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Sowunmi, Oluwole Samuel (2023) The validation of a screening tool for use in a faith-based education intervention study in the prediabetic population in an urban town in Nigeria. Doctoral thesis, London Metropolitan University.
There is an increasing prevalence of Type 2 Diabetes Mellitus (T2DM) in Nigeria due to economic and nutritional transition, particularly in the urban population. The aim of this study was to find an easy-to-administer, cheap, simple and effective tool to identify people at risk with T2DM and intervene to ultimately reduce the burden of the disease on individuals and the healthcare system in Nigeria. The Finnish Diabetes Risk Score (FINDRISC) tool was used to assess the prevalence of T2DM and obesity in an urban town in Nigeria and was validated with HbA 1c and fasting blood glucose. Participated identified as at risk were invited to attend a culturally-specific faith-based intervention educational program.
In the first phase of the study, congregants from six Pentecostal churches in Sagamu, Nigeria, were invited for screening for risk of T2DM using the FINDRISC tool, which included questions on age, BMI, waist circumference, vegetable and berries consumption, physical activity, history of high blood pressure, family history of T2DM and history of high blood sugar. Overall, from the total number of participants (n=581), 51.8% were assigned a risk of developing T2DM in the next 10 years, with 34.4% identified as at slightly elevated risk (risk score 7-11); 11.2% were screened at moderately elevated risk (risk score 12-14); 5.3% indicated a high risk (risk score 15-20) and 0.9% (risk score higher than 20) were identified at very high elevated risk. The results of this study concurred with other studies in Nigeria.
The prevalence of overweight and obesity in this urban population (56%, n=325) was similar to that seen in developed countries, with the rates of overweight and obesity being 34.3% and 21.7%, respectively. There was a statistical difference in the prevalence of overweight and obesity between males and females (37.4% vs 65%, p<0.001, respectively) as with age categories (45yrs and under (28.3%) vs 45-55yrs (14.9%) vs over 55yrs (11%) p<0.001).
In the study's third phase, 143 individuals with FINDRISC risk scores equal to and above 9 were invited for HbAlc and FBG blood testing. HbAlc revealed the presence of prediabetes in 106 cases (74.1%) and diabetes in 26 cases (18.2%), while the FBG revealed 113 (79%) prediabetes and 13 (9.1%) diabetes in the population. The sensitivity at the FINDRISC cut-off value for detecting unknown diabetes using the HbAlc was 93%, 97%, and 95% at FINDRISC cut-off values 9, 11 and 13, respectively. The sensitivity analysis using FBG was 89.5%, 97%, and 82.6% at FINDRISC cut-off values 9, 11 and 13, respectively. We demonstrated that the FINDRISC scoring tool was a simple, reliable, non-invasive, effective, cheap, and fast diagnostic tool for assessing and identifying individuals at high risk of T2DM in an urban town in Nigeria.
The final phase of the study was to deliver an intervention in a faith-based setting with an intense 4-week education program addressing knowledge of T2DM, diet and lifestyle factors and, uniquely, to most interventions in Nigeria, a follow-up at week 12. All participants (n=143) with a FINDRISC score equal to and above 9 were invited to attend. We observed changes from week 1 to 12 in BMI (27.4±4.4 kg/m2 vs 26.1± 4.8 kg/m2, p<0.05, respectively) in HblAc (6.3±1.4 vs 6.1±1.0 p<0.05, respectively) and knowledge scores of T2DM, diet and lifestyle.
In conclusion, the FINDRISC tools, a simple and non-invasive screening tool for prediabetes and T2DM, can be utilised with an educational intervention among Nigerian adults to improve knowledge and body composition. Furthermore, the validity of the tools and the intervention's high feasibility level further renders it suitable for rollout in the study population.
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