Date of Award

Fall 11-7-2018

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Ike Okosun, MS, MPH, PhD, FTOS, FACE

Second Advisor

Rodel Desamu-Thorpe, MD, MPH

Abstract

Introduction: Chronic diseases such as diabetes are becoming more prevalent in Central America. According to the World Health Organization, Central America has some of the world’s highest prevalence of diabetes. Most studies have underlined urbanization, access to cheap, processed, and energy-dense foods, sedentary lifestyles, increase in obesity, as the main contributing factors to this phenomenon. One of those countries in Central America with high diabetes rates is Nicaragua - which also happens to be the most impoverished. In Nicaragua, diabetes is among the leading causes of death and causes a public health concern. Another issue is the lack of diabetes research in rural Nicaraguan communities. Most of the diabetes research focuses on the capital city Managua and other urban populations; leading to the disproportionate allocation of resources for diabetes intervention to urban areas due to the gap in knowledge about the risk and healthcare burden of diabetes in rural areas. Therefore, understanding the health prevalence and risk factors for diabetes in these communities would have profound public health implications.

Aim: The purpose of this study is to examine the prevalence and risk factors for diabetes in rural settings in Nicaragua. Other interesting public health findings of the community were recorded and analyzed. Recommendations for future studies, public health intervention planning, and implementation of programs will be made based on the information derived from this study.

Methods: The data used for this study was from the Nicaragua Community Health Connection (NCHC) project at the Emory Diabetes Training Academy. One hundred twenty-seven participants from a small rural community in Nicaragua called Los Robles were included in a cross-sectional study. Univariate and bivariate analyses were conducted to obtain descriptive statistics of the sample population using SPSS 22 and SAS 9.3. Chi-square tests were used to describe the relationship between risk factors and diabetes. Multiple logistic regression was used further analyze association. P-Value <0.05 was set as the base for statistical significance.

Results: From the study population (n=127), our mean age was 48 years, 81% were literate, 62% unemployed, and 67% reported a family income of less than 1000 Cordoba (est. $35) bi-weekly. Over half of the study sample were on a high-carb diet, 12% consumed fruits and vegetables daily, while only 23% participated in regular physical activity. We found that the prevalence of diabetes was 10.8% and 19% reported being overweight. From the analysis, unemployment, hypertension, family history of diabetes, high cholesterol, and family history of high cholesterol were associated with diabetes in our study population. Multivariate regression analysis showed a strong association between diabetes and having a family history of diabetes (P=<0.004).

We also found disparities in gender as women had higher rates of diabetes and hypertension. They were also less likely to employed or participate in physical activity.

Conclusions: The results from the study showed a slightly higher prevalence (10.8%) of diabetes in our rural study population than the rate of diabetes (8.5%) in Managua reported in previous studies. Despite limitations in our study, valuable descriptive epidemiology was obtained of Los Robles community. We recommended future studies to validate our findings and immediate implementation of diabetes awareness programs.

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