Level of dietary adherence and determinants among type 2 diabetes population in Ethiopian: A systemic review with meta-analysis

BACKGROUND: The beneficial effect of the dietary practice is significant reduction in the risk of developing diabetes related complication. Dietary practice among type 2 diabetes is not well-implemented in Ethiopia. Up to now, in the nation, several primary observational studies have been done on dietary adherence level and its determinants among type 2 diabetes. However, a comprehensive review that would have a lot of strong evidence for designing intervention is lacking. So, this review with a meta-analysis was conducted to bridge this gap. METHODS: A systematic review of an observational study is conducted following the PRISMA checklist. Three reviewers have been searched and extracted from the World Health Organization- Hinari portal (SCOPUS, African Index Medicus, and African Journals Online databases), PubMed, Google Scholar and EMBASE. Articles’ quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with low and moderate risk were included in the final analysis. The review presented the pooled proportion dietary adherence among type2 diabetes and the odds ratios of risk factors favor to dietary adherence after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42020149475. RESULTS: We included 19 primary studies (with 6, 308 participants) in this meta-analysis. The pooled proportion of dietary adherence in the type 2 diabetes population was 41.05% (95% CI: 34.86–47.24, I(2) = 93.1%). Educational level (Pooled Odds Ratio (POR): 3.29; 95%CI: 1.41–5.16; I(2) = 91.1%), monthly income (POR: 2.50; 95%CI: 1.41–3.52; I(2) = 0.0%), and who had dietary knowledge (POR: 2.19; 95%CI: 1.59–2.79; I(2) = 0.0%) were statistically significant factors of dietary adherence. CONCLUSION: The overall pooled proportion of dietary adherence among type 2 diabetes in Ethiopia was below half. Further works would be needed to improve dietary adherence in the type 2 diabetes population. So, factors that were identified might help to revise the plan set by the country, and further research might be required to health facility fidelity and dietary education according to diabetes recommended dietary guideline.