Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria

Ugwu, Ejiofor; Adeleye, Olufunmilayo; Gezawa, Ibrahim; Okpe, Innocent; Enamino, Marcelina; Ezeani, Ignatius

doi:10.4239/wjd.v10.i3.200

Cited by 56 publications

(58 citation statements)

References 34 publications

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“…Outcome variables of interest included ulcer healing, amputation, duration of hospitalisation and mortality. Other details of the MEDFUN protocol is as published elsewhere [21]. Here we present the sub-group analysis for the influence of diabetes foot care education on health-seeking behaviour of the subjects as well as on treatment outcome.…”

Section: Resultsmentioning

confidence: 99%

Untitled

2019

Int J Foot Ankle

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Background: Considerable advances have been made in the field of diabetic foot care over the past 25 years in developed countries. On the contrary, diabetes foot ulceration (DFU) still remains a common diabetes related complication of substantial public health importance in sub-Saharan Africa. Diabetic foot outcome in Nigeria is reportedly poor, with high amputation and mortality rates. Proper foot care education is known to impact positively on both DFU prevention and outcome in the developed societies. However, this relationship has not been well characterised in Nigeria. Objective: To determine the relationship between diabetic foot care education, health-seeking behaviour and DFU outcome. Methods: In this one-year observational Multi-Centre Evaluation of Diabetes Foot Ulcer in Nigeria (MEDFUN) study, subjects admitted for DFU in six tertiary hospitals were evaluated for demographic and diabetes related information, ulcer characteristics and treatment modality prior to hospitalisation. Prior participation in foot care education and knowledge of proper foot care were sought while relevant laboratory tests were performed. All patients benefitted from appropriate multidisciplinary care and were followed up until discharge or death. Outcome of interest were wound healing, lower extremity amputation (LEA) and mortality. Logistics regression was used to determine the impact of foot care education on DFU outcomes.

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Section: Resultsmentioning

confidence: 99%

Untitled

2019

Int J Foot Ankle

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“…Detailed protocol of the MEDFUN study has been published elsewhere. 15 In summary, socio-demographic information and relevant clinical history of eligible and consenting subjects were obtained and documented in a proforma designed for the study, including age, gender, diabetes type and duration, knowledge of foot care, primary diabetes care facility, prior history of DFU, and duration of ulcer prior to presentation. This was followed by foot examination and ulcer assessment, with particular attention to foot deformities, peripheral neuropathy, peripheral arterial disease (PAD), ulcer severity, and presence of wound infection.…”

Section: Methodsmentioning

confidence: 99%

Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

Adeleye

Ugwu

Gezawa

et al. 2020

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Background: Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. This study was undertaken to determine factors that predict mortality in patients hospitalized for DFU in Nigeria.Methods:The current study was part of Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN), an observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented to participate were recruited and subjected to relevant clinical, biochemical and radiological assessments and multidisciplinary care until discharge or death. Data for type 1 diabetes mellitus (DM) patients were expunged from current mortality analysis due to their small number.Results: Three hundred and twenty three type 2 DM subjects with mean age and mean duration of DM of 57.2 11.4 years and 8.7± 5.8 years respectively participated in this study. The median duration of ulcers was 39 days with a range of 28 to 54 days and majority (79.9%) presented with advanced ulcers of at least Wagner grade 3. Mortality of 21.4% was recorded in the study, with the highest mortality observed among subjects with Wagner grade 5. Variables significantly associated with mortality with their respective p values were DM duration more than 120 months (p 0.005), ulcer duration > one month (p 0.020), ulcer severity of Wagner grade 3 and above (p 0.001), peripheral arterial disease (p 0.005), proteinuria (p <0.001), positive blood cultures (p<0.001), low HDL (p <0.001), shock at presentation (p<0.001), cardiac failure (p 0.027),and renal impairment (p <0.001). On Multivariate regression analysis, presence of bacteraemia (OR 5.053; 95% CI 2.572-9.428) and renal impairment (OR 2.838; 95% CI 1.349 – 5.971) were significantly predictive of mortality independent of other variables.Conclusions: This study showed high intra-hospital mortality among patients with DFU, with majority of deaths occurring among those with advanced ulcers, bacteremia, cardiac failure and renal impairment. Prompt attention to these factors might be helpful in improving survival from DFU in Nigeria.

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“…Detailed study protocol of the MEDFUN has been published elsewhere. 15 Patients' demographics were collected from admission records obtained on the first day of admission. Other clinical information sought from participants were, duration and type of DM, if ever received foot care education since DM diagnosis, if ever received diabetes care at study centers prior to current admission, past history of DFU, duration of ulcer prior to current admission and history of cigarette smoking.…”

Section: Methodsmentioning

confidence: 99%

Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

Adeleye

Ugwu

Gezawa

et al. 2019

Preprint

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Background/Objective : Diabetic foot ulcers (DFU) are associated with high morbidity and mortality globally. Mortality in patients hospitalized for DFU in Nigeria is unacceptably high. We sought to document contributory factors which predict mortality in patients hospitalized for DFU. Methods : Multi-centre Evaluation of Diabetic Foot Ulcer in Nigeria ( MEDFUN ), one-year observational study conducted in six tertiary healthcare institutions across the 6 geopolitical zones of Nigeria. Consecutive type 1 or 2 diabetic patients hospitalized for DFU who consented. Co-morbid complications were documented. Results : Mean age 55.9 12.5 years.96.1% had type 2 diabetes (DM), mean duration of DM was 8.5 ± 5.7 years. Duration of ulcer was 39 days with a range of 28 to 54 days. 79.2% presented with at least grade 3 DFU. About one-fifth of the patients died (20.5%). Highest mortality among subjects with Wagner grade 5. Middle-aged subjects ( 45-64 years) had significantly higher mortality- odds ratio (OR) 5.107, Confidence interval (CI) of 1.429-18.252, and P-value 0.022. Variables significantly associated with mortality with the respective p- values are DM duration more than 120 months (0.008), ulcer duration > one month (0.013), ulcer severity of Wagner grade 3 and above (0.001), peripheral arterial disease (0.002), foot gangrene (< 0.001). Laboratory variables associated with mortality ; proteinuria (<0.001), positive blood cultures (<0.001), severe vascular stenosis (0.001), moderate vascular stenosis(< 0.001), Low HDL (< 0.001). Co-morbid complications significantly associated with mortality; shock at presentation (<0.001), anemia (0.034), cardiac failure (0.020), renal impairment (<0.001). Sepsis was the strongest predictor of mortality (adjusted OR 5.128; 95% CI 2.614 – 10.060) followed by renal impairment (adjusted OR 2.831; 95% C.I. for OR 1.346 – 5.953). Conclusions : Mortality among Nigerian diabetic patients admitted for DFU is high, univariate predictors of mortality: older age, higher Wagner grade (≥ 3) ulcer, longer duration of DM, longer duration of ulcer, peripheral arterial disease, foot gangrene, renal impairment, low HDL- cholesterol, anemia, shock, and cardiac failure. Renal impairment and positive blood culture were independent determinants of mortality.

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Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria

Cited by 56 publications

References 34 publications

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Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

Predictors of intra-hospital mortality in patients with diabetic foot ulcers in Nigeria: data from the MEDFUN Study.

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