Influence of Nutritional Counseling, Socio-Economic Status, And Social Policy On Diabetes Management in The Somali Community of Garissa County

Abstract

The twenty-first century has underscored the critical role of proper nutrition, emphasizing a healthy and balanced diet, in mitigating the prevalence of diabetes and related autoimmune conditions. This study focuses on Type 1 and Type 2 Diabetes Mellitus (DM), which are increasingly recognized as significant health challenges. Conducted in Garissa County, the research examines the effectiveness of nutritional counseling provided by professional healthcare workers. The study assesses the influence of nutrition counseling, socio-economic status and policy on diabetes management in the Somali community of Garissa County. The study specifically sought to examine the relationship between socio-economic status (income, education, occupation) and diabetes management outcomes, to assess the role of self-care practices including dietary habits, physical activity, and stress management, in diabetes outcomes, to explore the role of policies and health programs in facilitating diabetes care and nutritional counselling and to identify barriers and facilitators to effective diabetes management related to socio-economic and policy contexts. The study was anchored on the Andersen- Expanded Behavioural Model and the Theory of Planned Behaviour. The study further employed a cross-sectional research design and targeted a population of 2400 individuals with Type 1 and Type 2 diabetes, employing a stratified random sampling technique to select 331 participants. A semi-structured questionnaire and key informant interviews were utilized to collect data. Statistical analysis, conducted using the Statistical Package for Social Studies Version 25, involved quantitative data analysis to evaluate the final field data. The results, presented through frequency tables, pie charts, and bar graphs, clearly illustrate the frequencies and percentages involved. The findings revealed that socio-economic factors significantly influenced outcomes, with 71.0% unemployment and 91.9% lacking health insurance linked to limited access to medications (significant association with management effectiveness, χ²=12.85, p=0.002); individual behavioral factors were pivotal, as high medication adherence (98.2% moderate to very high) correlated with strong overall plan adherence (χ²=14.67, p<0.001) and frequent physical activity (62.1%) boosted confidence (χ²=10.24, p=0.006); and social policies showed limited effectiveness, with only 7.4% awareness and 8.8% benefiting from programs, yielding no significant associations with adherence (χ²=1.23, p=0.267) or confidence (χ²=4.89, p=0.087). To address these challenges, targeted interventions such as community-based health literacy programs, expanded nutrition counselling, and subsidized medication initiatives, alongside comprehensive policy reforms, are essential to enhance diabetes care and improve health outcomes. Future research should investigate the facilitators of effective diabetes management strategies among healthcare providers and community leaders, as well as the barriers they face in delivering nutritional counselling and diabetes education, to strengthen service delivery and community health outcomes.