Diabetic foot: prevalence, knowledge, and foot self-care practices among diabetic patients in Dar es Salaam, Tanzania – a cross-sectional study
Chiwanga and Njelekela Journal of Foot and Ankle Research
Diabetic foot: prevalence, knowledge, and foot self-care practices among diabetic patients in Dar es Salaam, Tanzania - a cross-sectional study
Faraja S. Chiwanga 0
Marina A. Njelekela 0 1
0 Muhimbili National Hospital , Kalenga Street, Upanga, P.O Box 65000, Dar es Salaam , Tanzania
1 Muhimbili University of Health and Allied Sciences , Mindu Street, Upanga, P.O Box 65001, Dar es Salaam , Tanzania
Background: At the time of diagnosis, more than 10 % of people with type 2 diabetes mellitus have one or two risk factors for a foot ulceration and a lifetime risk of 15 %. Diabetic foot ulcers can be prevented through well-coordinated foot care services. The objective of this study was to determine knowledge of foot care and reported practice of foot self-care among diabetic patients with the aim of identifying and addressing barriers to preventing amputations among diabetic patients. Methods: Patients were randomly selected from all public diabetic clinics in Dar es Salaam. A questionnaire containing knowledge and foot care practice questions was administered to all study participants. A detailed foot examination was performed on all patients, with the results categorized according to the International Diabetes Federation foot risk categories. Statistics were performed using SPSS version 14. Results: Of 404 patients included in this study, 15 % had foot ulcers, 44 % had peripheral neuropathy, and 15 % had peripheral vascular disease. In multivariate analysis, peripheral neuropathy and insulin treatment were significantly associated with presence of foot ulcer. The mean knowledge score was 11.2 ± 6.4 out of a total possible score of 23. Low mean scores were associated with lack of formal education (8.3 ± 6.1), diabetes duration of < 5 years (10.2 ± 6.7) and not receiving advice on foot care (8.0 ± 6.1). Among the 404 patients, 48 % had received advice on foot care, and 27.5 % had their feet examined by a doctor at least once since their initial diagnosis. Foot self-care was significantly higher in patients who had received advice on foot care and in those whose feet had been examined by a doctor at least once. Conclusions: The prevalence of diabetic foot is high among patients attending public clinics in Dar es Salaam. There is an urgent need to establish coordinated foot care services within the diabetic clinic to identify feet at risk, institute early management, and provide continuous foot care education to patients and health care providers.
Diabetes; Diabetic foot; Foot care
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Background
It is estimated that, at the time of diagnosis of type 2
diabetes mellitus, more than 10 % of patients have one
or two risk factors for foot disease, such as peripheral
neuropathy (PN) or peripheral vascular disease (PVD)
[1]. The burden of diabetic foot disease is expected to
increase given the increasing global prevalence of
T2DM. Worldwide, 3 %–10 % of people with diabetes
have a foot ulcer (DFU); the lifetime risk for developing
DFU is 15 % [1]. Rates of foot ulceration in Africa vary
between regions and have been estimated to be between
4 % and 19 % [2].
Several studies have shown that a majority of people
with diabetes do not receive guideline-recommended
foot care, including regular foot examinations. [3] In a
study conducted by Basu et al. in the United Kingdom,
33 % of people with diabetes did not recall receiving
information about foot care [4]. In a study conducted at
the Muhimbili National Hospital (MNH) diabetic clinic,
87 % of patients reported never inspecting their feet, and
66 % reported they were not interested in further
knowledge of diabetes foot care [5].
Among the complications of diabetes, lower limb
amputation is considered to be potentially preventable. [6]
Most lower limb amputations in patients with diabetes
are preceded by a foot ulcer, whose risk factors apart
from PVD and PN, are barefoot walking, inappropriate
footwear, poor foot hygiene and delay in seeking medical
attention [7]. These non-traditional risk factors can be
modified if identified early, and if patients have adequate
knowledge of foot care and put that knowledge into
practice. [7] In recent years, the level of interest and
knowledge about DFU has grown considerably, as
witnessed by the development of an international
consensus, clinical guidelines to be used in both prevention and
treatment of diabetic foot, and improvements in
evidence-based clinical practice. All patients, if given
proper guidance and education regarding foot care,
should be able to make significant improvements in their
foot care. Evidence that foot care education alone
prevents DFU and amputation has been inconsistency due
to lack of high quality randomized trials. However, this
lack of evidence is not evidence of no effect [8, 9].
Current guidelines for standardized care of diabetic
patients recommend annual screening for high risk feet.
Those identified as high risk should receive enhanced
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