
technique, and the validity through (23) experts from different specialties (Face Validity) for reviewing the study
instrument. The data was analyzed through using of the descriptive and inferential statistical analysis approaches. The
findings of the present study indicate that the Overall assessment for Mothers’ Knowledge about the management of
diabetes mellitus are Fair. Also there is a highly significant association between the Mothers’ Knowledge concerning
management of diabetic children and their (Number Of Children, Father’s Occupation, Father’s Education, and

Mother’s Education). While there is a non-significant relationship with remaining demographic and clinical data . The

study concludes The study concludes most mothers have insufficient knowledge about management their children
with diabetes mellitus type 1 and that is a strong effect of educational levels of mothers on management of diabetic
children. The study recommends that An educational program should be designed and implemented to increase mothers
information about etiology, signs and symptoms and treatment of their children with TIDM in order to reduce or
prevent complications, and Make new unit within the diabetes center to develop the association between mothers and
center to training mothers of diabetic on management and insulin injection.

KEY WORDS: Assessment, Mother's, Knowledge, management, Children with Diabetes, Type 1 diabetes.

INTRODUCTION:
Diabetes is one of the significant medical issues in the world . It is a gathering of metabolic sickness
described by an increase level of glucose in the blood ( hyperglycemia ) resulting from defects in insulin secretion,
insulin activity or both. Regardless of, the advance in treating , diabetes in nowadays is reflected a main reason for
morbidity and mortality.it has important effect on life value of the children , their capacity of development, and high
expenses for the medicinal services given to the patient (Al-Metbai, 2016).
 As indicated by the most recent version of the Diabetes Atlas, an expected 490,100 youngsters underneath
the age of 15 years are living with type 1 diabetes.1 A further 77,800 kids less than 15 years are expected to develop the
illness in 2011 (Guariguata , 2011).

Diabetes Mellitus is a global health issue affecting children, adolescents, and adults that requires
continuing care and instruction. When compared with the general population, mortality and morbidity is increased in
diabetes, due mainly to connected Chronic complications of diabetes such as retinopathy, neuropathy, coronary heart
disease and nephropathy, which are still present, might be prevented . A cute metabolic complications (e.g. diabetic
ketoacidosis) remain to be a common acute complication to main causes of mortality in developing countries (
Cade,2008 ).

Diabetes Mellitus is a chronic disorder of metabolism characterized by a partial or complete lack of the
hormone insulin. It is the most widely recognized metabolic infection, bringing about metabolic alteration or
physiologic change in every aspect of the body . Type 1 diabetes (previously known as insulin-dependent, juvenile or
childhood-onset diabetes ) is described by inadequate insulin creation in the body. Individuals with type 1 diabetes
require day by day organization of insulin to manage the measure of glucose in their blood. If they do not have
admission to insulin, they cannot survive (WHO,2016) .

Type 1 diabetes is described by destruction of the pancreatic beta cells, which create insulin, this usually
leads to absolute insulin deficiency, Type 1 diabetes is one of the most common endocrine and metabolic conditions in
childhood. The International Society for Pediatric and Adolescent Diabetes (ISPAD) depicts the objectives for working
with kids and teenagers with diabetes as taking after: ideal wellbeing, and a good quality of life emphasizing the
importance of age-appropriate education and the addition of the family, school or college in the process (Jonsson,
2014).
Type 1 diabetes mellitus is a compound disease requiring an ongoing care to prevent acute and chronic
complications. It also requires continuing medical care and an ongoing patient self-management education. Likewise to
prevent sickness , requires collaboration between the health care team and the family especial the mothers Because she
is adjacent to the child and thus the most essential point in the management (American Diabetes Association, 2013 ).

Then again, ineffectively controlled diabetes may happen on the grounds that mothers of kids with type 1
diabetes likely neglect to appreciate diabetes instructions. A current review has demonstrated that proficiency and
numerical abilities of the mothers are identified with an enhanced glycemic control in the kids with type 1 diabetes
(Hassan and Heptulla, 2010).

Information Regarding the Management of Children with Diabetes Mellitus Type 1 is the more
prominent weapon in the battle against diabetes. Data can help individuals survey their danger of diabetes, can help
people assess their risk of diabetes, and the motivate them to assume the responsibility of their infection. It is similarly
imperative to plan and actualize appropriate demonstrative, administration, and treatment conventions for youngsters
with diabetes. This study, therefore, was conducted to assess the mothers knowledge and how this information
influences in management their diabetic children and thus control of the illness (Maina et al., 2011).
The mother is the individual most personally bound to the points of interest of the sickness, , any
problems that she has in coping with the illness may affect the whole family. Studies show analyzing the difficulties
mothers have in treatment a child with diabetes are rare in number, the literature suggests that there are at least 11
aspects of care of the diabetic child that may be of concern to mothers: injections, diet, control, hypoglycemic episodes,
urine testing, finances, amount of help and support available, time demands, independence of the child, sensation that
the illness is a stigma, and fears about what to come ( Al-Odayani et al., 2013).
The fundamental point of each diabetes management is to enhance controlling the glucose in the blood.
Management select for diabetes be disposed to be numerous and quality of life of children and their family.( Gupta
,2007 ). Along these lines, the health care group must be the guides who set the phase, provides instruction and
oversight and helps to re-focus the efforts when the aims were not being met at all ( Al-Odayani et al., 2013).

METHODS AND MATERIALS

Design of the Study:
A descriptive cross-sectional design was adopted in the current study to achieve the early stated objectives.
The period of the study is from 20th September 2016 20th September 2016 to August 20th , 2017.

Setting of the Study:

The study was conducted in Al-Najaf City/Al-Najaf Al-Ashraf Health Directorate / Al-Sadder Medical
City/ At Al - Najaf Center for Diabetes and Endocrine .

Sample of the Study:

A Non-probability (purposive sample) of the study consisted of ( 100 ) mothers with their diabetic children , those who
visit Al- Sadder Medical city / Al- Najaf Center for Diabetes and Endocrine, are included in the study sample.

Including Criteria:

1- children with diabetes mellitus type 1 under 13 years of age.

2- Mothers with no specific age group and educational level.
3- Mothers who attend the center for diabetes and endocrine

Study Instrument:
An assessment tool was adopted and developed by the researcher to assess the mother's knowledge regarding
management of Children with Diabetes Mellitus Type 1 . The complete instrument of the study consists of (2) parts:
Part I: Socio-Demographic Characteristics of Diabetic Child .
Part II: Information of the Mothers Knowledge Regarding Management of Children with Diabetes Mellitus type 1.

Data Collection:

The data collection is done by applying of the developed questionnaire with the aid of arranged interview. The
researcher uses Arabic version of the questionnaire. The study subjects are interviewed in a similar method. The data
collection process has started from March 28 , 2017 to May, 11th, 2017. The interview technique spends about 20-25
minutes for each subject.

Validity of the Instrument:

The questionnaire validity faces validity for the initial developed instrument which is specified through panel of (23)
experts (with experience of > 5 years at their jobs field.
Statistical analysis:

The data were analyze through application of the descriptive and inferential data analysis methods, included:
- Frequency, mean, Standard Deviation , and mean of scores.
 - Chi-square.
- Alpha Cronbach for the reliability of questionnaire (Internal consistency ).

STUDY RESULTS AND FINDINGS

Table (1) Children’s and their Parents Demographic Data (n 100)

Children’s and Their Parents Demographic Data Rating And Intervals Frequency

<= 5.00 11

Age / Years 6.00 - 8.00 19

9.00+ 70

Male 53
Gender
Female 47

<= 3.00 32

Number of Children In The Family 4.00 - 6.00 54

7.00+ 14

<= 2.00 49

Number of Diabetic Child 3.00 - 4.00 30

5.00+ 21

<= 29 12

Age of Mothers / Years 30 - 39 45

40+ 43

Married 98
Marital Status
Widowed 2

Dead 2

Highly Qualified 1
Father Occupation
Lower Professional 36

Unskilled 61

Lower Professional 8
Mother Occupation
Unskilled 92

Dead 2

Illiterate 12

Father Education Read And Write 6

Primary School 18

Intermediate School 28
 Secondary School 21

High Education 13

Illiterate 61

Read And Write 7

Mother Education
Primary School 53

Intermediate School 61

Secondary School 61

High Education 1

Nuclear 77
Family Type
Extended 61

Middle 13

Socio-Economic Status High 62

Low 1

Urban 18
Residency
Rural 68

Table (1) shows the Children’s and their parents Demographic Data of the study sample .The majority of
the study sample (70 %) are at age ( 9.00+). Regarding gender the study results revealed that the majority (53 %) are
male. About ( 54%) are Number of Children in the Family between (4.00 - 6.00), and about (49%) are number of
diabetic child. Regarding the age of mothers, the study sample show (45%) are within the age (30 – 39) , Concerning
the marital status the highest percentage ( 98%) are married. Also concerning the father occupation the majority of the
study sample (61%) are unskilled, and Regards the mothers occupation, the majority of the study sample (92%) are
unskilled , and father education show ( 28%) are intermediate school , and Regards the mother education the study
show that ( 35%) are primary school graduate , Concerning the family type the results show that (74%) are nuclear
type. As for the socio-economic status more than half of the sample ( 65%) reveal their economic status who are
middle , and (80 %) are living in urban residency.

Table (2) Overall Mothers’ Knowledge about management of diabetes mellitus (n 100).

Main Domain Levels Frequency M.S. Assessment

Good 4

Fair 75
Overall Mothers’ Knowledge 1.89 Fair
Poor 21

Total 100

Table (2) In this table shows that the overall Mothers’ Knowledge about the management of diabetes mellitus is Fair .
 Table (3) Association between the Overall Mothers’ Knowledge about Management of Diabetes Mellitus and
selected variables.

Selected Variables Chi-Square Value D.F. P-Value

Number of Children 14.475 4 0.006

Number of Diabetes Children 5.064 4 0.281

Age of Mothers 6.602 4 0.158

Marital Status .680 2 0.712

Father’s Occupation 34.149 6 0.001

Mother’s Occupation 3.578 2 0.167

Father’s Education 44.211 12 0.001

Mother’s Education 21.496 10 0.018

Family Type 2.366 2 0.306

Socio-Economic Status 4.177 4 0.383

Residency 5.693 2 0.058

Age of Child At Diagnosis 2.650 4 0.618

Disease Duration 1.136 4 0.888

Visit Center 4.180 2 0.124

Table (3) reveals that there is a highly significant association between the Mothers’ Knowledge concerning
management of diabetic child and their (Number Of Children, Father’s Occupation, Father’s Education, and Mother’s
Education), while there is a non-significant relationship with the remaining demographic and clinical data

Discussion:
The present study revealed that ( 70%) among diabetic children of the study are within ( 9 and more)
years. This outcome is reinforced by a study done by Darwish et al., ( 2011) who concluded in their results that the
dominant age of the study are 9 years old and more.

Regarding gender, the results reveal that the Majority are (53%)of subjects are males. Several studies are
in agreement with the results of the present study, Maja , et al., ( 2016) Alisha et al., (2012); and Khandelwal et al., (
2016) and Noorani et al., ( 2016) . In their studies they Mentioned that males are the dominant gender for children
with diabetes mellitus. This will lead to the fact that the diabetes mellitus are more common in male than in female.

Regarding the number of diabetic children, the results reveal, that the Majority are (49%) of subjects are
<=2 ( middle child). This outcome is reinforced by a study done by Moawad et al., ( 2014) who concluded in their
results that the highest percentage was for middle child.
 Regarding age of mothers, show that there are (45%) among mothers diabetic children of sample study is
within (30-39),this result agrees with the results done by Abdel Megeid and El-Sayed ,(2012) who concluded in their
results that the dominant age of the study sample are 30 years old and more.

Concerning the Martial status, the majority of subjects (98%) are married. this result is agrees with the
results done by Al-Odayani et al., ( 2013) in this study they found that the most of the sample of their study samples
were married mothers.

In regard to the mother's occupation, the highest percentage of mothers is unskilled (housewife). This
result is matches with Abdel Megeid and El-Sayed ,(2012). mentioned that the most of mothers are housewives.

Concerning the father's education the higher percentage (28%) are intermediate school. This results is an
agreement with the results which are obtained from Amer,( 2005) .They found that the majority of study subjects are
completed intermediate school graduates .

Concerning the type of family, the highest percentage of participants is from Nuclear families. This result
is an agreement with Khandelwal et al.,(2016), who reported that the majority of study sample are from Nuclear
family.

Regarding to socio-economic status, the most of the study sample are with middle socio-economic status.
This result approving with Johnson et al., ( 2001). stated that the most of the study sample are with middle socio-
economic status.

Regarding Residency, the current study results show that most of the sample ( 80%) live who at urban areas, and
remaining is living in the rural areas, This result is an agreement with AL-Rubaee, (2013), who reported that the
majority of study sample from urban. these results might come because of the Diabetes Mellitus that refer to a modern
scourge of an industrialized society .therefore, the diabetes mellitus incidence increases in people who live in urban
areas, than those in rural areas. Also those individuals in rural residential area often practice daily exercises when
compared with those in urban areas, so they less risky for diabetes than urban residents. Furthermore, the rural residents
are lived in a good environment in regarding to noises, pollution, and psychological stressors so they less prone to get
Diabetes Mellitus because of the danger reasons that are common in town that countryside areas e.g. psychological
stress.

Regarding the overall mothers knowledge about management of diabetes mellitus type 1 table ( 4.15) shows that
mothers have are fair knowledge about management their children. The results of this study emphasize in importance of
measuring the knowledge of mothers from several domains. There are few studies have assessed knowledge mothers.
So, the researcher showed that the mothers had fair knowledge and she had limited or insufficient knowledge about
management of TIDM. This was in agreement with the result obtained by Noorani et al., ( 2016), Abdel Megeid and
El-Sayed , (2012); and Johnson et al., ( 2001). All of them reported as overall there is a significant deficit in
knowledge about management of TIDM.

The study results reveal that there is a high-significant relationship between the mothers knowledge and
their ( Number of children, Father's occupation, Father's education, and mother's education), while there is a non-
significant relationship with other demographic and clinical data. These study results are supported by the Maureen et
al., ( 2006) who indicated that there is a high significant effect of Number of children ( family composition) on their
mothers knowledge, Forsander, (2000) who reported significant relationship between father education on their mothers
knowledge about management of diabetic children.
Conclusion :
Based on the study results, the study concludes the following :

1- . Most mothers have insufficient knowledge about management their children with diabetes mellitus type 1.

2-. The great member of children with TIDM are males.

3- . There is a strong effect of educational levels of mothers on management of diabetic children.

4- Education about management is not applied by medical nursing staff for most of the mothers who attend the center.

Recommendations :
Based on the study results and conclusion, the study recommends that:

1- Mothers need to instruction with means of education, to improve their knowledge and skills and to provide them
with new devices.
2-An educational program should be designed and implemented to increase mothers information about etiology, signs
and symptoms and treatment of their children with TIDM in order to reduce or prevent complications .
3- Make emphasize must be direct toward the helping for sharing in continues educational program and course by
nursing staff related to management of diabetic children.
4.Nurses providing scientific booklet , publication and journal about diabetes mellitus type1.
Make new unit within the diabetes center to develop the association between mothers and center to training mothers of
diabetic on management and insulin injection

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