Lower limb amputations among individuals living with diabetes mellitus in low- and middle-income countries: A systematic review protocol

Abstract

Background The burden of diabetes mellitus (DM) and its associated complications continue to burgeon, particularly in low- and middle-income countries (LMICs). Lower limb amputation (LLA) is one of the most life-altering complications of DM, associated with significant morbidity, mortality and socio-economic impacts. High-income countries have reported a decreasing incidence of DM-associated LLA, but the situation in many LMICs is unknown. We aim to conduct a systematic review to determine the incidence and prevalence of DM-associated LLA in LMICs to better inform appropriate interventions and health system response. Methods and analysis A systematic search of the literature will be conducted on five databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus and African Journal Online (AJOL). Only observational, quantitative studies reporting the incidence and/or prevalence of DM-related LLA will be considered. A validated study design-specific critical appraisal tool will be used to assess the risk of bias in individual studies. We will determine the incidence of LLA by examining the number of new cases of LLA among individuals with confirmed DM diagnosis during the specified period, while the prevalence will be based on the total number of all new and existing LLAs in a population. LLA will be considered as the resection of the lower limb from just above the knee to any point down to the toe. If heterogeneity is low to moderate, a random-effects meta-analysis will be conducted on extracted crude prevalence/incidence rates, with the median and interquartile range also reported. The systematic review will be performed in accordance with the JBI guideline for prevalence and incidence review. Study reporting will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guideline. Prospero registration number CRD42021238656.

Understanding Lower Limb Amputation: A Review of the Strategies for Healthcare Improvement, Prevention, and Management

“…For instance, in sub-Saharan Africa, LLA is a significant health concern. Studies conducted in countries like Uganda, Kenya, and Nigeria have reported a high burden of LLA, particularly among individuals with diabetes and those affected by trauma [16][17][18].…”

“…for female patients, increasing to 41.9 and 34.8 per 100,000, respectively, in 2017 (LEA study group, 2020). LLA is commonly observed in males, individuals with diabetes, and those residing in rural settings [16,31,32]. However, the trend of LLA in Uganda is currently unknown due to the lack of past data and the absence of an amputee registry [33].…”

Reliability and Validity Testing of the Persian Version of the Derriford Appearance Scale 24 in a Sample of Individuals With Craniofacial Irregularity and Amputation

“…2 Traumatic amputation, amputation due to Diabetes Mellitus and burn injuries are among the leading causes of disfigurement in low to middle-income countries. 3 , 4 Despite the recent advancements in the design and manufacture of prostheses to improve their natural size, shape, and movement, prosthesis users may become self-conscious about their appearance. 5 This is partly due to the judgment and stigma they experience in their daily life.…”