Published online Mar 15, 2019. doi: 10.4239/wjd.v10.i3.200
Peer-review started: January 11, 2019
First decision: January 25, 2019
Revised: February 23, 2019
Accepted: March 8, 2019
Article in press: March 8, 2019
Published online: March 15, 2019
Nigeria bears the greatest burden of diabetes prevalence in Sub-Saharan Africa. Diabetic foot ulcer (DFU) is a serious and potentially life-threatening complication of diabetes. Significant improvements in diabetic foot incidence and outcomes have been recorded in many Western countries in the past decade. However, the current burden of DFU in Nigeria is largely unknown.
To evaluate the patients’ profile, ulcer characteristics, associated co-morbidities and outcome of patients with DFU in Nigeria.
Multicenter evaluation of diabetic foot ulcer in Nigeria was a one year multicenter observational study of patients hospitalized for DFU in six tertiary health institutions in Nigeria from March 2016 to March 2017. Demographic and diabetes information, ulcer characteristics and associated co-morbidities were assessed. Relevant laboratory and imaging studies were performed. All patients received appropriate multi-disciplinary care and were followed up until discharge or death. Outcome variables of interest were ulcer healing, lower extremity amputation (LEA), duration of hospitalization and mortality.
A total of 336 patients (55.1% male) with mean age of 55.9 ± 12.5 years were enrolled into this study. Majority (96.1%) had type 2 diabetes. Only 25.9% of the subjects had prior foot care knowledge. Most of the subjects presented late to the hospital and median (IQR) duration of ulcer at presentation was 39 (28-54) d. Ulcers were already advanced (Wagner grades ≥ 3) in 79.2% of the subjects while 76.8% of the ulcers were infected at the time of admission. The commonest co-morbidities were systemic hypertension, anemia and hyperglycemic emergencies. One hundred and nineteen subjects (35.4%) suffered LEA while 10.4% left against medical advice. The median (IQR) duration of hospitalization was 52.0 (29-66) d with case fatality rate of 20.5%.
The burden of DFU in Nigeria is very high. The major gaps include low level of foot care knowledge among diabetic patients, overdependence on self-medication and unorthodox medicine following development of foot ulceration, late hospital presentation, and high amputation and mortality rates. Extensive foot care education within the framework of a multi-disciplinary foot care team is highly desirable.
Core tip: The multicenter evaluation of diabetic foot ulcer in Nigeria was a one year observational study of 336 adults who were hospitalized for diabetic foot ulcer in six tertiary hospitals in Nigeria. The subjects were managed by multi-disciplinary diabetic foot care teams and were followed up until discharge or death. This study demonstrated a high burden of diabetic foot ulcer in Nigeria which accounted for about a quarter of diabetes related hospital admissions over the study period. The study recorded high amputation and mortality rates of 35.4% and 20.5% respectively. Major challenges in diabetic foot care identified in this study include low level of foot care knowledge among the patients, poor health-seeking behavior and late hospital presentation.