ALKAN HEALTH SINCE BUSINESS TECHNOLOGY COLLAGE

Department of Pharmacy

Assessment of Glycemic Control and Associated Factors among Patients with

Type II Diabetes in Fitche Hospital Oromia Regional State, Ethiopia, 2021

Investigators: Hanna Mergia and Eyael Nigus

A Research Proposal Submitted to ALKAN Health Science Business Technology

Collage, Department of Pharmacy, in Partial Fulfillment for the Requirement of
Bachelor of Pharmacy (B. Pharm).

0
 ALKAN Health since Business Technology Collage

Department of Pharmacy

Assessment of Glycemic Control and Associated Factors among Patients with

Type II Diabetes in Fitche Hospital Oromiya Regional State, Ethiopia 2021

Investigators: Hanna Mergia and Eyael Nigus

Advisors: Tadele Eticha

May, 2021
Addis Ababa, Ethiopia

0
 Acknowledgments

Primarily we would like to thank Fitche Hospital for letting us do this research proposal in their
hospital and all staff members for there every support. Once again, we would like to thank our
adviser Mr. Tadelsse Eticha for his guide and advice then special thanks for patients who
consented to participate for giving us helpful information, finally we thank our family.

i
Lists of Abbreviation and Acronyms

ADA: American Diabetes Association

AOR: Adjusted Odds Ration
ASA: Acetyl salicylic acid
CI: Confidence Interval
CKD: Chronic kidney disease
CNCDs: Chronic Non-Communicable Disease

DM: Diabetes Mellitus

FBS Fasting Blood Sugar

IHD: Ischemic heart disease
HbA1c: Glycosylated Hemoglobin

IDF: International Diabetes Federation

NGO: lNon-Governmental organization

SDSCA: Score of Diabetic Self-Care Activities

T2 DM: Type Two Diabetes Mellitus

ii
Table of Contents
Acknowledgments............................................................................................................i
Lists of Abbreviation and Acronyms..............................................................................ii
Table of Contents...........................................................................................................iii
List of Tables..................................................................................................................iv
Abstract............................................................................................................................v
Introduction......................................................................................................................1
1. Background of the study...........................................................................................1
1.1. Statement of the problem......................................................................................2
1.2. Significance of the study.......................................................................................3
2 Literature review.....................................................................................................5
3 Objectives.................................................................................................................7
3.1. General objective..................................................................................................7
3.2. Specific objectives................................................................................................7
4 Methods....................................................................................................................8
4.1. Study area and period............................................................................................8
4.2. Study design..........................................................................................................8
4.3. Population.............................................................................................................8
4.4. Sample size determination....................................................................................9
4.5. Sampling technique...............................................................................................9
4.6. Data collection tool andprocedure......................................................................10
4.7. Study variables....................................................................................................10
4.8. Data processing and analysis..............................................................................11
4.9. Data quality management....................................................................................11
4.10. Operational definition...................................................................................11
4.11. Ethical consideration....................................................................................12
4.12. Dissemination plan.......................................................................................12
5 Result :....................................................................................................................13
5.1 Baseline characteristics of patient……………………………………………….13
5.2 Glycemic control and factors affecting glycemic control……………………13
6 Discusion………………………………………………………………………..15
7 Conclusion and Recommendation………………………………………………...17
iii
8 Limitation………………………………………………………………………….17
9 Reference………………………………………………………………………..20
Annex: participant information sheet and informed consent form…………………..26
Information sheet……………………………………………………………….. 26

iv
 List of Tables

Table1: Characteristic of type 2 diabetes patients at Fitche Hospital…………………….14

Table2: Type of anti diabetic medications of type 2 diabetic patients attending the diabetic clinic of
Fitche hospital…………………………15

Table 3 Factors associated with glycemic control of type 2 diabetes patients at Fitche
Hospital………………………………………17

v
 Abstract

Background: Diabetes mellitus is one of the chronic non-communicable disease which have
emerged as a leading global health problem. It is a known risk factor for coronary heart disease,
cerebro vascular disease, peripheral vascular disease, blindness, renal failure, and limb
amputation. Despite the established facts that diabetes patients benefited from the control of
hyperglycemia, in Ethiopia majority of the patients fail to achieve an adequate level of glycemic
control. Besides, the reasons for poor glycemic control in different socioeconomic contexts are
complex and multi factorial.
Objective: to assess glycemic control and associated factors among patients with type II diabetes
mellitus in Fitche Hospital, Oromia Regional State, Ethiopia

Methods: Institutional based cross-sectional study design were employed. A total of 245patients
with type 2 diabetes selected by systematic random sampling were enrolled in the study. Data
abstraction format were used to collect data on clinical characteristics. A structured questionnaire
were used to collect the patient’s socio demographic and economic characteristics. Data
collectors were trained for one day. Data were entered analyzed using SPSS version 21.
Description statistics like frequency, percent, and standard deviation of a given data for each
variable were calculated. Bivariate and multivariate logistic regression analysis were used for
identifying variables associated with poor glycemic control. Finally, the data were presented
using text, tables, and graphs accordingly.

Result: A total of 174 type 2 diabetic patients were interviewed and were studied. Mean age of
the patients was 48.98± 14.96 year (range 18-80). More than half(51.7%) of the patients were
males. About a third of patients 53(30.5%), were on ant diabetic medication for less then 5 years.
The most common prescribed ant diabetic medication were insulin, 48(27.6%), and metformin
15(8.6%). One hundred seven patients(61.5%) were on combination therapy(two drug treatment)
and the remaining patients were on monotherapy. The majority, 103(59.2%), of patients had
uncontrolled blood glucose. A large proportion of female patients, 54(52.4%), had uncontrolled
blood glucose than males. Level of education (p<0.001)and duration of diabetes treatment
(p<0.001) were significantly associated with glycemic control. Adherence of patients to regular
vi
follow uo(Adjusted Odds Rtio(AOR)= 2.42,95%CI 1.08 – 5.44, p= 0.03) and diabetic treatment
for 5-10 year (AOR= 4.64, 95% CI 1.79-12.06, p= 0.002) are found to be independent predicators
of glycemic control among type 2 diabetes patients.
Conclusion: Our study finding showed that the rate of poor glycemic control was high. Level of
education and duration of diabetes treatment were significantly associated with glycemic control.
Keywords: Type 2 Diabetes mellitus, Glycemic control, associated factors

vii
 1. Introduction
1.1. Background of the study
Non-communicable diseases (NCDs) are becoming major health challenges with a continually
increasing burden. Prediction made indicated that the burden of NCDs will increase about three-
quarters of all deaths and 60% of all diseases globally by the year 2020. Diabetes mellitus is one
main segment of chronic non-communicable diseases (1). Diabetes mellitus (DM) is a group of
metabolic diseases of prolonged hyperglycemia due to either the pancreas not producing enough
insulin or the cells of the body not responding properly to the produced insulin(2).

There are four types of diabetes mellitus: type 1diabetes, type 2 diabetes gestational diabetes, and
other specific types. Type 2 diabetes constitutes about 85–95% of all diabetes in high-income
countries with a higher percentage in low- and middle-income countries due to rapid socio-
cultural changes, aging populations, increasing urbanization, reduced physical activity, and
unhealthy lifestyle and behavioral patterns (3). Diabetes mellitus is one of the major public
health issues of the 21st century. Diabetes is a globally chronic disease affecting 366 million
people, a number which has been forecast to rise to 552 million by 2030(4,5).

Globally,8.8%(415million)of adults suffered from diabetes in 2015,and it is estimated that 652

million pe ople (10.4%) will have diabetes by 2040 also imposes significant economic burdens
with medical expenditures attributable to hospitalizations, medications, outpatient visits, and
treatment of chronic complications (6).

The World Health Organization (WHO) reported that high blood glucose level due to diabetes is
the third highest risk factor for premature mortality after high blood pressure and tobacco use
(7).It has been reported that more than 80% of deaths associated with T2DM in low and middle-
income countries occur due to poor metabolic control(8).

In Africa, the International Diabetes Federation (IDF), estimated about 19.8 million adults were
estimated to have diabetes and the regional prevalence of DM is 4.9%. Out of this more
than50%livesinfourhighlypopulatedcountriesnamely: Nigeria, South Africa, Ethiopia, and
Tanzania(9).

1
In Ethiopia, International Diabetes Federation (IDF) reported about 1.9 million adults aged 20–
79 years were estimated to have diabetes in 2013, and another 2.9 million people living with
impaired glucose tolerance are at higher risk of developing diabetes. With a national diabetes
prevalence of 4.36% and there were about 34,262 estimated diabetes-related deaths occurred in
the same year (10).

Even though appropriate glycemic control and management are fundamental to prevent and
delay DM complications, data on glycemic control and its associated factors are scanty in
Ethiopia, particularly in the study area. Therefore, this study aimed to assess glycemic control
and DM its associated factors among patients with type II DM attending at Fitche Hoapit,
Oromiya Regional State, Ethiopia.

1.2. Statement of the problem

A major concern in the management of diabetes is the occurrence of complications, many of

which are irreversible. Complications in diabetes occur as a result of the injurious effects of
hyperglycemia (11). It has various long-term complications that negatively impact the
individuals’ quality of life and potentially their life spans, causing deleterious effects for both
individuals and societies. Diabetes complications are categorized as micro vascular
(nephropathy, neuropathy, retinopathy) or macro vascular (cardiovascular and cerebro vascular
disease). Several co morbidities are related to poor metabolic control including dyslipidemia,
hypertension, and obesity, increasing the risk of long-term macro and micro vascular
complications (12).

Evidence shows that the main therapeutic goal for all diabetes patients is maintaining good
glycemic control to prevent organ damage and micro vascular and macro-vascular complications.
However, the majority of patients fail to achieve good glycemic control and the reasons for poor
glycemic control are complex and multi factorial (13).

Glycemic control in T2DM is a critical component in diabetes care. Without well-established

glycemic control, complications can arise increasing mortality rates and lowering quality of life
—this represents an important burden of disease for low-middle income countries (14).

2
There is evidence that good glycemic control in diabetic patients can be achieved when patients
are educated about the disease and become compliant (15). Hence, health care professionals
should not only provide treatment but also provide lifestyle guidance and education support
(16).For optimal management of people with diabetes, the health care team must devise a
treatment plan tailored specifically to the needs of the individual patient. A treatment plan also
requires dietary modifications, exercise, and administration of medication on schedule. Patients
should be allowed to play active roles in the management of their health and encouraged to
participate in diabetes self-management education programs (17). Studies have also emphasized
the importance of achieving optimal glucose control through strict adherence to medications,
dietary modification, and exercise to minimize serious long-term complications (18).

Glycemic control is considered the main therapeutic goal for the prevention of organ damage and
other complications of diabetes (19). In contrast, evidence showed that the magnitude of poor
glycemic control in DM patients in different parts of the world is high. For instance, a
studyconductedinMalaysiashowed75.3%, in Spain45%, in Jordan65.1%, and in Ethiopia61.9%
(20,21, 22,23).

Although glycemic control is the main target of the treatment, it is not being provided to the
majority of diabetic patients. It is quite difficult to obtain glycemic control clinically. Because
there are several genetic and environmental factors such as age, sex, educational status, body
mass index (BMI), duration of diabetes, lifestyle, and family history, which are related to poor
glycemic control (24, 25).

Despite the established facts that diabetes patients benefited from the control of hyperglycemia,
In Ethiopia majority of the patients fail to achieve an adequate level of glycemic control.
Besides, the reasons for poor glycemic control are complex and multi-factorial (26). Therefore,
this study aimed to assess glycemic control and its associated factors among patients with type II
DM attending at Fitche Hospital, Oromiya Regional State, Ethiopia.

1.3. Significance of the study

Even though, having adequate evidence and information on glycemic control have paramount
importance for the prevention of complications and related outcomes of type two DM,

3
information regarding appropriate glycemic control and its associated factors is lacking. As per
the literature search there no research report on glycemic control and its associated factors in
Fitche Hospital, Oromiya Regional State, Ethiopia.

Therefore, assessing glycemic control and associated factors is crucial for health policy planners
and implementers in designing appropriate intervention and prevention programs to alleviate the
problem. It will also valuable to health planners and implementers at sub-city and woreda level
health offices to plan and design appropriate strategies for improving the management of type
IIDM. Moreover, the result of this study will provide baseline data for NGOs, researchers, and
other concerned bodies working on the area.

4
 2. Literature review

Diabetes is attributed to14.5% of all-cause mortality among adults, and half of these deaths occur
in adults under the age of 60 years. Nonetheless, diabetic complications are a major cause of
disability and reduced quality of life. The estimated total global health expenditure due to
diabetes is $673 billion in2015, and it willreach$802 billion in 2030(27).

ARandomizedcontrolledtrialconductedinSpainandGermanyin2013tocomparetheeffectiveness of
education tools versus regular care of adults with type2 diabetes indicates that, the effectiveness
of diabetes self-management education and ongoing self-management support on glycemic and
psychological outcomes of people with type 2 diabetes (28).

A study conducted in older Mexican American diabetes patients in 2012 showed that of the
209diabetics, 65.1% had poor glycemic control. Education level and longer disease duration
were factors that showed an association with poor glycemic control(29).

A cross-sectional study to investigate the status of glycemic control and the factors associated
with it among656 diabetic patients from the Southeast of Brazil in 2018, Indicated that over
60%ofpatientshadpoorglycemiclevels.Factorsassociatedwithpoorglycemiccontrolwereschooling
for less than 4 years, a long time since diabetes diagnosis, treatment with insulin, and less
frequent follow-up with endocrinologists and dietitian’s units (30).

Another cross-sectional study conducted in south India, 2012 found that 51% of the patients had
good glycemic control, and patients in the age group are more likely to have good glycemic
control as compared to those who. A longer duration of disease is also associated with poor
glycemic control as compared to those with a shorter duration of disease (31).

An institutional-based study done in type 2 diabetes mellitus (T2DM) in Saudi

Arabia2018revilespoor glycemic control of 74%.patientswere more likely to have poorly
controlled diabetes if they had a family history of diabetes mellitus had longer diabetic durations
for 5–10 years and did not undertake sufficient physical exercise

5
a cross-sectional study carried out at the diabetic clinics for T2DM patients 2014 at the national
and municipal hospitals in Dar es salaam Tanzania 2014 revealed that 69.7% had poor glycemic
control.(33).

A study conducted among T2DM patients in Mathai National Teaching and Referral Hospital
in Nairobi Kenya 2017found that more than half (60.5%) of patients were poorly controlled their
glycemic level and being female , and using drugs for other co-morbidities were found to be
associated with poor glycemic control among type II diabetes patients(34).

Accordingtoastudyconductedonpatientswithtype2diabetestoassessglycemiccontrolat Shanan Gibe

Hospital, Southwest Ethiopia 2017, the majority, 1, of patient’s had uncontrolled blood glucose.
A larger proportion of female patients, had un controlled blood glucose than males. Level of
education and duration of diabetes treatment were significantly associated with glycemic control.
Adherence of patients to regular follow up (AOR and diabetes treatment for 5–10 years are
found to be independent predictors of glycemic control among type 2diabetes patients (35).

Another hospital-based cross-sectional study conducted at the University of Gondar Referral

Hospital, 2013 found that 64.7% of diabetic patients were poorly controlled their glycemic level
and Being on insulin treatment and reporting poor medication adherence was found to be
associated with poor glycemic control(36).

According to a study conducted on 412 patients with type 2 diabetes at Tikur Anbessa
Specialized Hospital 2018, eighty (80%) of the respondents had uncontrolled fasting blood
glucose levels. The factors which are significantly associated with poor glycemic control were
longer duration of diabetes), and being on insulin therapy (37).

6
 3. Objectives
3.1. General objective
 To assess the magnitude of glycemic control and associated factors among type II
diabetes mellitus patients in Fitche Hospital, Oromiya Regional State, Ethiopia, 2021.

3.2. Specific objectives

 To determine the magnitude of glycemic control among type II diabetes mellitus
patients in Fitche Hospital, Oromia Regional State, Ethiopia, 2021.
 To identify factors associated with glycemic control among type II diabetes
mellitus patients in Fitche Hospital, Oromia Regional State, Ethiopia, 2021.

7
 4. Methods
4.1. Study area and period

The study was conducted at Fitche Hospital, which located in Oromia Regional State in North
Shewa. Fitche is the capital city of North Shewa which has an estimated population 300,000 and
it have one hospital, two Primarily Health Center and more than five community pharmacies.

The study was conducted from March to August 2021.Fitche hospital is selected for this study because
there is no specific study concerning this topic.

4.2. Study design

An Institutional based descriptive cross-sectional study design was used to assess glycemic
control and associated factors among patients with type II diabetes mellitus.

4.3. Population
4.3.1. Source population

All patients with type 2 diabetes attending a diabetes clinic at Fitche Hospital were the source
population of the study.

4.3.2. Sample population

A total of 245 sampled patients with type 2 diabetes who had been on treatment for at least 12
months will be the sample population.

4.3.3. Inclusion and exclusion criteria

4.3.3.1. Inclusion criteria

The inclusion criteria were include diagnosis of T2 DM for more than 12 months from the
recruitment day,>=18years old, patients with at least three consecutive blood glucose

8
measurements for 3 months, and patients who consented to participate.

9
 4.3.3.2. Exclusion criteria

Patients who was were presented with a major complication of type II DM, mental disorders,
and seriously ill and patients with an in complete record will be excluded from the study.

4.4. Sample size determination

Sample size was determinedwas determined using single population proportion formula by
considering the following assumption: the proportion of poor glycemic control 80% (from the
previous study conducted in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia) (37),
95% confidence interval with 5%marginof error.

n = (z 2*P(1-p)
α/ 2)

d2
Where
 Zα/2=critical value for normal distribution at 95% confidence interval which
equals to1.96
 P=prevalence of poor glycemic control=80% from previous study conducted in
Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
d= margin of error=0.05
) =(1.962*0.80(1-.0.80) =245

0.052

Therefore, from the above calculation the final sample size is 245.

4.5. Sampling technique

Systematic random sampling technique will be used to select the study subjects. The target is to
recruit 245 participants during the study period According to the hospital chronic illness clinic
10
registration book an average of 530 type 2 DM patients were enrolled at the clinic with in the one
month. Hence, by dividing the total patient attending the clinic in one month (530) with the total
sample size (245), (N/n). We will get sampling interval (K) 2. To apply Systematic random
sampling technique, the first patient to be recruited in to the study, will be selected by lottery

11
 method and consecutive participants will be selected every second patients. Participants will be
approach edit waiting room.

4.6. Data collection too land procedure

English version Data collection format and structured questionnaire was preparedwas prepared
after reviewing different relevant literatures and used to collect data. Structured questionnaire
consists bothconsists both open and close ended question will be used to collect patient’s socio
demographic and economic characteristics. Four-item Morisky Medications Adherence Scale
(MMAS-8) was used to assess adherence to anti-diabetic medication. Structured questionnaire
was usedwas used to collect data on clinical characteristics such as diagnosis, duration of illness,
dosage regimen of medications, co morbidities, diabetes complications, blood pressure and blood
glucose measurements. Accessories materials like pencil, binder, eraser and sharper will be used

4.7. Study variables

4.7.1. Dependent Variable
 Glycemic control
4.7.2. Independent Variables
Socio-demographic characteristics
 Age
 Sex
 Marital status
 Residence
 Religion

 Behavioral characteristics of patients

 Clinical Characteristics of Patients
 Duration of illness
 Treatment
 Diabetic Complication

12
 Diabetes self-care activities related of patient’s
 General diet
 Specific diet

13
  Exercise
 Diabetic medication adherence level
 Education level
 Family history of type 2 DM
 Income
 Occupation status
 Type of Diabetic Complication
 Co-morbidities
 medication, and
 foot care

4.8. Data processing and analysis

We analyzed the data using SPSS version 21. Description statistics like frequency, percent and
standard deviation of a given data for each variable will be calculated. Bivariate and
multivariate logistic regression analysis will be used for identifying variable associated with the
glycemic control and the variables which have significant association will be identified on the
base of P-value <=0.05. Odds ratio with 95% confidence interval (CI) will be calculated to
determine the strength of association between glycemic control and independent variable.
Finally, date will be presented using text, tables and graphs accordingly.

4.9. Data quality management

Questionnaires wasA questionnaire was pretested 2 weeks before the actual data collection time
on 13 type 2 DM patients attending diabetic clinics Fitche hospital. Based on the finding of the
pretest, necessary correction and adjustment was made in the questionnaires. Patient cards with
incomplete information wasPatient cards with incomplete information were excluded. Data
collectors wasData collectors were trained on the aim of the research, content of the
questionnaire, and how to complete data abstract format for one day. The investigator was check
for completeness of the checklists on daily base during the whole period of data collection.

4.10. Operational definition

14
 Good glycemic control-is defined as average fasting blood glucose
measurement on three consecutive visits is 80–130 mg/dL

15
  Poor glycemic control - is defined as patients whose average blood
glucose measurement on three consecutive visits is >130 or <70 mg/dL
(38).

To assess Medications Adherence of patients we will use four-items Morisky

Medications Adherence Scale (MMAS-4) which demonstrated a good
concurrent and predictive validity and good internal consistency (39). This scale
is answered with “yes” or “no.” Because the four questions are negatively
coded items, 0 point is given to “no” answer and 1 point is given to “yes”
answer: the less score the more adherences.

The score is from 0 to 4 and is classified as 0 = high adherence, 1–2 = medium

adherence, 3– 4 = low adherence Self-care practice patient with DM was
evaluated by self-reported 18-item Summary of Diabetes Self-Care Activities
(SDSCA). SDSCA scale measured frequency of self- care activity in the last7
days; specifically, general and specific diet, physical activity, blood glucose
testing, foot care and medication. SDSCA was calculated by summing of the
mean score for each dimension divided by the sum of the number of questions
under each scale. After calculating an overall mean score, it was classified as
having desirable self-care if scored ≥ 3 or not desirable self-care if scored < 
3(40).

4.11. Ethical consideration

Ethical clearance was obtained from ALKAN health since business technology
collage. A letter of support was written to the study area and permission was
secured from Fitche hospital. The purpose of the study was explained to the
study subjects and verbal consent was obtained before the data collection. To
maintain confidentiality and privacy, the questionnaire wasquestionnaire was
coded and the name of the patient was excluded.

4.12. Dissemination plan

16
 The results of this study will be disseminated to all concerned bodies. A print
copy and soft copy of the research will be submitted to ALKAN Health Science
Business Technology Collage, Department of Pharmacy. It also will be
submitted to Fitche hospital, Semen Shewa Zone and Girar Jarso Woreda
health offices. Furthermore, the paper will be presented on workshops,
seminars and on other professional gathering.

5. Results

5.1 Baseline characteristics of patients

We studied 174 patients who visited the hospital during the study period. More than half, 90
(51.7%), of the patients were males. Mean age of the patients was 49.98 ±14.9 years(years (range
18-80 years). More than a third of the patients,74, 74(42.5%),attended, attended primary school.
Seventy four (42.5%)patients) patients did not adhere to their regular follow up at the diabetes
clinic of the hospital. The majority of patients,111, 111(63.% %),did, did not get adherence
support from their families (Table-1)about) about a third of patients ,53patients, 53(30.5%),were,
were no anti diabetic medication for less than 5 years. Almost half of the patients were on
treatment for more than 10 years 86 (49.4%).Ninety (51.7%)patients) patients had at least one
co-morbidity. Hypertension was the major type of co-morbidity ;71co-morbidity;
71(78.9%).Seventy one (40.8%) of the patients had ≥1 diabetes related complication. Diabetic
neuropathy was the most common compli-cation;31, 31(43.7%).

The most common prescribed ant diabetic medication was insulin, 48(27.6%) followed by
metformin 15(8.6%) More than half ;92half; 92(52.9%)of) of the patients were taking a
combination of metformin and glibenclamide (table 2). One hundred seven (61.5%) of patients
were no combination therapy (two drug treatment)and) and remaining patients were on mono
therapy. Sixty-two (35.6%) patients had concomitant medication(s) for the treatment of
comorbidities .Enalapril was the most common prescribed concomitant medication;47, 47(75.8).

17
5.2 Glycemic control and factors affecting glycemic control

Fasting blood glucose readings of last three clinic visits were obtained from patients medical
recorders and the mean last three fasting blood glucose measurements were used to determine the
level of glycemic control means fasting blood glucose measured over 3 month was 130+- 30.7
mg/dl. The minimum and maximum recorded fasting blood glucose measurements were 33 and
254 mg/dl respectively. Less than half 71(40.8%)of) of the patients achieved the American
Diabetes Association recommended target fasting blood glucoseblood glucose range (80-
130mg/dl). The majority, 103(59.2),of, of patients had uncontrolled blood glucose. The rate of
glycemic control was 71 (40.8%)

A larger proportion of female patients, had uncontrolled blood glucose than males. Level of
education (p < 0 .001) and duration of diabetes treatment (p < 0.001) were significantly
associated with glycemic control.

On a multivariable logistic regression analysis (Table 3) adherence of patients to regular follow

up (adjusted adds ratio (AOR) = 2.42, 95% CI 1.08- 5.44,p =0.03) and diabetes treatment for 5-
10 years (AOR = 4.64, 95% CI 1.79 – 12.06,p = 0.002) were found to be independent predictors
of glycemic control among type 2 diabetes patients at Fitche hospital.

Table 1 Characteristics of type 2 diabetes patients at Fitche Hospital, North Shewa

Oromia, Ethiopiya
Variable category Characteristics n(%)
Sex Male 90(51.7)
Female 84(48.3)
Age category <30 21(12.1)
30-60 114(65.5)
>60 39(22.4)
Level of education Illiterate 60(34.5)
Primary education 74(42.5)
Secondary education 35(20.1)
College and above 5(2.9)

Marital status Single 14(8.0)

18
Regular follow up Married 142(81.6)
Divorced 18(10.3)
Regular follow up No 74(42.5)
Yes 100(57.5)
Family support No 111(63.8)
Yes 63(36.2)
Duration of diabetes <5 53(30.5)
treatment(year) 5-10 35(20.1)
>10 86(49.4)
Yes 90(51.7)
Co-morbidity No 84(48.3)
Type of co-morbidity Hypertension 71(78.9)
Ischemic heart disease(IHD) 10(11.1)
Hypertension + IHD 5(5.6)
CKD 2(2.2)
Others 2(2.2)
Diabetic complication Yes 71(40.8)
No 103(59.2)

Type of diabetic complications Neuropathy 31(43.7)

Retinopathy 10(14.1)
Retinopathy + neuropathy 28(39.4)
Retinopathy + neuropathy+ 2(2.8)
nephropathy
Others dyslipidemia and obesity

6 Discussion

This study assessed the magnitude of glycemic control among type 2 diabetic patients at Fitche
hospital North shewa Oromia Regional State Ethiopia .the mean fasting blood glucose was 130.3
±30.7 mg\dl. We found that the majority of patients had poor glycemic control. Adherences to
regular follow up schedule and diabetes treatment for 5-10 years were predictors of glycemic
control.

19
Table 2 Type of anti diabetic medication of type 2 diabetic patients attending at the Fitche
Hospital

Variable category Type of ant diabetic medication n(%)

Type of ant diabetic Insulin 48(27.6)
medication Metformin 15(8.6)
Glibeclamide 4(2.3)
Insulin + metformin 15(8.6)
Metformin + glibenciamide 92(52.9)

Concomitant medication Yes 62(35.6)

No 112(64.40
Type of concomitant Enalapril 47(75.8)
medication Enalapril + ASA +atenolol 6(9.7)
Enalapril + ASA 3(4.8)
Enalapril +ASA + Hydrochlorothazide 3(4.8)
Others
3(4.8)

In our study thestudy meanthe mean fasting glucose over three months was 130.3 ± 30.7mg/dl.
This value is lower than the study in Malaysia (13) where the mean fasting blood glucose was
166.5 ± 86.4 mg/dL. It was also higher than the studies in Addis Ababa (190 ± 89.6mg\dl)[14]
and Jjima university specialized hospital (171 ± 63mg\dl) [15] and higher than the American
diabetic association recommendation [12] . This higher value indicates that the rate of blood
glucose in our setup it poor and does not meet the recommended target of the American diabetes
association. This may be due to poor medication adherence; poor lifestyle condition and failures

20
to adherence to regular follow up at diabetic clinic.

We found that the majority of our patients (59.2%) had uncontrolled blood glucose. The rate of
uncontrolled blood glucoseblood glucose in our finding is lower than findings in Jordan(Jordan
(16), Malaysia(Malaysia (13) and India(India (17) ranging from 65.1 to 78.6%.

The reason for the difference in the rate of glycemic control between our study and other studies
may be the variation in clinical characteristics of participants. For example, in Malay study, the
participants were older thenthan our and the patients with duration of diabetes < 5 years in ours
was 30.5% whereas in Malay it was 24.4%. In Jordan, about 50% of the patients had diabetes
duration > 7 years and the majority of patients had obesity, dyslipidemia and hypertension. In
addition, in Indian study, larger proportion of patients wereproportion of patients was 50 years
old. Evidence also show longer duration of diabetes, use of multiple medications, and old age are
associated with poorly controlled blood glucose. (13, 16, 18, 19).

Other studies in Ethiopia showed that the rate of uncontrolled blood glucose ranged from 48.7%
based on HBA1C measurement to 70.9% on fasting blood glucose measurement (20, 21). This is
comparable to our study finding with a slightly higher value (70.9%) in only one study. The
similarity of our study finding with other local studies may be due to similar characteristics of
the study patients and similar diabetes management practice.

The rate of uncontrolled blood glucose in our study finding west higher then study findings in
Nigeria(Nigeria (22),China, China [23], Brazil[Brazil [24], Mexico[Mexico [25] and united
statesUnited States [26].Level of uncontrolled blood glucose in these countries ranged from 12.9
to 57% this variation could be due to difference in patient characteristics and difference in
diabetes management practices. For example in our study the rate of illiteracy was high and
regular follow up off diabetes patients was minimal.in addition, appropriate diabetes
management guideline was used in the management type 2 diabetes in our hospital
.moreover ,Moreover,fasting blood glucose was measured to assess the level of glycemic control
in our setup while glycated hemoglobin was used in the studies we compered.

21
In our study, the number of illiterate patients with uncontrolled blood glucose was high and
about half(half (48.3) of them uncontrolled blood glucose. Education level was also significantly
associated with glycemic control in our study. The possible explanation could be illiterate
patients may have low diabetes knowledge, low self-management behavior, lower self-efficacy
and lower continuity of care leading to poor glycemic control. However, in contrast to our study
finding, in the united Kingdom, patients with lower level of educational had better compliance to
medications and more trust in the physicians’’ advice (27).

The duration of diabetes mellitus was significantly associated with glycemic control. A study in
Hong Kong(Kong (26) revealed that patients with longer duration of diabetes and more complex
treatment regimens were associated with poor glycemic control. Juarez et al. (28) also reported
that patients who had diabetes for 10 years were about nine times more likely to have poor
glycemic control than those who had diabetes for 3 years. A longer duration of diabetes
negatively affects glycemic control, possibly because of progressive impairment of insulin
secretion over time as a result of β-cell failure. Therefore, as the disease progresses, most
patients require an increase pharmacotherapy to maintain glycemic control.

Adherence of patients to regular follow up and diabetes treatment for 5-10 years found to be
independent predictors of glycemic control among type 2diabetes patients. This study finding is
similar to other studies (13,18,19). Viana et al. (29) and Ramirez et al. (25) also reported that
duration of diabetes, use of insulin, and unsatisfactory patient physician relationship were
significantly associated with level of glycemic control.

22
 Table 3 Factors associated with glycemic control of type 2 diabetes patients at Fitche Hospital,
Oromia Regional State, Ethiopia

Variable category Glycemic AOR (95%

control CI)
Controlled (n) Uncontrolle
d (n)
Gender Male 41 49 1.58 (0.79–3.15)
Female 34 54 1

Educational status Illiterate 10 50 1

Primary school 39 35 2.20 (0.81–5.97)
Secondary school 19 16 2.31 (0.71–7.52)
College and above 3 2 1.79 (0.20–15.86)

Regular follow up No 17 57 1
Yes 54 46 2.42 (1.08–5.44)*
Duration of treatment (years) < 5 28 25 2.03 (0.85–4.84)
5–10 23 12 4.64 (1.79–12.06)*
> 10 20 66 1
AOR adjusted odds ratio
p < 0.05 was considered
statistically significant
*Statistically significant

7. Conclusion and Recommendation

In conclusion, our study finding showed that the rate of poor glycemic control was high. Level of

23
education and duration of diabetes treatment were significantly associated with glycemic control.
A longer duration of diabetes and lack of regular follow up at diabetic clinic independently affect
the rate of glycemic control in type 2 diabetes patients. Therefore, we recommend that Fitche
Hospital develop strategies for improving glycemic control of type 2 diabetes patient.

8. Limitation

The study has some limitations

 We used fating blood glucose to assess level of glycemic control as there was no
laboratory facility to measure glycated hemoglobin. Measurement of glycated
hemoglobin would show the rate of glycemic control over 3 monthes while fasting blood
sugar may have some drawbacks to show the true level of glycemic control.
 In our proposal sample size were 245, but we only collect 174, because most of the
patients does not have regular follow up and the rest of the patients only come when their
symptoms are exacerbated or out of medication.

24
25
REFERENCES

1. American Diabetes Association (ADA), Position Statement; Standards of Medical Care in

Diabetes 2013. Diabetes Care.36 (Suppl1): S11–66.2013,ADA:USA.[PMC free article] [Pub
Med]]

2. WorldHealthOrganization.DiabetesFactSheetWorldHealthOrganization,2013;No312. Availableat;
http://www.who.int/en/news-room/fact-sheets/detail/diabetes.

3. World Health Organization, Global Health Risks: Mortality and Burden of Disease
Attributable to Selected Major Risks, World Health Organization,Geneva, 2009.

4. J.E.Shaw, R.A. Sicree, and P.Z.Zimmet, “Global estimates of the prevalence of diabetes for
2010 and 2030,”DiabetesResearchandClinical Practice,vol.87, no.1, pp.4–14, 2010

5. Whiting DR, GuariguataL, Weil C, ShawJ.IDF diabetes atlas: global estimates of the prevalence
of diabetes for2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311– 321

6. Simon D. Epidemiological features oftype2diabetes.2010;60(4);469-73

7. DR Whiting, L. Guariguata, C. Weil, and J. Shaw, IDF diabetes atlas: global estimates of the
prevalence of diabetes for 2011 and 2030, Diabetes Research and Clinical Practice, vol.94, no.3,
pp. 311–321, 2011

8. World Health Organization (2014) World health Organization. Global health estimates:
deathsbycause, age, sexand country 2000–2012.WHO;Geneva: 2014

9. Ashenr P,Beck-Nielsen H,Bennet P,Boulton .A,Colagiuri R. Diabetes and

impairedglucosetolerance.5thed.Brussels;IDFDiabetes Atlas;2013

10. Cho N, Whiting D, Guariguata L, Montoya PA, Forouhi N, Hambleton I, et al.

Internationaldiabetesfederation atlasreport: Globalburden of diabetes. Belgium,Brussels;2013

11. GhazanfariZ,NiknamiS,GhofranipourF,LarijaniB,Agha- AlinejadH,MontazeriA.Determinants of

glycemic control in female diabetic patients: a study from Iran. Lipids HealthDis 2010;11: 79-
83.

26
12. Colosia, Palencia & Khan, Colosia AD, Palencia R, Khan S. Prevalence of

hypertension and obesity in patients with type 2 diabetes mellitu16s in observational

studies: a systematic literature review. Diabetes, Metabolic Syndrome and

Obesity.2013;6:327–338.doi:10.2147/DMSO.S51325.

13. American Diabetes Association. Standards of medical care in diabetes – 2012. Diabetes
Care.2012;35(Suppl1): S11–S63.

14. Aschner P, Aguirre L, Franco L. Diabetes in South and Central America: an update. Diabetes
Research andClinicalPractice.2014;103:238–243. doi: 10.1016.

15. Venugopal S, Kunju R, Al Harthy S, Al Zadjali N. Hemoglobin A1c in Muscat, Oman - A 3-

yearstudy. Oman Med J 2009; 23(3): 170-200

16. Camara A, Baldé MN, Sobngwi-Tambekou J, Kengne AP, Diallo MM, Tchatchoua APK, Poor
glycaemic control in type 2 diabetes in the South of the Sahara; the issue of limited access to an
HbA1ctest. Diabetes Research and Clinical Practice, Elsevier 2014;108(1)

17. Nathan DM, Buse JB, Davidson MB, et al. Medical management of hyperglycemia in type
2diabetes:a consensus algorithm for the initiation and adjustment of therapy: a consensus
statement of the American Diabetes Association and the European Association for the Study of
Diabetes. Diabetes Care.2009; 32:193–203

18. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and
national estimates on diabetes in the United States, 2009. Antlanta, GA: US Department of
Health and Human Services, Centers for Disease Control and Prevention, 2009

19. RodbardH, BlondeL, Braithwaite S. American Association of Clinical Endocrinologists medical

guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract.2009;
13:1–68

20. Hasimah I, Muhamad H, Siti S, et al. Control of glycosylated hemoglobin (Hba1c) among type2
diabetes mellitus patients attending an urban health clinic in Malaysia. Med Health Sci J.2011;
9:58–65.

21. Rodrıguez A, Calle A, Vazquez L, et al. Blood glucose control and quality of health

27
 care in non-insulin- treated patients with type 2 diabetes in Spain: a retro-spective and cross-
sectional observational study. 6 S. MIDEKSAET AL. Diabet Med.2011;28(6):731–40.

22. Maysaa K, Yousef S, Abdelkarim A, et al. Factors associated with poor glycemic control among

patients with type 2 diabetes. J Diabetes 17 Complications.2010;24(2):84–92

23. S Mideksa, S Ambachew, B Biadgo & H W Baynes (2018):Glycemic control and its associated
factors among diabetes mellitus patients at Ayder comprehensive specialized hospital, Mekelle-
Ethiopia, Adipocyte, DOI:10.1080/21623945.2018.1467716

24. Khattaba M, KhaderYS, Al-Khawaldehd A, AjlounidK. Factors associated with poor glycemic
control among patients with Type2 diabetes. J Diabetes Complicate 2010;24: 84-89

25. Cheneke W, Suleman S, Yemane T, Abebe G. Assessment of glycemic control using glycated
hemoglobin among diabetic patients in Jimma University specialized hospital, Ethiopia. BMC
Res Notes. 2016; 9:96.

26. Ghazanfari Z, Niknami S, Ghofranipour F, Larijani B, Agha-Alinejad H, Montazeri

A. Determinants of glycemic control in female diabetic patients: a study from Iran. Lipids Health
Dis. 2010; 9:83

27. G Puppalwar, S Sawant, B Silgiri, K Shukla, H Barkate, International Diabetes Federation

Diabetes Atlas , ,7(1-142), 2015.

28. M Reaney, Mathew, E G Zorzo, A Golay, N Hermanns, S Cleall, U Petzinger, V Koivis is to

Impact of Conversation Map education tools versus regular care on diabetes knowledge of people
with type2 diabetes: a randomized, controlled study.diabetesspectrum26.4(2013):236-245

29. ME Otiniano, S Al Snih, JS Goodwin, L Ray, M ALGhatrif, K S Markides. Factors associated

with poor glycemic control in older Mexican American diabetes aged 75 years and orders. J
DiabetesComplication.2012; 26:181-184.

30. D Gonçalvesa, LASimeoni, An AAmato, Factors Associated with Poor Glycemic Control among
Patients with Type 2 Diabetes in the Southeast Region of Brazil,

28
 International Journal of Diabetes Research.2018; 7(2):36-40

31. Khattab M, Khader Y, Al-Khawaldeh A, Ajiouni K. Factors associated with poor glycemic
control among patients with type 2diabetes.J Diabetes. 2012; 24:84-89.

32. Riyadh A Alzaheb, Abdullah H Altemani The prevalence and determinants of poor glycemic
control among adults with type 2 diabetes mellitus in Saudi Arabia Diabetes Metab
SyndrObes.2018; 11: 15–21

33. Kamuhabwa A, Charles E, Predictomr,s of poor glycemic control in type 2 diabetic

patients attending public hospitals in Dar es Salaa Drug, Healthcare and Patient Safety 2014
Volume:6; 155—165

34. Otieno CF, Kariuki M, Ng’ang’aL. Quality of glycaemic control in ambulatory diabetics at the
out-patient clinic of Kenyatta National Hospital, Nairobi. East Afr Med J. 2017;80(8):406–410

35. Yigazu and Desse Glycemic control and associated factors among type 2 diabetic patients at
Shanan Gibe Hospital, Southwest Ethiopia, BMCRes Notes (2017)10:597.

36. Abebe, et al. Level of sustained glycemic control and associated factors among patients with
diabetes mellitus in Ethiopia: A hospital-based cross-sectional study. Diabetes Metab Syndr
Obes.2015;50:65-71

37. Tekalegn, Y., Addissie, A., Kebede, T., & Ayele, W. (2018). Magnitude of glycemic control and
its associated factors among patients with type 2 diabetes at Tikur Anbessa Specialized Hospital,
Addis Ababa, Ethiopia. PloSone, 13(3), e0193442

38. American Diabetes Association. Standards of medical care in diabetes – 2012. Diabetes
Care.2012;35(Suppl 1): S11–S63

39. Jamous RM, Sweileh WM, Abu-Taha AS, Sawalha AF, Zyoud SH, Morisky DE. Adherence and
satisfaction with oral hypoglycemic medications: a pilot study in Palestine. Int J
ClinPharm(2011)33:942–8.10.1007/s11096-011-9561-7

40. Clifford S, Perez-Nieves M, Skalicky AM, Reaney M,coyne KS. Asystematic literature review of
methodologies used to asses medication adherence in patients with diabetes. Curr Med
ResOpin.2014:30(6):1071-85.

29
41. Eid M, Mafauzy MFA. Glaycenic control of type 2 diabetic patients on follow up at Hospital Unversity
Sains Malaysia. Malays J Med Sci. 2003;10(2):40-9.
42. Feleke Y, Enquselassie F. An assessment of the health care system for diabetes in Addis Abeba, Ethiopia.
Ethio J Health Dev. 2005;19(3):204-10.
43. Gudina EK, Amade ST, Tesfamichael FA, Ram R. Assessment of equality of care given to diabetic patients
at Jimma University Sepcialized Hoapital Diabetes follow-up clinic, Jimma, Ethiopia. BMC Endocr Disord.
2011;11(1):19.
44. Association AD. Glycemic targes. Diabetes Care. 215;38:33-40.
45. Khattab M, Khader YS, Al-khawaldeh A. Ajlouni K. Fctors associated with poor glycemic control among
patients with type 2 diabetes. J Diabetes Comlicat. 2009;24(2):84-9.
46. Gopinath B, Sri Sai Prasad M, Jayarman N, Prabhakara K. Study of factors associated with poor glycemic
control in Type 2 Diabetic patients. Glob J Med Public Health. 2013;2(2):1-5.
47. Benoit SR, Fleming R, Philis-tsimikas A, Ji M. Predicators of glycemic control among patients with type 2
diabetes: a longitudinal study. BMC Public Health. 2005;5(36):90-5.
48. Adham M, Froelicher ES, Batieha A, Ajloun K. Glycemic co troll and its associatrd factors in type 2 diabetic
patients in Amman, Jordan. East Mediterr Health J. 2010;16(7):3-10.
49. Eticha T, Mulu A, Gebretsadik H, Kahsay G, Ali DRY. Factors associated with poor glycemic control in
type 2 patients investigated at Ayder Referral NHospital, Mekelle, Ethiopia. Ijppr Human. 2016;6(3):160-71.
50. Kassahun T, Eshetie T, Gesesew H. Factors associated with glycemic control among adult patients with type
2 diabetes mellitus: a cross-sectional survey in Ethiopia. BMC Res Notes. 2016;9(78):1-6.
51. NwaokoroJ, Okokon B, Nwaokoro A, Emerole C, Ibe S, Onwuliri, Oputa R. Problem associated with
treatment compliance among type 2 diabetic patients at a teritiary health institution in Nigeria. Afr J Diabetes
Med. 2014;22(1):24-6.
52. Chen Y, Liu L, Gu L, Babineaux S, Colclough H, Curtis B. Glycemic control in Chinese patients with type 2
diabetes mellitus reciviing oral antihyperglycmic medication only or insulin only treatment: a cross-
sectional survey. Diabetes Ther. 2015;6(2):197-211.
53. Marczynski MA, Cortellazzi KL, Barberato-Fiho S, Motta RHL, Vieira AEF, Quilici MTV, et al.
Unsatisfactory glycemic control in type 2 diabetes mellitus patients: predictive factors and negative clinical
outcomes with the use of antidiabetic drug. Braz J Pharma Sci. 2016;52(4):801-12.
54. Ramirez LHD, Soto AF, Valenzuela CLC, Ochoa MC, Gonzalez HR, Lopez MCM. Factors influencing
30
 glycemic control in patient’s with diabetes type 2 in Mexican patients. J Fam Med.2016;3(2):1-6.
55. Ali MK, Mckeever Bullard K, Imperatore G, Barker L, Gregg EW, Centers for Disease Control and
Prevention (CDC). Characteristics associated with poor glycemic control among adults with self-reported
diagnosis diabetes- National Health and Nutrition Examination Survey, United State, 2007-2010. MMWR
Suppl. 2012;61(2):32-7.
56. Senior V , Marteau TM, Weinman J. Self-reported adherence to cholesterol lowering medication in patients
with familial hypercholesterolemia: the role of illness perceptions. Cardio Drugs Ther. 2004;18(4):475-81.
57. Juarez DT, Sentell T, Tokumaru S, Goo R, Davis JW, Mau MM. Fctors associated with poor glycemic
control or wide glycemic variability among diabetes patients in Hawaii, 206-2009. Prev Chronic Dis.
2012;9:120065.
58. Viana LV, Leitao CB, Kramer CK, Zucatti ATN, Jezini DL Felicio J, et al. Poor glycemic control in
Brazilian patients with type 2 diabetes attending the public healthcare system: a cross-sectional study. BMJ
Open. 2013;3(9):4003336.

31
 Annex:
Participant information sheet and informed consent form
Information’s sheet:
Our name is Hanna Mergia and Eyael Nigus. We are here to collect data for research purpose
which we are conductingtocompleteourresearchforthepartialfulfillmentofpharmacydegreeat
ALKAN Health Since Business Technology Collage.
The study title: To assess glycemic control and associated factors among type II diabetes
mellitus patients in Fitche Hospital, Oromiya Regional State, Ethiopia
Purpose of the study: The finding of this study will contribute evidence and input for sub city
and woreda and other related sectors to address diabetic related problems and improve the
current practice. It will be also valuable to health planners’ implementers Sub city and woreda
level health officers to plan and design appropriate strategies on improving the management of
type two DM more over the result of this study will provide baseline data for NGOs researchers
and other concerned body working in the area.
Procedure and duration: You are selected by systematic randomly and we are inviting you to
take part in the study. Your participation will help us to assess glycemic control and associated
factors among type II diabetes mellitus patients. We are going to ask question about glycemic
control activities and related factors. Your honest answers are very useful to our study.
Theinterviewwilltake20-25minutes.Sokindlyrequestyoutosparemethistimefortheinterview.Iwould
like to appreciate your help in responding to these questions.
Risky and benefit : The risky of participating in this study is very minimal but only taking 20-
25minutesfromyourtime.Therewouldnotbedirectpaymentforparticipatinginthisstudy.Butthefindin
gfrom this study may reveal important information for the concerned bodies.

32
Confidentiality: The information you will provide us will be confidential. There will be no
information that will identify in particular. The finding of the study will be general for the study
population and will not reflect anything particularly of individual persons. The questionnaire will
be coded to exclude showing name.
Rights: Participation for this study is fully voluntary. You have the right to declare to
participate or not in this study. If you decide to participate, you have the right to withdraw from
the study at any time and this will not label you for any loss of benefits which you otherwise are
entitled.
Do you agree to participate in this study?

Yes: No:

Signature of respondent:

Signature of interviewer:
Contact address:
If there is any question or enquire about the study or procedure, please contact by this address at
any time

33
 I. Socio-demographic and behavioral characteristics of patients

S/N Question RESPONSE Remark

101. Age in year In year
102. Sex 1. Male
2. Female
103. Religion 1. Orthodox
2. Muslim
3. Catholic
4. Others (specify)……….
104. Marital status 1. Single
2. Married
3. Living together
4. Divorced
5. Widowed
105. Education Status 1. Illiterate(can’t read and write)
2. Can read and write
3. Primary(grade1-8)
4. Secondary(9-12)
5. Tertiary education
106. Occupation 1. Housewife
2. Farmer
3. Government employee
4. Private employee
5. Daily labor
6. Merchant
7. Other (specify)………..
107. Estimated average birr
Monthly income (ETB)
108. Residence 1. Urban
2. Rural

34
109. Family history of DM 1. Yes
(mother or father) 2. No

35
 Part Two: Self-care activities (SDSCA)

S/N QUESTIONS RESPONSE Remark

201. General alimentation
1.1Inhowmanyofthelast7DAYSdidyoufollowahealthy diet?

days
1.2During the last month, HOWMANYDAYS A WEEK, on
average, did you follow the nutritional guide lines from a health
Professional (nurse)? days
202. Specific Diet
2.1 In how many of the last 7 DAYS did you
Eat five or more portions of fruit and/or vegetables?
days
2.2 In howmanyofthelast7DAYSdidyoueatfat-rich foods, such as
red meat or foods
days
With whole milk or derived?
1.3 In how many of the last 7 DAYS did you eat candies?

days
203. Physical Activity
3.1 In how many of the last 7 DAYS did you perform physical
activity during at least 30 minutes? (Total minutes of continuous
activity, including walking) days
3.2 In how many of the last 7DAYS did you participate in some
specific physical exercise (swimming, walking, riding a bicycle),
excluding your activities at home or at work? days

204. Glucose Monitor ing

4.1 In how many of the last 7 DAYS did you test the blood sugar? days

1.2 In how many of the last 7 DAYS did you test the blood sugar
in number of times as recommended by the nurse?
days

36
205. Foot Care
5.1 In how many of the last 7 DAYS did you examine your feet?

days

37
 5.2 In how many of the last 7 DAYS did you check inside the
shoes before put them on?
days
5.3 In how many of the last 7 DAYS did you dry your feet
between the toes after wash them?
days
206. Medication
6.1 In how many of the last 7 DAYS did you take your
medicines for diabetes, as prescribed?
days
207. Smoking
7.1 Did you smoke a cigarette–even if only a single puff-during 1. yes
the last SEVEN DAYS? 2. no
7.2 When did you smoke your last cigarette? years

3. Part III. Patient Adherence to Anti-Diabetic Medications

Morisky Medication Adherence scale (MMAS_8)

Questions Yes No
1 Do you sometimes forget to take your medicine?
2 People sometimes miss taking the ir medicine for reasons other than forgetting. Thinking
Over the last 2 weeks, where there any day when you did not take your medicine?
3 Have you ever cut back or stopped taking your medicine without telling your doctor
Because you felt worse when you took it?
4 When you travel or leave home, do you sometimes forget obringa long your medicine?
5 Did you take all your medicine yesterday?
6 When you feel like your symptom is under control, do you sometimes stop taking your
medicine?
7 Taking medicine every day is areal in convenience for some people. Do you ever feel
hassled about sticking to your treatment plan?
8 How often do have difficult remembering to take all your medicine?
1)Never/rarely 2)Once in a while 3)Sometimes 4)Usually 5)All the time

38
 Part IV. Clinical Characteristics of Patients

S/N QUESTIONS RESPONSE Remark

401. Diagnosis 1,type 1 DM
1.TypeIIDM
402. Durationofillness 1. <5years
2. 5– 10years
3. >10years
403. Do you have Regular 1. Yes
Follow-up? 2. No
404. Treatment 1. No treatment
2. Oral anti diabetic medication(OAD)
3. Insulin
4. OAD plus insulin

405. Diabetic Complication 2. Yes

3. No
406. Ifyesforqus.205TypeofDiab 1. Neuropathy
eticComplication 2. Retinopathy
3. Retino pathy neuropathy
407. Co-morbidities 1. Yes
2. No
408. Ifyesforqus.207TypeCo- 2. Hypertension
morbidities 3. Ischemic Heart Disease
4. Dyslipidemia
5. Hypertension + IHD
409. Blood pressure MMHG
410. patients’ blood glucose 1. mg/dL.
measurement on the last 2. mg/dL.
three consecutive visits 3. mg/dL.

39
ተጨማሪዎች:የተሳታፊዎችመረጃቅጽእናፈቃድመጠየቂያፎርም የመረጃገጽ
ስማችን ሀና መርጊያ እና ኢያኤል ንጉስ እንባላልን፡፡ በአልካን የጤና ኮሌች የፋርማሲ የትምህርት ዘርፍ

ተማሪ ስንሆንየመመረቂያ ፅሁፋችንን ለመስራት ይህንን መጠይቅ አሰራጭተን መረጃ መሰብሰብ ስለሚጠበቅብን

እርሶም የፅሁፋችን አካል እናተሳታፊእንዲሆኑልን

በማለትበትህትናእናበአክብሮትእንጠይቃለን፡፡

የጥናቱአርዕስት:የጥናቱአርእስትበፊቼሆስፒታልውስጥ የሚገኙየ 2 ኛ ደረጃ

የስኳርበሽታታካሚዎችበደማቸውውስጥየስኳርመጠንከፍእንዲልስለሚዲርጉነገሮችእናሌሎችተዛማጅበሽታዎችንእንዴትመቆ

ጣጠርችንደሚቻልበሚልመሰረትየተሰራነው፡፡

የጥናቱዓላማ:የዚህጥናታዊፅሁፍግኝቶችለወረዳዎች፣ለክፍለከተማእናለሚመለከታቸውየጤናተቋማትስለስኳርበሽታእና ከስኳር

በሽታ ጋር ተያያዥነት ስላላቸው ሌሎች በሽታዎች ተጨባጭ ማስረጃ እንዲያስገኝ እና ችግሩን

ስለሚያባበሱሁኔታዎች ከህብረተሰቡ መረጃ በመውሰድ የተሻለ የአኗኗር እና የባህሪ ለውጥ እንዲያስገኝ በማሰብ

የተሰራ ጥናት

ነው፡፡በተጨማሪምጥናቱለጤናጥበቃተቋማትእናወረዳዎችአሁንያለውንየአሰራርሁኔታለማሻሻልእናየተሻሉየጤናእቅዶ

ችንአውጥተው በ 2 ኛ ደረጃ ላይ የሚገኙ የስኳር ህመምተኞችን በተሻለ ሁኔታ መጠበቅ የሚቻልበትን

መንገድለመስራችእንዲችሉበማሰብየተሰራሲሆንጥናታዊፅሁፉለበጎአድራጎትድርጅቶችእናበስኳርህመምዙሪያእየሰሩላ

ሉአካላትምጥሩየሆነመረጃንእንደሚሰጥተስፋበማድረግነው፡፡

የጥናታዊ ጽሁፍ አካሄድ እና ቆይታ:ተሳታፊዎች በዘፈቀዳዊ ሁኔታ የሚመረጡ እና ለፅሁፉ ተጋባዥ የሚሆኑ

ይሆናል፡፡.የእርስዎ ተሳትፎ የ 2 ኛ ደረጃ የስኳር በሽታ ታካሚዎች በደማቸው ውስጥ የስኳር መጠን ከፍ እንዲል

ስለሚዲርጉ ነገሮች እናሌሎች ተዛማጅ በሽታዎችን እንዴት መቆጣጠር ችንደሚቻል ጠቃሚ የሆን መረጃን

እንድናገኝ ያግዘናል፡፡ ስለ ስኳር መጠንከፍ እንዲል ስለሚዲርጉ ነገሮች እና ሌሎች ተዛማጅ በሽታዎችን ሚያስከትሉ

ነገሮች ጥያቄ የምናቀርብ ይሆናል፡፡ የእርስዎግልፅነት የተሞላበት ምላሽ ለፅሁፋችን እጅጉን ጠቃሚ ነው፡፡ ቃለ

መጠይቁ ከ 20 – 25 ደቂቃ ሊወስድ ስለሚችል በቅድሚያለሚያደርጉልን ትብብር ላቅ ያለ ምስጋናችን

እናቀርባለን፡፡ በመጨረሻም ጊዜዎን ሰውተው ይሄን ቃለመጠይቅ

ለመሙላትፈቃደኛበመሆንዎምስጋናዬንአቀርባለሁ፡፡

ጉዳት እና ጥቅሞች፡ በዚህ ጥናታዊ ፅሁፍ ውስጥ መሳተፍ የሚያመጣው ጉዳት የለም በሚያስብል መልኩ

ለመናገርቢያስደፍርም ከእንቁ ጊዜዎ ሰውተው ለሚሰጡን ከ 20 -25 ደቂቃ ለሚሆነው ጊዜ በቅድሚያ

እናመሰግናለን፡፡ ይሄን መጠይቅመሙላት የሚያስገኘው ቀጥተኛ የገንዘብ ጥቅም ባይኖርም ፅሁፍ ተጠናቆ ሲያበቃ
40
ለማህበረሰቡ እና ለሚመለከተው አካልበዘርፉተጨማሪመረጃንእናመፍትሄንእንደሚያመነጭበማመንነው፡፡

ምስጢራዊነት፡ ለሚሰጡን መረጃዎች በሙሉ ሚስጥሮት የተጠበቀ ነው፡፡ ስለ ማንነትዎ የሚገልፅ ምንም ማስረጃ

የሚኖርአይሆንም፡፡ መረጃው የሚሰበሰበው ሁሉንም ህብረተሰብ ባማከለ መልኩ ስለሚሆን የአንድን ግለሰብ አመለካከት

ብቻ ይዞየሚያንፀባርቅ ነገር በምንም መልኩ አይካተትም፡፡ መረጃውም የማንንም ስም ሆነ መረጃ በማይጠቅስ መልኩ

እንዲሆን ተደርጎየሚዘጋጅነው፡፡

መብቶች: በዚህ መረጃ አሰባሰብ ውስጥ የሚካፈሉት ግለሰቦች ሙሉ ለሙሉ በራሳቸው ፍቃድ የተስማሙ ናቸው፡፡

ግለሰቦችመጠይቁ ላይ ለመሳተፍም ሆነ ላለመሳተፍ ሙሉ መብት አላቸው፡፡ በጽሁፉ ለመሳተፍ የወሰኑ ግለሰቦችም

በማንኛውም ሰዓትተሳትፎዋቸውን ማቋረጥ የሚችሉና ያለመቀጠል ሙሉ መብት ያላቸው ሲሆን ይኼም ድርጊታቸው

በማንኛውም አይነት ነገርእንደማያስጠይቃቸው እና መጠይቁን ሲጀምሩ ቃል የተገቡላቸው ጥቅማጥቅሞች ከነበሩ

እንደማያስቀሩባቸው ከወዲሁእናስታውቃን፡፡

በጥናታዊጽሁፍውስጥመሳተፍይፈልጋሉ?

አዎ: አይ:

41
 የተጠያቂውፊርማ:

የቃለ-መጠይቅአድራጊውፊርማ:
የፀሀፊውአድራሻ:
ስለመጠይቁምሆናስለጥናትፅሁፉአካሄድምንምአይነትጥያቄካለዎትከታችባለውአድራሻመሰረትበማንኛውምጊዜያስታውቁን ስንልእንጠይቃን፡፡

II. የታካሚዎችመረጃእናልማዳዊባህሪያትመጠይቅ

ቁጥር ጥያቄ ምላሽ አስተያየት

101. ዕድሜ ዓመት
102. ፆታ 1.ወንድ

2. ሴት
103. ሃይማኖት 1.ኦርቶዶክስ

2.ሙስሊም

3.ካቶሊክ

4.ሌሎችያልተጠቀሱ……….
104. የቤተሰብሁኔታ 1.ያላገባ/ች

2.ያገባ/ች

3.አብረውሚኖሩ

4. የተፋታ/ች

5.ባል/ሚስትየሞተባት/በት
105. የትምህርትሁኔታ 1.ያልተማረ(ማንበብእናመፃፍየማይችል)

2.ማንበብእናመፃፍየሚችል

3.የመጀመሪያ ደረጃ (ከ 1-

8)4.2 ኛደረጃ(ከ 9-12)

5.ከፍተኛትምህርት
106. የሥራሁኔታ 1.የቤትእመቤት

2.ገበሬ

3.የመንግሥትሰራተኛ

4.የግልሰራተኛ

42
 5.የቀንሰራተኛ

6.ነጋዴ

7.ሌሎች(ያልተጠቀሱ)………..
107. ወርሃዊገቢ(ደመዎዝ) ብር
108. የሚኖርበትቦታ 1.ከተማ

2.ገጠር

43
109. የቤተሰብአባልየስኳርበሽታ 1.አዎ

ነበረበት(እናትወይምአባት) 2.የለም

ክፍል 2:የራስአጠባበቅእናክብካቤመጠይቅ

ቁጥር ጥያቄ ምላሽ አስተያየት

201. አጠቃላይየተመጣጠነምግብአወሳሰድ

1.1 በአንድሳምንትውስጥለምንያህልጊዜነው

የተመጣጠነምግብአመጋገብስርአትየተከተሉት? ቀናቶች

1.2 በአንድወርጊዜውሰጥበግምትበሳምንትለምንያክል

ቀናቶችበጤናባለሙያ(ነርስ)የሚሰጡትንየተመጣጠነየም ግብ

አወሳሰድ መመሪያዎችን (ትምህርቶችን) ቀናቶች

በመከተልተግባራዊያደርጋሉ?
202. የተወሰነየአመጋገብስርዓት

2.1 በአንድሳምንትውስጥምንያህልጊዜአትክልትወይም

ፍራፍሬከ 5 ጊዜ በላይአመጋገብዎስርአካተዋል? ቀናቶች

2.2 በአንድሳምንትውስጥለምንያህልጊዜእንደስጋእና

ወተት(የወተትቅባትየያዙ)ያሉ ቀናቶች

በፋትየበለፀጉ(ቅባታማ)ምግቦችንያዘወትራሉ?
3.3.በአንድ ሳምንት ውስጥ ለምን ያህል ጊዜ

ከረሜላ(ቸኮሌት)ይጠቀማሉ? ቀናቶች

203. የሰውነትእንቅስቃሴ

3.1 በአንድሳምንትውስጥለምንያህልጊዜበቀንውስጥ

ለ 30 ደቂቃእንኳንየሰውነትእንቅስቃሴያደርጋሉ?(ያልተ

ቋረጠእንቅስቃሴእርምጃንምጨምሮማለትነው) ቀናቶች

3.2 በነዚህ 7 ቀናቶችውስጥለምንያህልጊዜከቤትውስጥ

እናከስራቦታእንቅስቃሴውጪየአካልብቃትእንቅስቃ

ሴዎችን አከናውነዋል (ለምሳሌ፡ መዋኘት፤ ቀናቶች

44
 የእግርጉዞማድረግ፣ብስክሌት መጋለብ…ወዘተ)
204. የጉሉኮስመጠንንስለመከታተል

4.1 በሳምንቱ 7 ቀናቶችውስጥለምንያህልጊዜየደም

ውስጥየስኳርመጠንንለማወቅምርመራአድርገዋል? ቀናቶች

45
 5.2 የደምውስጥየስኳርመጠንንለማወቅምርመራነርሶች

በነገሩዎትመሰረትየደምውስጥየስኳርመጠንን ቀናቶች

ለማወቅምርመራአድርገዋል?
205. የእግርአጠባበቅ(ክብካቤ)

5.1.በሳምንቱ 7 ቀናቶችውስጥለምንያህልጊዜየእግር ቀናቶች

ምርመራአድርገዋል?
5.2.በነዚህ 7 ቀናቶችውስጥለምንያህልጊዜጫማዎን

ከመጫምዎ(ከማድረግዎ)በፊትውስጡምንእንዳለአይተ

ውረጋግጠውያደርጋሉ?
ቀናቶች
5.3.በነዚህ 7 ቀናቶች ውስጥለምን ያህልጊዜእግሮን

ከታጠቡ በኋላ የመጨረሻው ቀናቶች

ጣቶትን(በተለምዶማርያምጣት)ከፍተውአደራረቀው

ያውቃሉ?
206. መድኃኒትአወሳሰድ

6.1.በነዚህ 7 ቀናቶችውስጥለምን ያህልጊዜየስኳር

መድኃኒቶንበታዘዘውመሰረትሳያቋርጡወስደዋል? ቀናቶች

207. ማጨስ

7.1.በነዚህ 7 ቀናቶችውስጥሲጋራአጪሰዋል(አንዴ 1.አዎ

ስበውመጣልምቢሆን)? 2.አይ
7.2 ለመጨረሻጊዜሲጋራመቼነውያጨሱት? ዓመት
ክፍል 3.ታካሚዎችለስኳርበሽታመድሃኒትየሚሰጡትተገቢየአወሳሰድጥንቃቄዎች

ቁጥር ጥያቄ ምላሽ አስተያየት

301. መድኃኒትመውሰድረስተህ/ሽ 1.አዎ

ታውቃለህ/ታውቂያለሽ? 2.አይ
302. መድኃኒት ለመውሰድ ስልቹ 1.አዎ

46
 የሆንክባቸው/ሻቸውጊዜያቶችአሉ? 2.አይ
303. የህመምስሜትበጣምእየባሰ 1.አዎ

ሲመታብህ/ሽ 2.አይ

መድኃኒትመውሰዱንአቋርጠህ/ሽታውቃለህ/ታውቂያለሽ?
304. እንደተሻለህ/ሽሲሰማህ/ሽመድኃኒት 1.አዎ

መውሰዱን አቋርጠህ/ሽ ታውቃለህ/ታውቂያለሽ? 2.አይ

47
 Ibsa dabalataa;-
Unka formii halaa hirmatotaa fi hayyuma ittin gaafetamu

Shitti Odeefenno
Maqaa keenya Haannaa Margaa fi Eyyaa’el Nuguss jedhamna. Iddoonbarnoota keegna Alkan xeena
saayins kollajjii dha. Bareffemaa ebba kegnaa hojechuuf gaafilee kana hiree raga guurachuu waan
barbaachisuf isiinis odeefanoo jiruu nuuf kennun akka nu gargaarte kabajaan isin gaafanna.

Mataduree:- Nannoo Oromiya magaala Fiitchee, Hospitaala Fiitchee dhibamtooni sukara sadarka
lamaffa yaallamtoota dhiiga isanii keessatti baayyinni sukkaraa akka baayyatu dhimmonni godhanii fi
dhibeen akkaakuu biraa akkamitti tohatamuu akka danda’amu beekuf qoranna hojetamee dha.

Kaayyoo Qo’annoo:- Argannolleen qorannoo kanaa rakkoolee dhukkuba sukkaaraan walqabatan furuu fi
akkaata kenniinsa tajaajila amma jiru fooyyeesuf saderkan kutaa magaalaa, aanaa fi secteroota kenaan
walqabataniif ragaalee fi galtee gumaach. Akkesumas saderkaa kutaa magaalee fu aanaatti ogeeyyi fayyaa
keroora fayya qopheessaniif gosa dhukkuba sukkaaraa (type II DM) jedhamurrati qabiinsa fooya'aa
karoorsuf ni fayyada. Dabalatanis qorwttota NGO fi dhimmi isaan ilaallatu hundaaf akka yaada
ka'uumsattif ni fayyada.

Adeemsa fi turmaat qo’anichaanichaa Isin ulaagaa sirna gabeessan waan filatamtanif addemsa qoranno
kanarratti akka hiemaathenif affeerramtanii jiruu. Hermaanna keessan dhibeen sukaraa sadarkaa lamaffaa
yaallamtoota dhiiga isanii keessatti baayyinni sukkaraa akka baayyatu dhimmonni godhani fi dhibee
akkakuu biraa akkamitti tohatamu akka danda’amu beekuf nu gargaara Deebin nuuf kennitan qo’anno
keenyaf baayee barbaachisa dha. Gaafin kun yeroon inni fudhatu dhaqiqaa 20-30 ta’uu danda’aa. Gaafin
dhihessinef deebii waan kennitanif baayee galatomaa.

Fayyida fi Midhaa:- Gaaffiiwwan sochii too’annoo gleemeric fi sabboota kanaan walqabaten irratti
gaaffilee singaafenuuf deebii quubsaa fi amansiisa isin nuuf tacten bu’aa qabeesumma keenyyaaf faayida
guddaa qabaa. Gaffileen kunninis daqiqaa 20-30 kan fudhatta yammuu ta’uu gaaffii isingaafenuuf yeroo
keessaninn aarsaa akka nuuf gootanif kabajaan isin nuuf gootaniif guddaa isin galateeffannaa.

Amantummaa;- Gaafilee gaafatameef odeefannoo nuuf kennitaniif icitiin issa kan eegamu dha. Wa’ee
48
eenyummaa kan ibsu odeffannoon tokkoyuu hin jiru. Odeefannoon guuramu uummata hunda
geddugaleess kan godhate waan ta’eef ilaalcha nama tokko qofa kan ibsuu itti hin makamu. Gaafin
odeefannoo kun maqaa nama dhuunfas ta’ee odeefannoo nama dhuunfaa akka hin ibsine godhamee kan
qopha’e dha.

Mirga:- Odeefannoo kana kennuf kan hirmaatan hundi fedhii isaanitini. Namoonni gaafataman gaafilee
kanaaf deebi kennuuf hirmaachuu hiemachuu dhisuu mirga qabu Odeefannoo kana kennuuf kan
hirmaatan hundi yeroo kamiyyuu hirmannaa odeefannoo kana kenuu dhaabuuf /kutuuf/ mirga guutuu kan
qaban yoo ta’uu gochi kun kan isaan hin gaffachisne dha.

Bareefama odeefannoo kana keessatti hirmaachuuf ni barbaaddu?

A, eyyee B, hin barbaadu

49
 Malatto gaffatama------------------

1. Unka gaafii odeefannoo amala barmatalee yaalamtootaa itti funannamu

lakka Gaafilee Deebii Yaada

101 Umurii ------------
102 Sala A. Dhira
B. Dubara
103 Amantaa 1. Orthodoksii
2. Musilima
3. Katolikii
4. Kan biraa

104 Haala fuudha 1. Kan hin fuune yokeen hin heerumne

fi heerumaa 2. Kan keerumtee yokeen hin fuunee
3. Kan waliin jiran
4. Waliin hinjieane
5. Tokoo kan du’e
105 Sadarkaa 1. Kan hin baranne (barreessuff dubbisu
barnootaa kan hin dandeenye)
2. Baressuf dubbisuu kan danda’u
3. 1-8 kan barate
4. 9-12 kan barate
5. Unversitii kan barate
106 Haala hojii 1. Hojii kan hin qabanne
2. Qotee bulaa
3. Hoetaa mootummaa
4. Hojii dhuunfaa kan hojetu
5. Hojetaa humnaa
6. Daldalaa
7. Kanbiraa
107 Tilmaama ---------------------

50
 galii ji’aa
108 Iddoo 1. Magalaa

51
 jireenyaa 2. baadiyyaa
109 Duuran Mattii 1. eyyee
kessaa 2. hin jiruu
dhiibeen
sukaraa kan
kebuu

2, Akka waliigalaatti akkataa nyaata madalawaa itti fudhatan.

laak Gaafii Debbii Yadaa

201 Akka waliiigalaatti akkataa nyaata
madalawaa fudhatan
1.1 Torbee tokko keessatti nyaata ---------------guyyuta
madalawaa hangam hordoftan?
1.2 Gorsaa ogeessa fayyaa fudhachuu ---------------guyyuta
baatii tokko keessati yeroo meeqaf
nyaata madalawaa fudhatan?
202 Toftaa nyaata murrasaa
1.1 Torbee tokko keessatti yeroo meeqaf ---------------guyyuta
mudura fi fuduraa yeroo shan
caalaanyaata kee keessatti dabalattee
nyatte?
1.2 Foon, aannan, fi nyaata faatii ---------------guyyota
baayee qaban torbee tokko
keessatti yeroo meeqa
fayyadamtan?
1.3 Torbee tokko keessatti yeroo -----------guyyota
meeqa karamella yokken chokoleti
fayyadamta
203 Sochii jabeenya qaamaa
1.1 T orbee tokko keessatti yeroo meeqa --------------guyyota

52
 daqiqaa 30 sochii jabeenya qaamaa goota
?(sochii tarkaffi miilaa dabalateeti)
1’2 Guyyoota turban kana keessatti ----------guyyota
yeroo meeqaf sochii mana keessa fi
iddoo hojii ala sochii jabina qaamaa
hojettan? Fk. Garba daakuu, saayikilii
oofuu fi miilan deemuu kkf)
204 Hanga Guluukoosii hordofuu

53
 1.1 Guyyootii torbee tokko keessatti --------------guyyota
yeroo meeqaaf baayina sukaraa dhiiga
kee keessa jiru beekuu qorannoo
adeemsista?

205 Faana miila eeguu

1.1 Guyyooti torbee tokko keessatti ----------guyyota
yeroo meeqaf qorannoo miilaa
adeemsiste?
1.2 Guyyoota torba kena keessatti ----------guyyota
caamaa keessa osoo hin godhatin keessa
isaa waan jiru laaltan?
1.3 Guyoota torba kana keessatti miila -----------guyyota
keessan erga dhiqattanii booda quba
miilaa xiqoo jala carqiin gogoskitanii
beetu?
206 Haala qoriicha itti fudhatamu
1.1 Guyyoota turban kana keessatti -----------guyyota
yeroo meeqaf qoricha sukara akkataa
ogeessi siniif ajajetti fudhattan?
207 Tamboo(sijaaraa) xuuxuu
1.1 Guyyoota turban kana keessatti 1. eyyee
sijaara xuuxanii beektuu?( yeroo tokko 2. hin bekuu
xuuxanii getuus te’uu dendaa)
1.2 Isa dhumaatif yoom xuuxxaan? -------ogga
3, Yaallamtoonni qoricha sukara fudhachuu irrattii of-eggennoo godhan

laak Gaffii Debbii Yaada

301 Qoricha sukaraa fudhachuu irraffattee 1. Eyyee
beekta? 2. Hin bekuu
302 Qoricha sukaraa fudhachuuf 1. Eyyee
sijibisisee bekaa 2. Hin bekuu
303 Dhukubnni sukkaraa sitti cimaa yeroo 1. Eyyee
dhufetti qoricha fudhachuu dhiistee
54
 beektaa? 2. Hin bekuu
304 Akaa sitti wayyahe yeroo sitti 1. Eyyee
dhagahamu qoricha fudhachuu 2. Hin bekuu
dhiistee beektaa?

55