This mainly the adults as a result of

study seeks to investigate the health inequalities influencing feeding
practices among adult patients with type II diabetes in Dar es Salaam. This section
therefore provides information on prevalence, etiology and distribution of the
disease. It also gives a description on the significance of carrying out the
study and clearly states the objectives to undertaking it.

1.1 Background

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mellitus (type II diabetes) has recently emerged as an important public health
issue, globally affecting people in both middle and low income countries. In
the past 20 years, the disorder was given less attention and was thought to be
rare but evidence shows an increase in the morbidity and mortality trends1.
A high body mass index (BMI) characterized by overweight and obesity is a major
risk factor associated with diabetes. Moreover, excess body weight,
hypertension and physical inactivity among adults are associated with increased
health risks for type II diabetes. 

has been a steady increase in prevalence of diabetes over the past 3 decades. Worldwide,
type II diabetes accounts for 90% of all diabetes cases affecting mainly the
adults as a result of insufficient insulin production or ineffectiveness of the
produced insulin. The WHO diabetes global report estimated 422 million adults
(8.5%) of the world’s population had diabetes mellitus2. The disease
has been reported to cause 0.3 million deaths annually in the low income
countries. In Tanzania, it is estimated that the prevalence of diabetes is 4.3%
of the total population3.

Factors associated with the on-set of type II diabetes in adults
include ethnicity, genetics, previous gestational diabetes, older age,
overweight and obesity. Poor nutrition during early childhood has been linked
to the development of type II diabetes in later life. The risk of developing type
II diabetes is even higher among people who had poor fetal growth and or low
weight at birth; particularly when it is followed by rapid postnatal catch up
growth3. Active smoking is also associated with increased risk for
developing diabetes with much higher risk being reported among heavy smokers. However,
poor feeding practices and physical inactivity remains the most significant
contributors to excessive body weight which if not taken care of increases the
risk for developing type II diabetes.

dietary practices and physical exercise are amongst other health practices
which contribute to the achieving of remarkable control of diabetes as well as
avoiding other long term associated complications. Minimizing the consumption
of high glycemic foods, fats and carbohydrates has shown a significant
contribution in decreasing the level of blood glucose which lead to the
reduction of the insulin amount needed for metabolism2,4. Further,
because of the known strong link between overweight and obesity to diabetes,
strategies to halt the rise were set through a global voluntary target by 20253.

the available reports from various studies on diabetes, recent reviews shows
existence in the research gap of self care role particularly on cautious meal
selection among adults with type II diabetes. The complications that arise as a
result of improperly managed type II diabetes are usually detrimental to the
general body health and life at large. Uncontrolled abnormal high blood glucose
levels may trigger undesirable physiological conditions which can lead to the damage
of body organs and tissues including heart, kidney, eyes, blood vessels and
nerves. Such damages are usually associated with lifetime disability and even premature
deaths.  The current interventions mainly
from the biomedical perspective have been reported to improve lifespan of
people living with type II diabetes which is further reported to have also
changed the trends in morbidity. The complications associated with diabetes
have been associated with development of certain types of cancers and increased
rates of physical and cognitive disability. As such, there is a need to explore
more of other aspects that may contribute to improved quality of life among T2D
patients such that the increased years of life may be more productive and with less
health suffering.  

1.2 Statement of the

World Health Organization (WHO) recommends that people living with diabetes mellitus
live a healthy lifestyle by addressing healthy eating, doing physical
activities as tolerated by their health status as well as quitting from smoking3.
It further narrates that diabetic patients with other health risks like
overweight and obesity reduce their calorie intake, and choose unsaturated over
saturated fats while also increasing the intake of dietary fibres than that
recommended to the general population. They should also avoid foods and drinks
with added sugar, use of tobacco or cigarette smoking and excessive use of

there has been a remarkable increase in urbanization and rapid lifestyle
changes in Dar es Salaam which despite of their positive contribution to
development among other sectors, have also compromised the quality of living by
limiting individuals from accessing healthy diet and environmental friendly
areas for physical activities and exercise5. This has affected the
general population at large, whereas special groups including type II diabetes
individuals have not been left in isolation. The findings from STEPS survey reveals
provision of advice on diet, exercise and quit tobacco smoking among type II
diabetic patients, but it does not describe on how such advice influence on feeding
patterns among this group of population6.

study therefore seeks to establish the determinants to compliance of healthy eating
behavior among adults with type II diabetes.

1.3 Objective

1.3.1 General Objective

objective of this study is to examine health inequalities that determine
adherence to healthy dietary practices among adult patients with type II
diabetes age 40 years and above in Dar es Salaam using the Health Belief Model

1.3.2 Specific Objective

1.  To explore on dietary practices among patients
with type II diabetes

To investigate on the health inequalities and their influence towards dietary

To examine barriers contributing to health feeding practices among patients
with type II diabetes.

1.4 Research questions

order to be able to ascertain the knowledge for the gap identified which
critically affects the general health of type II diabetic patients, the
following research questions will need to be very well addressed

feeding practices associated with reduced frequency of hospital visits
resulting from abnormal high blood sugar levels? 
are the influencing factors to feeding practices among T2D adult patients?

there any motives other than blood sugar control associated with dietary
patterns among T2D adult patients?