RESEARCH PROPOSAL ON:

FACTORS CONTRIBUTING TO EMERGENCE OF HYPERTENSION IN DIABETIC

PATIENTS ATTENDING DIABETICS OUTPATIENT CLINIC IN NYAMIRA COUNTY
REFERRAL HOSPITAL.

BY:

OBADIAH RODGERS ATAYA

D/NURS/20016/4054

CLASS: MARCH 2020

A DISSERTATION SUBMITTED TO DEPARTMENT OF NURSING IN PARTIAL

FULFILLMENT FOR THE AWARD OF DIPLOMA IN KRCHN.

KENYA MEDICAL TRAINING COLLEGE

FACULTY OF KRCHN

P.O.BOX. 574, 40500

NYAMIRA.

APRIL 2023
DECLARATION

I hereby declare that this is my original copy and that it has never been submitted as credit for
academic qualification to this college or any other institution.

OBADIAH RODGERS ATAYA

KRCHN STUDENT

D/NURS/20016/4054

Signature _____________________________ Date ______________________

SUPERVISOR

MR. ONYONO

LECTURER DEPARTMENT OF NURSING

Signature _____________________________ Date ______________________

DEDICATION

This thesis is dedicated to the Creator the Almighty God who gave me the physical and mental
strength to undertake and accomplish this project in the prescribed period of time. My beloved
mum and dad for bearing with me during the whole study period. I further dedicate this work to
my friends, Mathews Mogeni, Nancy Omwenga and Bildad Nyaribo for their co-operation
during the research period.
ACKNOWLEDGEMENT

I take this opportunity to acknowledge my sincere gratitude to all those who assisted me in my
research. Special thanks to my research lecturer Mr. Onyono for his encouragement and wise
guidance.

I also thank the Almighty God for the strength and good health he has given me throughout the
period of study.
Table of Contents
DECLARATION............................................................................................................................iii

DEDICATION................................................................................................................................iv

ACKNOWLEDGEMENT...............................................................................................................v

LIST OF ABBREVIATONS..........................................................................................................vi

CHAPTER ONE..............................................................................................................................1

1.1 Background information........................................................................................................1

1.2 Problem statement..................................................................................................................2

1.3 Justification............................................................................................................................3

1.4 Broad objective......................................................................................................................3

1.5 Specific objectives.................................................................................................................3

CHAPTER TWO.............................................................................................................................5

LITERATURE REVIEW................................................................................................................5

2.1 Level of knowledge of health workers on waste segregation................................................5

2.2 Practice of health care workers on waste segregation………………………………………5

2.3 Attitude of health care workers on waste segregation………………………………………6

CHAPTER THREE.........................................................................................................................8

METHODOLOGY..........................................................................................................................8

3.0 INTRODUCTION.................................................................................................................8

3.1 Study area...............................................................................................................................8

3.2 Study Population....................................................................................................................8

3.3 Study design...........................................................................................................................8

3.4 Sampling Strategy..................................................................................................................8

3.5 Sampling method……………………………………………………………………………9

3.6 Sample size determination.....................................................................................................9

 3.7. Inclusive criteria..................................................................................................................10

3.8 Exclusive criteria..................................................................................................................10

3.9 Ethical considerations..........................................................................................................10

3.10 Study limitations................................................................................................................11

3.11 Data Collection procedure.................................................................................................11

3.12 Data analysis techniques....................................................................................................11

3.13 Pretesting............................................................................................................................11

APPENDICES...............................................................................................................................12

APPENDIX 1.................................................................................................................................15

QUESTIONNAIRE...................................................................................................................15

APPENDIX II................................................................................................................................16

BUDGET...................................................................................................................................16

APPENDIX III...............................................................................................................................17

WORK PLAN............................................................................................................................17
\

ABBREVIATIONS

% - Percentage

DM - Diabetes Mellitus

ADA - American Diabetes Association

WHO - World Health Organization

Et al - And others

DOPC - Diabetic Outpatient Clinic

NCRH - Nyamira County and Referral Hospital

 CHAPTER ONE
1.0 BACKGROUND INFORMATION
Hypertension which is an increase in blood pressure above 140mmHg systolic and 90mmHg
diastolic is the common comorbid disease in patients with diabetes. In most cases hypertension
and diabetes cause a significant increase in the risk of vascular conditions or complications in
this population and together both conditions predispose a serious life-threatening condition
(Kenore Y,2022)

Globally hypertension is estimated to cause 7.5million deaths and nearly 1 billion people have
hypertension, of these two thirds are in developing countries. The coexistence of hypertension in
diabetes patients is attributed to the risk of death and cardiovascular events by 44% and 40%
respectively, as compared to 7% and 9% of these risks in people with diabetes alone (Daba
Abdissa and Kumsa Kene,2019). Research conducted in Australia showed that hypertension is
the most frequently managed problem and current levels of control are sub optimal. It is present
in 35% of men and 40% of women and is the cause of 75% of all cardiovascular deaths in these
patients. In a recent study with patients, a total of 121(26.9%) patients had both hypertension and
diabetes and 328(73.1%) had hypertension only without diabetes (Fiona White 2020).

In Africa, Cameroon research conducted by Janet and Southerland among patients in Younde
Central Hospital and Etoub Ebe Baptist health center. They noted that most patients diagnosed of
hypertension in relation to diabetes are above 20 years old and the prevalence is 86% (Janet,
Southerland 2020). Generally, in Africa research conducted by Imad showed a higher prevalence
of hypertension 33.3% in Northern Africa and 27% in Sub Saharan Africa (Imad R. Musa 2018).
In Ethiopia research conducted by Kenore showed the magnitude of hypertension in diabetic
patients being at 37.4% and 55% respectively (Kenore Y 2022). In Nairobi city Kenya, research
showed that the [prevalence of hypertension in diabetic patients being low in women but high in
men. Up to 75% of adults living with diabetes also gave hypertension (Sanni Yaya 2021).

Nyamira county being my field of study has showed an increase I te number of diabetic and
hypertension related cases are precipitated by sociodemographic and socioeconomic behavioral
and lifestyle, clinical and anthropometric factors (Kenore Y 2022)
1.1 PROBLEM STATEMENT
Hypertension commonly known to many as an increase in blood pressure above 140mmhg
systolic and 90mmhg diastolic, has been a major cause of significant deaths secondary to
diabetes. In most cases diabetes and hypertension cause a significant increase in the risk of
vascular complications in this population and together both conditions predispose to serious life-
threatening conditions.

As a researcher working in NCRH Diabetic clinic, I have been able to face several cases of
diabetic patients presenting with hypertension as a substitute condition. Most of the patients
approximately 45% of them have been presenting with hypertension secondary to diabetes. It has
therefore created an alarming state in our diabetic clinic henceforth leading to me carrying out
research on factors contributing to the emergence of hypertension among diabetic patients
attending diabetic clinic at Nyamira County Referral Hospital.

1.2 JUSTIFICATION
Hypertension is the most common co-morbid disease in diabetic patients and its effects are
devastating if uncontrolled. The determinants of hypertension among diabetic patients include
socio-demographic and socioeconomic behavioral and lifestyle, clinical and anthropometric
factors.

In NCRH Diabetic Clinic many patients as per the clinical attendance are diagnosed of
hypertension. The graph has increased from 13% in May 2022 to 17% in August 2022 and this
has created an alarm and the need of me to conduct this research on factors contributing to the
emergence of hypertension among diabetic patients attending diabetic clinic in Nyamira County
Referral Hospital. In recent research carried out in Ethiopia it showed that a magnitude of
hypertension among diabetic patients being 37.4% and 55% respectively (Kenore Y 20222).

The findings of this research which am carrying out can act as basis for similar researches and be
used by the health programs to reduce the number of newly confirmed cases of diabetes in
relation to hypertension emergence.
1.3 BROAD OBJECTIVE

To determine factors contributing to emergence of hypertension in diabetic patients attending

diabetic outpatient clinic in NCRH.

1.4 SPECIFIC OBJECTIVE

 To determine knowledge on diabetic complications by the diabetic patients.

 To establish attitude by the diabetic patients.
 To assess the practice in management of hypertension in diabetic patients.
 CHAPTER TWO
LITERATURE REVIEW

This Chapter entails the relevant literature to the study. The organization is based on the specific
objectives which compare and give a relevant view of the study.

2.1 INRODUCTION

Hypertension is the most common comorbid disease in patients with Diabetes and its effects ae
devastating if uncontrolled. In most cases diabetes and hypertension cause a significant increase
in the risk of vascular complications in this population and together both conditions predispose to
serious life-threatening conditions. (Kenore Y 2022)

Appropriate measure should be taken by assessing the practice in management of hypertension in

diabetic patients, knowledge in diabetic patients relating to diabetic complications and to
establish attitude by the diabetic patients.

2.2 ASSESS THE PRACTICE IN MANAGEMENT OF HYPERTENSION IN

DIABETIC PATIENTS

It is evidence that the practice carried out by diabetic patients plays a very big role in
management of hypertension and prevention of high risks of vascular complications in this this
population. The key component practices to reduce glycaemia and control blood pressure is
lifestyle modification and weight management. (Arauz et al 2016)

A study carried out by Arauz in the United Kingdom showed that most diabetic patients with
hypertension are obese, also ethnic group and age. In Type 2 diabetes, hypertension may always
present as part of the metabolic syndrome of insulin resistance also including central obesity and
dyslipidemia. In Type 1 diabetes, hypertension may reflect the onset of diabetic neuropathy
(Arauz 2016). It was found out that dietary management with moderate sodium restriction and
moderate intense physical activity have been intense in reducing blood pressure in individuals
with essential hypertension (Ada 2013).

A study that was conducted in Canada by the Canadian Diabetes Association showed that for the
last five years hypertension has been a common problem among diabetic patients. The key
messages in the practice management is to ensure people with diabetes are screened for
hypertension, assess blood pressure at all appropriate healthcare visits, encourage home
monitoring of blood pressure with approved monitoring devices, Initiate pharmacotherapy and
lifestyle modification con currently assess and manage all other vascular risk factors and enable
sustained lifestyle and medication adherence (Mark Makowsky, Chapotte Jones 2012).

In Africa research was carried out in Kaduna and Imo states in Nigeria regarding diabetes and
hypertension management practices and they found out through accurate diagnosis and treatment
can reduce the risk of complications and early deaths (Jennifer Anyanti 2020). In Ashanti region,
Ghana, the hospital was identified as the most preferred choice among health facilities patients
suffering from hypertension and diabetes. They considered the enrollment of health insurance
scheme significant to increase the likelihood of seeking healthcare (Dennis 2020). IN Rwanda
research conducted by Opoku showed that in order to manage hypertension and diabetes,
attention must be paid to patient and provide-context related factors and this practice will enable
the management of hypertension in diabetic patients (Opoku et al 2019).

In our country Kenya, a region like Nairobi has shown a high rate of hypertension among
diabetic patients, and most patients are under drug influence abuse like smoking and alcohol
consumption. So, by encouraging the practice of drug abuse abstinence it can help manage such
vascular conditions of hypertension and also on enrolment to drug therapy (Werner et al 2015).

When we look at Nyamira county where it’s my field of research it was realized that patients do
not have drug adherence and do not take their visits serious also nutritional practice. So, by
encouraging the practice of drug therapy routinely and regular attendance visits to the diabetic
clinic and good nutritional practices this can be able to reduce and carb the risks of hypertension
among diabetic patients.
2.3 DETERMINING THE KNOWLEDGE ON DIABETIC COMPLICATIONS BY
DIABETIC PATIENTS

Adequate knowledge of diabetes is key component of diabetic care. Many studies have shown
that increasing patient knowledge regarding disease and its complications have significant
benefits with regard to patient compliance to treatment and to decreasing complications
associated with disease (BMC, PH 2021)
In research conducted in Pakistan it showed that diabetic patients who were urban dwellers were
more knowledgeable than their counterparts residing in the rural area. This study is consistent
with the present study finding where about 35.4% of urban settlers compared to 8.45 of rural
settlers had adequate knowledge on diabetic complications (Hoque, Kazan 2022). There is need
to urgent education on diabetes among participants in these areas. There are good evidences that
foot complications are preventable by appropriate foot care and education programme (BMC, PH
2021)
In Africa research done in Ghana showed that most diabetic patients had no knowledge about
diabetes only 13.1% of diabetic patients had adequate knowledge. Further expansion of diabetic
educative programme like using mass media and involving national curriculum of education can
improve self-regulatory awareness of diabetic complications which may reduce the morbidity
and mortality of diabetic patients. Adequate knowledge of diabetes is a key component in
diabetic care. Many studies have shown that increasing patient knowledge benefits with regard to
patient compliance to treatment and decreasing complications associated with disease.
(Yaa,Christian,ObiriKorang July 26 2020)
Research conducted in Ethiopia showed that most common diabetic complication known by
diabetic patients was poor wound healing, followed by heart disease, eye disease, hypertension,
and renal disease. In general, higher proportions of the were not knowledgeable on diabetes
complications, out of 308 patients 176(57.1%) had no knowledge on diabetic foot ulcer.
(Admasu Belay Gizaw et al 2022)
In Kenya research conducted in Thika level 5 hospital Kiambu on diabetic patients’ knowledge
about diabetic complications. It showed that there were several gaps in selfcare knowledge and
adherence of selfcare practices. It is hence important to integrate behavioral changes theories into
the diabetes educational interventions which may facilitate problem solving skills that will
enhance the application of acquired knowledge among the diabetic patients. (EG Wamucii 2020)
In Nyamira county, most patients attending the diabetic clinic have low knowledge about the
diabetic complications. It came to my attention that most of them have poor selfcare on foot
ulcers and have lost one or both of their lower limbs in the incident of treatment. It is up to the
health workers to provide proper health education o diabetic complications which can further
lead to loss of live or disability (BMC, PH 2022)

2.4 TO ESTABLISH ATTITUDE BY THE DIABETIC PATIENTS

Diabetes has come with a lot of perceptions in the face of populations. Diabetes and hypertension
have been seen as diseases of the rich, this is due to the stress factor that is active in the pathway
of both diseases. The rich have also been put in line with hypertension since it is believed to have
been caused by lack of regular controlled exercise. The rich are considered lazy as they don’t
involve themselves in simple walk or work due to help by machineries acquisition ability
(Kitabchi et al2020)

Research conducted in Melbourne; Australia showed the patients were more positive toward
their illness condition. This research also indicated that female gender had a high level of attitude
than their male counterparts. In their study Nielsen explained that female participants showed
more adaptive attitude towards lifestyle modification as part of diabetic management compared
to males. They also checked their blood glucose level and foot care frequently during the week
prior to completing their self-report measures. (Tapp et al 2021). In the Free State Province,
South Africa research on the adult diabetic patients and it showed that a higher percentage of
participants have a negative attitude to diabetes which may contribute to mortality and morbidity.
They sort to establish their attitudes by improving their knowledge so as to make them have a
positive attitude and equip patients to successfully manage their condition. (CWK AGM 2022)

Research done in Bale Zone; South East Ethiopia showed that the attitude score was significantly
lower in housewives’ respondents than the respondents of other occupations. Good attitude was
observed in subjects whose families had higher monthly incomes. These might be because of
having higher income level which will help to access and afford necessary information related to
diabetes that resulted in changed behavior among the participants. Respondents having a higher
educational level were found to also be having a good attitude towards diabetes complications
than the illiterate in the society. (CWK AGM). In Mombasa Kenya research was conducted and
it as evident that most people living in urban areas practice the western lifestyle in overreliance
on motorized transport and consumption of unhealthy diets rich in carbohydrates, fats, sugars
and salts. These lifestyles have contributed to a rise in levels of obesity and overweight in
population increasing the risk for diabetes. Whereas in rural areas their practice of traditional
lifestyle was characterized by regular vigorous exercise or activity accompanied by subsistence
on high fiber, whole grain-based diet rich in vegetables and fruits. (W. Maina Z. Muriuki2021)

In Nyamira County, moat patients attending diabetic clinic have a more negative attitude than
positive attitude. As I was able to assess them, I realized that they don’t practice on good dietary
intake and their daily lifestyle is not proper. It is up to the health workers to try and provide
health messages to them and also motivate them to have a positive attitude towards their
condition and by doing so it will help them improve in their health status. Also, it will be as a
way of controlling the increase of morbidity and mortality rates. (Eva Wangui 20222)
 CHAPTER 3
RESEARCH METHODOLOGY
3.0 INTRODUCTION
This chapter focus on research design, area of study, study population, sample design and
sampling procedures, research instrument of data collection and presentation.

3.1 STUDY AREA

The study is to be conducted in Nyamira county Referral Hospital. This is the largest and main
Referral hospital in Nyamira County. There are several departments in the hospital that is
inpatient and outpatient departments. Inpatient department had a bed capacity of approximately
40 beds in each unit. The county covers a total area of 912. 5 km² with a population of 605 576 at
2019. It has sub-county hospitals which include Manga masaba, Kijauri and Nyamusi were we
have patients are referred to Nyamira County Referral Hospital.

3.2 STUDY POPULATION

Population refers to the entire group of individuals, events or objects having a common
observable characteristic. As a researcher I would like to generalize the results to absolute
population which is known as target population (Mugenda 2009). The target population will
include all willing medicals personal and supportive staff in Nyamira County Referral Hospital.

3.3 STUDY DESIGN

The research design is a plan, structure and strategy of investigation of answering the research
questions the researcher selects to carry out the study. As a researcher I will use descriptive cross
sectional study design where individuals at different backgrounds will be sampled out then
subjected to prepare predetermined uniform questionnaires. The research design is preferred
since the researcher will be describing the real situation in a real setting over a short period of
time. Data collection will be done by different techniques such as questionnaires and interviews.

3.4 SAMPLING STRATEGY

As a researcher I intend to use the purposive sampling technique. The advantages of purposive
sampling is that it enables researchers to squeeze a lot of information out of the data that they
have collected. Purposive allows the researcher to gather qualitative responses which leads to
better insights and more precise results. However, the disadvantages of purposive sampling
techniques Is that either accidentally or by design eliminate important sub groups from the study.
It is also not effective on a large scale even total population sampling has its limitation before the
results are too diverse Scattered and specific to be useful. I will purposely select those
individuals that fit research topic and reject those who do not fit when creating the sample.

3.5 SAMPLING METHOD

Sampling is the selection of a substitute of individuals from within a statistical population to
estimate the characteristics of the whole population. Purposive sampling method refers to a
group of non-probability sampling techniques in which units are selected Because they have
characteristics that you need in your example. In other words, units how to selected on purpose
in purposive sampling. The common and simplest method for selecting participants for focus
group is called purposive or convenient sampling. This means that you will need to select those
members of the community who you think will provide you with the best information It need not
to be random selection. To avoid biasness in purposive sampling Define a target population and
something frame. Make online survey as short and accessible as possible. Follow up of none
respondents and also avoid convenience sampling. Advantages of purposive sampling, It helps
one to make the most out of small population of interest and arrive at valuable research outcome.
It allows the researcher together qualitative responses leads to better Insights and more precise
research results. However, did you set advantages of purposive sampling at the accidentally or by
design eliminates the sub group which are important. From this study It is also not effective in
large scale even though total population sampling has its limitations because the results are too
scattered diversely and specific to be useful.

3.6 SAMPLE SIZE DETERMINATION

To determine the estimate sampling size the Fishers statistical formula by Mugenda A Mugenda
is recommended which is;

n=Z2Pq/d2

Where:

N = the desired sample size (if the largest population is greater than 10000 people)
n = the standard normal deviation at the required levels

P = the proportion in the target population estimated to have particular characteristics.

Q=proportion of Population without derived characteristics

D= degree of accuracy desired at 10% the level of statistics significance set 50% is used as per
fisher et al if no estimate is available

If the target population is less than 10000 the required sample size will be smaller, in such cases
final sample estimate (nf) using the formula below

nf = (n/ 1+ n/N)

Where nf = the new sample size

N= the estimated population size

Therefore nf =20 /1+20/1000)=20/1+0.02

nf=20/1.02

nf =19.6078

N = 20 respondents

Therefore, the desired sample size is 20 respondents.

3.7 INCLUSIVE CRITERIA

This explains the key features of the target population that are directly involved in investigation.
In my research study I will include all the diabetic patients who have been attending NCRH for
their diabetic clinics not less than one year and willing to participate in this research together
with their caretakers.

3.8 EXCLUSIVE CRITERIA

Features potential study participants who meet inclusion criteria but decline in participating in
research. It will exclude the nondiabetic patients who have not been attending diabetic clinic for
the past one year in Nyamira County Referral Hospital.
3.9 ETHICAL CONSIDERATIONS
As the researcher I was ethical in the course of the study to ensure morality and disregard to
social, political and economic norms. Authority to conduct this research was obtained from the
training institution research lecture. The permission to conduct this study was open from medical
officer of hospital consent was sort from respondents before administering questionnaires. The
information collected was treated I was private and confidential and used for purpose of study
alone. I the researcher explained to the respondents on benefits of participating on the study So
as to avoid unnecessary speculations and expectations.

3.10 STUDY LIMITATION

These are characteristics or design or methodology that some extent impacted or influenced their
application and interpretation of the results of my study. They include constraints on
generalizability and utility of findings in my research study for instance some eligible
participants could decline to participate in the research study due to personal reasons. Some
participants could withhold Information that might be useful in analyzing my research findings
to come up with a reliable and viable solution towards my study problem. Likewise, there could
be informed participants among the subjects who could like to exaggerate their responses during
interviewing process thereby over rating and not representing the true picture of the whole target
population. It is therefore necessary to take a bold move and use proper sampling technique
during the sample size determination process and cluster the respondents into eligible quotas that
will give a proper presentation in order to be successful and fruitful in the research study. Finally
inadequate capital and resources for the entire study.

3.11 DATA COLLECTION PROCEDURE

It involved provision of structured questionnaires to the targeted individuals. The respondents
were given a chance to respond to all questions without fear. The questionnaire composed of
opens and closes ended questions and helped to get specific information within limited time.

3.12 DATA ANALYSIS TECHNIQUES

After data collection I assembled the written information into standard order, which may be
arranged according to the number of patients I had for the research to make it easy when looking
for any missing information. It helped in sorting complete and incomplete questionnaires and
account for it. The raw data after collection was interpreted, processed and sorted into a complete
package of software analysis test for statistical significance. It was summarized and presented by
bar graphs, pie charts and in frequency.

3.13 PRETESTING
Before data collection the prepared questionnaires were pretested in Nyamira County Referral
Hospital before the actual data collection to know whether the answers given are for the research
objective. I carried out a pretest to rule out and to know the number of health care providers
working in surgical unit to see their reactions, check sampling procedure, discover any missing
or any errors In the instruments and evaluate the procedures of data processing. I identified No
gaps and also spaces for writing the responses were enough and hence No deficiencies noted in
the questionnaire.
 APPENDICES
APPENDIX I: QUESTIONNAIRE
Instructions

 All information will be confidential and will only be used for research purposes
 No name or identification will be required during the interview
 Answer only what is asked
 Tick the correct answer in the space provided

SECTION A: SOCIO-DEMOGRAPHIC DATA

a. Gender
a) Male [ ]
b) Female [ ]

b. Marital status
a) Single [ ]
b) Married [ ]
c) Divorced [ ]
d) Widowed [ ]

c. Age
a) 30-39 years [ ]
b) 40-49 years [ ]
c) 50-59 years [ ]
d) 60-70 years [ ]

d. Education level
a) Primary [ ]
b) Secondary [ ]
c) Tertiary [ ]
 d) Others specify [ ]
e. Religion
a. Christian
b. Muslim
c. Hindu
d. Buddhist

SECTION C: ATTITUDE BY DIABETIC PATIENTS

1. Do you consider diabetes and hypertension to be diseases of the rich individuals?

a) Yes [ ]
b) No [ ]
c) Affects both rich and poor equally [ ]

2. How do you perceive diabetes mellitus?

a) Witchcraft [ ]
b) A medical condition [ ]
c) Others specify [ ]

3. How do you take other diabetic patients?

a) Rich [ ]
b) Poor [ ]
c) Cursed [ ]
d) Other specify [ ]

4. What is your attitude towards physical exercise?

a) Waste of time [ ]
 b) For the idle people [ ]
c) Helpful in the management of diabetes mellitus and hypertension [ ]

5. Do you consider hypertension as a predisposing factor to diabetes?

a. Yes
b. No
c. Other specify

SECTION C: KNOWLEDGE ON DIABETIC COMPLICATIONS

1. Has any other member of your family suffered from diabetes?

a) Yes [ ]
b) No [ ]

2. Do you know hypertension can be one of the complications of diabetes?

a) Yes [ ]
b) No [ ]

3. Does alcohol intake by diabetes patients increase the risk of developing hypertension?

a) Yes [ ]
b) No [ ]

4. Do you consider stress as a predisposing factor to hypertension?

a) Yes [ ]
b) No [ ]

5. Do you consider high intake of sugary foods can be a cause of diabetes and hypertension?
 a. Yes
b. No

SECTION D: PRACTICE IN MANAGEMENT OF HYPERTENSION IN DIABETIC

PATIENTS.

1. How often is your blood sugar monitored?

a) Weekly [ ]
b) After two weeks [ ]
c) After 2 months [ ]
d) Other specify [ ]

2. Do you put into action the health education given during clinic day?

a) Always [ ]
b) Sometimes [ ]
c) Not at all [ ]

3. Do you adhere to the scheduled diabetes clinics?

a) Yes [ ]
b) No [ ]
c) Sometimes [ ]

4. How do you control your diabetes mellitus?

a) Drug therapy alone [ ]

b) Diet alone [ ]
 c) Combined diet and drug therapy [ ]
d) Physical exercise, diet and drug therapy [ ]

5. What measures should be taken in your perspective to reduce rising numbers of hypertension
due to lifestyle habits?

a. Daily physical exercise

b. Quitting and avoiding alcohol
c. Intake of salty dietary foods
d. Diet modification
APPENDIX II: BUDGET
BUDGET ITEM QUANTITY AMOUNT

Plain papers 1 ream 400

pens 2@10 20

pencils 2@10 20

erasers 2@20 40

Spring files 1 50

Internet charges 250

Typing and printing 800

binding 200

miscellaneous 100

TOTAL 1800
 APPENDIX III: WORK PLAN
ACTIVITY OCT NOV DEC JAN FEB 23 APR
2022 2022 2022 2023 2023

Search for the topic, present the proposed topic

and the objectives of the research.

Problem statement justification, background

information and litreture review.

Research methodology describing the study

area, formulating the research design, target
population, sampling instrumentation,
pretesting, collection analysis and
presentation of tools.

Printing, binding and submission of the

research proposal.

Data collection analysis and presentation of

the research finding and recommendation.

Submitting of the project