General Socio-demographic Characteristics
One hundred eighty two adult diabetes patients participated in this study, with 93% response rate. The mean age of the participants was 51.45±14.8 with the age range of 18 to 82 years, 104 (57.1%) were female, and the majority (n = 136, [74.7%] were married. More than a third of the participants (n = 66,[36.3%]) were house wife, 30 (16.5% government servant, 41 (22.5%) were self- employed, and 18 (9.9%) private company employee. About one-third of the participants (n = 61, [33.5 %]) have attended secondary education, 165 (90.7%) were urban residents, and 86 (47.3%) earn less than 1500 ETB monthly (Table 1).
Table 1: Socio-demographic characteristics of the study participants
Variables
|
|
Frequency n (%)
|
Sex
|
Male
Female
|
78 (42.9)
104 (57.1)
|
Age, in year
|
<25
25-39
40-59
>=60
|
10 (5.5)
26 (14.3)
80 (44)
66 (36.3)
|
Marital status
|
Single
Married
Others (widowed, divorced)
|
26 (14.3)
136 (74.7)
20(11)
|
Occupation
|
House wife
Government servant
Student
Self employed
Private company worker
Other
|
66 (36.3)
30 (16.5)
6 (3.3)
41 (22.5)
18 (9.9)
21 (11.5)
|
Educational status
|
Illiterate
Primary
Secondary
College and above /
|
27 (14.8)
44 (24.2)
61 (33.5)
50(27.4)
|
Residence
|
Urban
Rural
|
165 (90.7)
17 (9.3)
|
Monthly income
|
<15000 ETB
1500-3000 ETB
3000-4500 ETB
4500-6000 ETB
>6000ETB
|
86 (47.3)
51 (28)
11(6)
24(13.2)
10(5.5)
|
3.2. Knowledge toward insulin injection devices disposal
Twelve questions were asked to assess the participants’ knowledge about insulin injection devices disposal. This 12-item tool consisted of both positive questions which were represented as true or false response options. For a positive question the ‘true’ response option was scored as 1 and the ‘false’ response option was scored as 0. For a negative question the ‘false’ response option was scored as 1 and the ‘true’ response option was scored as 0. Then the total score was computed and ranged from 0 to12. A median score of 8 was used to classify subjects into two as having adequate knowledge (scored ≥8) and inadequate knowledge (scored <8). More than half of participants (54%) scored below the median score of 8 on the knowledge questionnaire and considered as having inadequate knowledge (Table 2). Majority of the participants (n = 168, [92.3%]) did not know how to dispose lancets after use.
Table 2: Level of knowledge of respondents toward insulin injection device disposal
Level of knowledge
|
Frequency
|
Percentage
|
Adequate knowledge
|
84
|
46
|
Inadequate knowledge
|
98
|
54
|
3.3. Practice towards insulin injection device disposal
A 9-item tool was used for assessing the participants’ self-reported practice of insulin injection device disposal. The 9-item tool consisted of both positive and negative questions. For a positive question the ‘true’ response option was scored as 1 and the ‘false’ response option was scored as 0. For a negative question the ‘false’ response option was scored as 1 and the ‘true’ response option was scored as 0. Then the total score was computed and ranged from 0 to 9. A median score of 7 was used to classify subjects into two as having good practice (scored ≥7) and poor practice (scored <7). Majority of respondents (73.1%) had poor practice of insulin injection device disposal (Table 3). About 72% of respondents place insulin injection devices in their house hold garbage bag and 69.2% did not bring used insulin injection devices back to home when they travel outside and they threw it on street, toilet and river.
Table 3: Level of the participants’ practice of insulin injection device disposal
Level of practice
|
Frequency
|
Percentage
|
Good practice
|
49
|
26.9
|
Poor practice
|
133
|
73.1
|
3.4. Factors associated with knowledge score of study participants
In the bivariate logistic regression analysis, age group, marital status, educational status, occupation and residence, advice from HCP, information from pharmacist/friends, duration of insulin use, and type of DM have showed statistically significant association with the participants’ knowledge of insulin device disposal. However, in multiple regression model age, marital status, education, residence, type of diabetes, source of information, and duration of insulin use significantly associated with knowledge of insulin injection device disposal (Table 4). Compared to participants who were less than 25 years old those in age group between 25 to 39 years old were 8 times more likely to have adequate knowledge (AOR = 8.012, 95%CI = 2.168, 29.600, p-value = 0.02). Participants in marriage were 62% (AOR = 0.382, 95%CI = 0.152, 0.950, p-value = 0.014) and those in other marital status group (divorced and widowed) were 93% (AOR = 0.071, 95%CI = 0.016, 0.320, p-value = 0.01) less likely to have adequate knowledge compared to those who were single. Compared to participants who were illiterate those who had attended secondary school were 81% less likely to have adequate knowledge (AOR = 0.193, 95%CI = 0.056, 0.660, p-value = 0.009). Urban residents compared to rural residents were 80% less likely to have adequate knowledge (AOR = 0.197, 95%CI = 0.053, 0.730, p-value = 0.015). Participants with type 1 diabetes were 2.14 time more likely to have adequate knowledge than those with type 2 diabetes (AOR = 2.14, 95%CI = 1.12, 4.00, p-value = 0.020). Participants who received information from pharmacist or friends were 64% less likely to have adequate knowledge compared to those who did not receive information from the said sources (AOR = 0.358, 95%CI = 0.129, 0.990, p-value = 0.036). Compared to participants who used insulin injection for more than 5 years those who used for 5 years and below were 67% less likely to have adequate knowledge (AOR = 0.332, 95%CI = 0.154, 0.710, p-value = 0.014).
Table 4: Factors associated with knowledge of insulin injection device disposal
Variables
|
Knowledge
|
Crude Odds Ratio (COR), 95%CI
|
Adjusted Odds Ratio (AOR)
|
Inadequate (n)
|
Adequate (n)
|
p-value
|
95% CI
|
Age group
|
<25
|
4
|
6
|
1
|
|
1
|
25-39
|
7
|
19
|
2.308(0.593,0.9)
|
0.02
|
8.012(2.168,29.6)
|
40-59
|
47
|
33
|
4.176(1.540,11.32)
|
0.170
|
0.23(0.036,1.44)
|
>60
|
40
|
26
|
1.08(0.556,2.10)
|
0.108
|
0.213(0.033,
1.373)
|
Marital status
|
Single
|
8
|
18
|
1
|
|
1
|
Married
|
73
|
63
|
0.384(0.156.0.94)
|
0.014
|
0.382(.152,0.95)
|
others
|
17
|
3
|
0.078(.0018,0. 346)
|
0.01
|
0.071(.016.0.32)
|
Education
|
Illiterate
|
18
|
9
|
1
|
|
1
|
Primary
|
33
|
11
|
0.235(0.87,0.637)
|
0.045
|
0.261(.067,1.026)
|
Secondary
|
31
|
30
|
0.157(0.63,0.88)
|
0.009
|
0.193(.056,0.66)
|
College &above
|
16
|
34
|
.455(0.209,0.991)
|
0.0174
|
5.00(0.184,1.3)
|
Residence
|
Urban
|
84
|
8
|
0.22(0.62,0.802)
|
0.015
|
0.197(0.053,0.73)
|
Rural
|
14
|
3
|
1
|
|
1
|
Type of DM
|
Type 1
|
24
|
36
|
2.31(1,2,4.3)
|
0.020
|
2.14(1.12,4.0)
|
Type 2
|
74
|
48
|
1
|
|
1
|
Information from pharmacist/friend
|
Yes
|
18
|
32
|
.366(.186,.718)
|
0.036
|
0.358(0.129,0.99)
|
No
|
80
|
52
|
1
|
|
1
|
Duration of insulin use
|
1mon-5yeas
|
32
|
11
|
0.331(.145,.66
|
0.014
|
0.332(0.154,0.71)
|
>5years
|
66
|
73
|
1
|
|
1
|
Factors associated with practice of insulin injection device disposal
In bivariate logistic regression analysis, age group, marital status, occupation, educational level, duration of insulin use, advice from health care provider (HCP), type of DM, and knowledge of insulin injection device disposal were significantly associated with self-reported insulin injection device disposal practice. In multiple logistic regression models, age, marital status, educational level, advice from HCP, duration of insulin use, type of DM, and knowledge of insulin device disposal have shown statistically significant association with self-reported insulin device disposal practice (Table 5). Compared to participants aged less than 25 years old those in age group between 25 and 39 years were 90% less likely to have good self-reported insulin injection disposal practice (AOR = 0.101, 95%CI = 0.019, 0.535, p-value = 0.007). Participants in marriage were 86% less likely to have good self-reported practice than those who were single (AOR = 0.141, 95%CI = 0.049, 0.406, p-value < 0.001). Compared to illiterate participants those who attended primary education were 84% less likely to have good self-reported practice (AOR = 0.158, 95%CI = 0.028, 0.903, p-value = 0.038). Participants who received information from pharmacist or friends were 59% less likely to good self-reported practice compared to those who did not receive information from the said sources (AOR = 0.407, 95%CI = 0.169, 0.980, p-value = 0.046). Participants who used insulin for more than 5 years were 77% less likely to have good self-reported practice than those who used insulin for 5 years or below (AOR = 0.230, 95%CI =
0.077, 0.690, p-value = 0.009). Participants with type 1 diabetes were 2.1 times more likely to have good self-reported practice than those with type 2 diabetes (AOR = 2.1, 95%CI = 1.054, 4.200, p-value = 0.035). Furthermore, participants who had adequate knowledge of insulin injection device disposal were 2.5 time more likely to have adequate self-reported practice compared to those who had inadequate knowledge (AOR= 2.5, 95%CI = 1.025, 6.300, p-value = 0.044).
Table 5: Factors associated with self-reported practice of insulin injection device disposal
Variables
|
Self-reported practice
|
Crude Odds Ratio (COR), 95%CI
|
Adjusted Odds Ratio (AOR)
|
Poor
|
Good
|
P-value
|
95% CI
|
Age group
|
<25
|
3
|
7
|
1
|
|
1
|
25-39
|
16
|
10
|
7.933(1.824, 34.5)
|
0.007
|
0.101(0.019, 0.535)
|
40-59
|
63
|
17
|
2.125(.799,5.6)
|
.389
|
0.093(.017,0.52)
|
>60
|
51
|
15
|
.917(.418, 2.014)
|
.306
|
0.131(.024,0.71)
|
Marital status
|
Single
|
9
|
17
|
1
|
|
1
|
Married
|
107
|
29
|
10.704(2.462,46.52)
|
0.000
|
0.141(.049, 0.406)
|
Other
|
17
|
3
|
1.536(.421, 5.603)
|
.563
|
0.624(0.127,3.07)
|
Education
|
Illiterate
|
24
|
3
|
1
|
|
1
|
Primary
|
35
|
9
|
2.057(.504, 8.393)
|
0.038
|
0.158(0.028,0.903)
|
Secondary
|
45
|
16
|
2.844(.753, 10.743)
|
0.341
|
0.551(0.161,1.88)
|
College &above
|
29
|
21
|
5.793(1.540, 21.79)
|
0.001
|
0.429(0.153,1.20)
|
Advice from HCP
|
Yes
|
67
|
34
|
.448(.223, 0.898)
|
.046
|
0.407(0.169,0.98)
|
No
|
66
|
15
|
1
|
|
1
|
Duration of insulin use
|
1mon-5yr
|
39
|
4
|
1
|
|
1
|
>5 years
|
94
|
45
|
.214(.072,.636)
|
0.009
|
0.230(0.077, 0.690)
|
Type of DM
|
Type1
|
37
|
23
|
2.3(1.16,4.51)
|
0.035
|
2.1(1.054,4.2)
|
Type 2
|
96
|
26
|
1
|
|
1
|
Knowledge
|
Inadequate
|
83
|
15
|
1
|
|
1
|
Adequate
|
50
|
34
|
3.76(1.87, 7.6)
|
0.044
|
2.5(1.026,6.3)
|