Every year more than 36 million people die, due to non communicable diseases (NCDs) out of this, 80% deaths-29 million reported only in low and middle income countries (WHO, 2013a).Global burden of NCDs was 43% in year 1999 which is estimated to increase up to 60% and supposed to be responsible for 70% of global deaths by the year 2020 (WHO, 2013b). Diabetes is one of the NCD which is negatively affecting the quality of life and increasing per capita health expenditure. In diabetes, body does not have capacity to produce insulin hormone which is required for a cell to utilize glucose and use it as energy. Globally, about 382 million people are currently suffering from diabetes in age group of 40-59 years, which is estimated to increase by 55 % in year 2035 i.e. 592 million (IDF Diabetes Atlas, 2013) and 80% of cases reported in low-middle income countries. In year 2013, 5.1 million deaths are only attributed to diabetes. i. e. one person losing his life every 6 second by diabetes (IDF Diabetes atlas, 2013). Few decades back diabetes was called 'disease of wealthy' but now the scenario is changing, it is not any more a disease of affluent. Purpose of this study is to explore illness perception of diabetes & to know about health seeking practices in urban slums.
A study by Hussain, Rahim, Khan, Ali & Vaaler in Bangladesh describes that due to urbanization and migration, there is an increase in number of slum dwelling in the vicinity of cities. These people are exposed to many risk factors which can be responsible for NCDs like diabetes (2005). Diabetes mellitus is caused by the effect of obesity, intake of high calorie food and less physical activity. (Auchincloss, 2009).Adler & Newman stated that low socio economic conditions are associated with sedentary life style & less fiber consumption which can lead to diabetes. Slum dweller often have limited opportunity of education so it limits their knowledge about risk (2001).Besides this, stress is also an important factor which can serve as a risk factor, although it affects all classes but lower socio economic people have more stressful life. Some of the factors can indirectly increase the stress like crowding and noise exposure, low control at work, and social isolation which in turn affects health (Adler & Newman, 2001).
Schulz et. al has shown model of health determinant in which he has shown correlation of above mentioned factors is ultimately responsible for causing diabetes.
Hjelm & Atwine stated in their study about illness perception of diabetes that, general weakness, fall down, collapse, vaginal itching, dizziness, dry tongue, severe thirst, high blood pressure, joints pains, dysfunctional sex were described by participants as a reason of health seeking. They also found people stating the influence of natural and supernatural forces causing DM (2011). Participant are also asked to tell from where they sought health care and they mentioned to sought care from, professional sector doctors or nurses in the hospital, private for profit clinic, pharmacy, self-care measures. In case health care sector fails to relieve their symptoms, they were also seeking care of folk healer like Chinese medicine or herbal medicine. Few participants also visited traditional healer & spiritual healers (Hjelm & Atwine, 2011). Researchers attribute complications and high mortality to poor medical management and harmful self care practices, including use of ethno-medicine (Kolling, Winkley & Deden, 2010).
It is found that low income consumers are more likely fail to stick to dietary guidelines. Bhojani, in his study talked about constraints faced by urban poor in accessing health care which are financial hardship, compromised care, dependency of woman on other family members for buying medicine, family structure, inter-generational conflict, provider's attitude, patients consciousness about their economic condition & difficult access to health care system (2013).
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