CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Diabetes mellitus is a chronic, non-communicable disease characterized by persistent hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. It represents one of the fastest-growing global health challenges, with significant implications for morbidity and mortality. In recent years, the global burden of diabetes has risen sharply, particularly in low- and middle-income countries where health systems often struggle to cope with chronic diseases (International Diabetes Federation [IDF], 2021). The increasing prevalence of diabetes has been linked to rapid urbanization, unhealthy dietary patterns, physical inactivity, and rising rates of obesity. These factors have collectively contributed to making diabetes a major public health concern, especially among vulnerable populations such as pregnant women.

During pregnancy, diabetes can exist either as pre-existing diabetes (Type 1 or Type 2) or as gestational diabetes mellitus (GDM), which develops during pregnancy and is usually diagnosed in the second or third trimester. Gestational diabetes mellitus is defined as any degree of glucose intolerance with onset or first recognition during pregnancy (American Diabetes Association [ADA], 2022). It is one of the most common metabolic disorders affecting pregnant women globally. Physiological changes during pregnancy, including increased insulin resistance due to placental hormones, predispose women to impaired glucose metabolism, thereby increasing the risk of developing GDM. This condition is of particular concern because it often goes undetected in its early stages, especially in settings where routine screening is limited.

The prevalence of gestational diabetes has increased considerably worldwide. According to the International Diabetes Federation, approximately 16% of live births globally are affected by hyperglycaemia in pregnancy, with the majority of cases attributed to gestational diabetes (IDF, 2021). The burden is disproportionately higher in low-resource settings, where access to screening, diagnosis, and management is often inadequate. Variations in prevalence across regions are influenced by differences in diagnostic criteria, genetic predisposition, lifestyle factors, and healthcare access (McIntyre et al., 2019). The rising trend of delayed childbearing, increasing maternal age, and higher rates of obesity have further contributed to the growing incidence of diabetes among pregnant women.

The health implications of diabetes during pregnancy are significant for both the mother and the fetus. For pregnant women, diabetes increases the risk of complications such as pre-eclampsia, pregnancy-induced hypertension, infections, prolonged labour, and the need for operative delivery, particularly caesarean section (Plows et al., 2018). In addition, women who develop gestational diabetes are at a higher risk of progressing to Type 2 diabetes later in life. For the fetus and newborn, maternal hyperglycaemia is associated with adverse outcomes such as macrosomia, birth injuries, neonatal hypoglycaemia, respiratory distress syndrome, and increased risk of perinatal mortality. Long-term effects on the child include a higher likelihood of developing obesity and glucose intolerance in later life, thereby perpetuating a cycle of metabolic disease (Sacks et al., 2020).

In sub-Saharan Africa, the prevalence of diabetes in pregnancy is rising steadily, reflecting broader epidemiological transitions occurring across the region. Studies have reported prevalence rates ranging between 10% and 20% in some African populations, indicating a growing burden that is often under-recognized (Nakabuye et al., 2021). The situation is compounded by weak health systems, limited access to antenatal screening, and low levels of awareness among pregnant women. Many women are not routinely tested for diabetes during pregnancy, leading to underdiagnosis and poor management of the condition. Cultural beliefs, poverty, and limited health education further hinder early detection and treatment.

In Cameroon, diabetes mellitus is increasingly becoming a public health issue, including among pregnant women. Available studies indicate varying prevalence rates of gestational diabetes, generally ranging from moderate to high levels depending on the population studied and the diagnostic methods used (Sobngwi et al., 2018; Ndziessi et al., 2022). Despite this growing burden, knowledge of diabetes mellitus among pregnant women remains inadequate. Many women lack sufficient information about the risk factors, symptoms, preventive measures, and potential complications associated with diabetes during pregnancy. This knowledge gap often results in delayed health-seeking behaviour, poor adherence to medical advice, and increased risk of adverse pregnancy outcomes.

Furthermore, the level of awareness and understanding of diabetes among pregnant women plays a crucial role in its prevention and management. Adequate knowledge enables women to adopt healthier lifestyles, comply with antenatal care recommendations, and recognize early warning signs of complications. Conversely, poor knowledge contributes to increased vulnerability and worsens health outcomes. Studies have shown that educational level, socioeconomic status, and access to healthcare services significantly influence knowledge levels among pregnant women (Olagbuji et al., 2020). Therefore, assessing knowledge alongside prevalence is essential in understanding the full scope of the problem.

Kumba District Hospital, located in the South West Region of Cameroon, serves as a major referral health facility for a large population of pregnant women within Kumba and its surrounding communities. Despite the increasing number of antenatal clinic attendees, there is limited empirical data on the level of knowledge and prevalence of diabetes mellitus among pregnant women in this setting. Given the socio-political challenges in the region, which have disrupted healthcare delivery and reduced access to quality maternal services, the risk of undiagnosed and poorly managed diabetes may be even higher. This situation underscores the need for context-specific data to guide interventions.

It is against this background that this study seeks to assess the knowledge and prevalence of diabetes mellitus among pregnant women attending Kumba District Hospital. The findings of this study are expected to provide valuable information that will inform health education strategies, improve early detection through screening, and contribute to better maternal and neonatal health outcomes.

1.2 Problem Statement

Diabetes mellitus during pregnancy, particularly gestational diabetes, is becoming increasingly common and poses serious risks to both maternal and neonatal health. Despite the rising prevalence globally and in sub-Saharan Africa, many cases remain undiagnosed or poorly managed due to inadequate screening and low levels of awareness among pregnant women (IDF, 2021; McIntyre et al., 2019). In Cameroon, available studies indicate a growing burden of diabetes in pregnancy, yet knowledge of the condition among pregnant women remains insufficient, contributing to delayed diagnosis and increased complications (Ndziessi et al., 2022).

At Kumba District Hospital, where a large number of women attend antenatal care, there is limited documented data on both the prevalence of diabetes mellitus and the level of knowledge among pregnant women. This gap in information makes it difficult to design effective interventions, health education programs, and screening strategies. Therefore, there is a need to assess the knowledge and prevalence of diabetes mellitus among pregnant women in this setting in order to improve early detection, management, and overall pregnancy outcomes.

1.3 Objectives of the Study

1.3.1 General Objective

To assess the knowledge and prevalence of diabetes mellitus among pregnant women attending antenatal care at Kumba District Hospital.

1.3.2 Specific Objectives

• To determine the level of knowledge of diabetes mellitus among pregnant women attending Kumba District Hospital.
• To determine the prevalence of diabetes mellitus among pregnant women attending Kumba District Hospital.
• To identify the risk factors associated with diabetes mellitus among pregnant women in Kumba District Hospital.
• To examine the relationship between knowledge of diabetes mellitus and its occurrence among pregnant women attending Kumba District Hospital.

1.4 Research Questions

1.4.1 General Research Question

What is the level of knowledge and prevalence of diabetes mellitus among pregnant women attending antenatal care at Kumba District Hospital?

1.4.2 Specific Research Questions

• What is the level of knowledge of diabetes mellitus among pregnant women attending Kumba District Hospital?
• What is the prevalence of diabetes mellitus among pregnant women attending Kumba District Hospital?
• What are the risk factors associated with diabetes mellitus among pregnant women in Kumba District Hospital?
• Is there a relationship between knowledge of diabetes mellitus and its occurrence among pregnant women attending Kumba District Hospital?