Essay: Literature review: Illness perception of Diabetes & health seeking practices in urban slums

Each year more than 36 million people die, due to non communicable diseases (NCDs) out of this, 80% deaths (29 million) reported only in low and middle income countries (WHO, 2013a).Global burden of NCDs was 43% in year 1999, which is estimated to increase up to 60% and supposed to be responsible for 70% of global deaths by the year 2020 (WHO, 2013b). Diabetes is one of the NCDs which is negatively affect quality of life and increasing per capita health expenditure. In diabetes, body does not have capacity to produce insulin hormone which is required for cells to utilize glucose and use it as energy. Globally, about 382 million people are currently suffering from diabetes in age group of 40-59 years, which is estimated to increase by 55 % in year 2035 i.e. 592 million (IDF Diabetes Atlas, 2013) and 80% of cases are reported in low-middle income countries. In year 2013, 5.1 million deaths are only attributed to diabetes, i. e. one person is losing his life in every six second by diabetes (IDF Diabetes atlas, 2013). A few decades back diabetes was called ‘disease of wealthy’ but now it is not any more a disease of affluent.
Purpose of this study is to explore illness perception of diabetes & to know about factors which determine health seeking behavior in urban slums. Random search of literature is done to have an insight on the topic.
A study by Rahim et al. in context of Bangladesh describes that due to urbanization and migration, there is an increase in number of slum dwelling in the vicinity of cities. These people are exposed to many risk factors which can be responsible for NCDs such as diabetes (2005). Diabetes mellitus is caused by the effect of obesity, intake of high calorie food and less physical activity (Auchincloss, 2009).Adler & Newman stated that low socio economic conditions are associated with sedentary life style & less fiber consumption which can lead to diabetes, Slum dweller often have limited opportunity of education so it limits their knowledge about risk (2001).Besides this, stress is also an important factor which can serve as a risk factor, although it affects all classes but lower socio economic people have more stressful life. Some of the factors can indirectly increase stress such as crowding and noise exposure, low control at work, and social isolation which in turn affects health (Adler & Newman, 2001).
Hjelm & Atwine in their study about illness perception of diabetes stated that, general weakness, fall down, collapse, vaginal itching, dizziness, dry tongue, severe thirst, high blood pressure, joint pains and dysfunctional sex are few reasons of health seeking. They also found people saying that the influence of natural and supernatural forces can also cause diabetes (2011). Participants sought health care from professional sector -doctors or nurses, private for profit clinic, pharmacy or with home-made remedies. Where modern medicine fails to relieve their symptoms, they also sought care from folk healer such as chinese medicine or herbal medicine. Few participants also visited traditional healer & spiritual healers (Hjelm & Atwine, 2011). Researchers often found ethno-medicine is responsible for complication & high mortality besides poor medical management and harmful self care (Kolling, Winkley & Deden, 2010).There are also constraints in their life which make them choose low cost options of care.
Bhojani et al., in their study explored about constraints in accessing health care such as financial hardship, compromised care and dependency of woman on other family members for buying medicine, family structure, inter-generational conflict, provider’s attitude, patient’s consciousness about their economic condition & difficult access to health care system (2013).
It was found that there is not much literature on illness perception of diabetes & health seeking practices particularly in urban slums, even less literature available on determinants of health seeking behavior for diabetes in urban slums. Considering this, a qualitative approach might allow us to explore the illness perception of diabetes and health seeking in urban slums.
References:
Adler, N. E. & Newman, K. (2001). Socioeconomic disparities in health: Pathways and policies inequality in education, income, and occupation exacerbates the gaps between the health ‘haves’ and ‘have-nots. Health Affairs, 21 (2). Retrieved from http://www.sph.umich.edu/sep/downloads/Adler_Newman_Socioeconomic_Disparities_in_Health.pdf
Auchincloss, A.H., Roux, A.V.D., Mujahid, M.S., Shen, M., Bertoni, A.G., Carnethon, M. R. (2009).Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: The multi-ethnic study of atherosclerosis. JAMA Internal Medicine, 169 (18), 1698-704. doi: 10.1001/archinternmed.2009.302.
Bhojani , U., Mishra, A., Amruthavalli, S., Devadasan, N., Kolsteren, P., Henauw, S. D. and Criel, B. (2013). Constraints faced by urban poor in managing diabetes care: Patient’s perspectives from South India .Global Health Action. Retrieved from http://www.globalhealthaction.net/index.php/gha/article/view/22258
Hjelm, K. & Atwine, F. (2011). Health-care seeking behavior among persons with diabetes in Uganda: An interview study.BMC International Health and Human Rights. doi:10.1186/1472-698X-11-11
Rahim, M. A., Hussain, Azad Khan, A.K., Sayeed, M.A., Ali, M.S.K., & Vaaler, S. (2005). Rising prevalence of type 2 diabetes in rural Bangladesh: A population based study. Diabetic Medicine , 22 (7), 931’936.
International Diabetes Federation. (2013). IDF diabetes atlas, (6th ed.). Brussels, Belgium: International Diabetes Federation. Retrieved from http://www.idf.org/diabetesatlas
Kolling, M., Winkley, K. & Deden, M.V. (2010). ‘For someone who’s rich, it’s not a problem”: Insights from Tanzania on diabetes health-seeking and medical pluralism among Dar es Salaam’s urban poor, Globalization and Health. Retrieved from http://www.globalizationandhealth.com/content/6/1/8
World Health Organization. (2013a). Non communicable diseases. Retrieved on March 1, 2014 from http://www.who.int/mediacentre/factsheets/fs355/en/
World Health Organization. (2013b). WHO NCD surveillance strategy. Retrieved on March 1, 2014 from http://www.who.int/ncd_surveillance/strategy/en/