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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria
Ejiofor Ugwu, Olufunmilayo Adeleye, Ibrahim Gezawa, Innocent Okpe, Marcelina Enamino, Ignatius Ezeani
Ejiofor Ugwu, Department of Medicine, Enugu State University of Science and Technology Enugu, Enugu 400001, Nigeria
Olufunmilayo Adeleye, Department of Medicine, Lagos State University Lagos, Lagos 100001, Nigeria
Ibrahim Gezawa, Department of Medicine, Bayero University Kano, Kano 700001, Nigeria
Innocent Okpe, Department of Medicine, Ahmadu Bello University Zaria, Kaduna 800001, Nigeria
Marcelina Enamino, Department of Medicine, Federal Medical Center Keffi, Nasarawa 961101, Nigeria
Ignatius Ezeani, Department of Medicine, Federal Medical Center Umuahia, Abia 440001, Nigeria
Author contributions: All authors contributed significantly at every stage of this study; Ugwu E conceptualized and designed the study protocol, and developed the manuscript; all authors took part in data collection; Adeleye O, Gezawa I and Okpe I participated in data analysis and interpretation; Enamino M and Ezeani I critically reviewed the manuscript for intellectual content; all authors read and approved the final manuscript.
Institutional review board statement: Approval for the study was given by the local Research and Ethics committee of each of the participating centers.
Informed consent statement: Participation in this study was voluntary. Verbally granted informed consent was obtained from each patient prior to enrollment into the study. Confidentiality was ensured at all stages by means of unique coding system consisting of patients’ initials and assigned numbers.
Conflict-of-interest statement: All authors declare no conflict of interest. This study did not receive funding from any external source.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ejiofor Ugwu, MBBS, Consultant Endocrinologist, Department of Medicine, Enugu State University of Science and Technology Enugu, Parklane, Enugu 400001, Nigeria. ofornet@yahoo.com
Telephone: +234-803-5703482
Received: January 11, 2019
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
ARTICLE HIGHLIGHTS
Research background
Diabetic foot ulcer (DFU) is a serious and costly complication of diabetes that is associated with high morbidity and mortality. However, DFU-related lower extremity amputation (LEA) and death are both preventable through appropriate healthcare measures.
Research motivation
The prevalence of diabetes in Nigeria is steadily rising with the country currently harboring the largest burden of diabetes in Sub-Saharan Africa. Evaluation of a disease burden helps in identifying healthcare gaps that need to be addressed. However, the current burden of DFU in Nigeria is largely unknown.
Research objectives
We evaluated the patient and ulcer characteristics as well as the outcomes of patients hospitalized for DFU in six tertiary healthcare centers in Nigeria over a one year period.
Research methods
In an observational study design, we followed up a total of 336 type 1 and type 2 diabetic patients who were hospitalized for DFU until they exited the hospital. Then we documented their baseline profile, clinical progress, disease outcomes and mode of exit.
Research results
The study revealed that DFU accounted for about a quarter of diabetes related hospitalization in Nigeria. It further showed that most of the affected patients lacked knowledge of foot care and resorted to self-medications or alternative medicine approaches following development of foot ulcer. Consequently, over three-quarter of the patients presented late to the hospital with advanced ulcer. The study revealed a high LEA and mortality rates of 35.4% and 20.5% respectively.
Research conclusions
We concluded that the burden of DFU in Nigeria is still substantial and decried the high degree of foot care ignorance and poor health-seeking behavior among patients with DFU in our country.
Research perspectives
We advocate for massive public enlightenment programmes about diabetic foot with emphasis on its prevention and timely treatment. Massive training of diabetes educators and podiatrists in Nigeria to improve foot care knowledge and foot care practice is strongly recommended.
