Prevalence and associated factors of foot ulcer among diabetic patients in Ethiopia: a systematic review and meta-analysis

Abstract Background Diabetes and its complications including foot ulcer constitute a global public health challenge attributing to a significant cause of morbidity and mortality. Foot ulcer is one of the long-term complication of diabetes mellitus which lead to infection and amputation of lower extremities. In Ethiopia, findings from few studies were inconsistent and there is a need to systematically pool existing data to determine the magnitude of foot ulcer in diabetics and factors contributing to it. Methods We identified articles through electronic databases such as Medline, Hinari, Pub Med, Cochrane library, the Web of Science and Google Scholar. Accordingly, we identified 95 published and one unpublished article. Finally, eleven studies which fullfilled eligibility criteria were included in final systematic review and meta-analysis. Data were extracted using a standardized data extraction checklist and the analyses were conducted using STATA version 14. The Cochrane Q test statistic and I2 tests were used to assess heterogeneity. Results The overall magnitude of foot ulcer was 12.98% (95%CI: 7.81–18.15) in diabetic patients in Ethiopia. Sub-group analyses revealed highest prevalence in Addis Ababa (19.31% (95%CI: 2.7. 41.37)). Foot ulcer was significantly associated with rural residence (OR = 2.72, 95%, CI: 1.84–4.01)), presence of callus on the feet ((OR = 12.67, 95%, CI: 6.47–24.79)), a body mass index of ≥24.5 ((OR = 2.68, 95%, CI: 1.58–4.56)), poor self- care practice ((OR = 1.47, 95%CI: 1.25–1.73)), type I diabetes mellitus ((OR = 0.42, 95%, CI: 0.22–0.79)), staying with DM for < 10 years ((OR = 0.23, 95%, CI: 0.11–0.50)), and age < 45 years ((OR = 0.44, 95%, CI: 0.21–0.92)). Conclusion The prevalence of diabetic foot ulcers in Ethiopia is relatively low, although its trend is increasing from time to time. Socio-demographic factors, body weight, and healthcare practice contribute to the development of diabetic foot ulcers. Appropriate interventions towards patient self-care practice, lifestyle modification and follow-up are wanted to prevent diabetic foot ulcers.

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SELF CARE PADA PASIEN DIABETES MELITUS DENGAN PENYULIT ULKUS KAKI DIABETIK

Jurnal Riset Kesehatan Nasional ◽

10.37294/jrkn.v5i1.306 ◽

2021 ◽

Vol 5 (1) ◽

pp. 13

Author(s):

Sri Dewi Megayanti ◽

Ns. Putu Inge Suantika, S.Kep.,M.Kep

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Self Care ◽

Foot Ulcer ◽

Sampling Technique ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Foot Care ◽

Convenience Sampling

ABSTRAKLatar Belakang: Diabetes self-care merupakan perilaku perawatan diri pasien diabetes yang meliputi pengaturan diet, penggunaan insulin, olahraga dan perawatan kaki. Diabetes self-care memiliki efek langsung pada kontrol glikemik dalam terjadinya ulkus kaki diabetic. Skor PEDIS merupakan form pemeriksaan yang digunakan perawat dalam menilai keparahan ulkus kaki. Keterbatasan intervensi ulkus kaki yang diberikan oleh perawat saat ini disebabkan oleh terbatasnya data tentang self-care pada pasien diabetes. Tujuan penelitian mengetahui self-care pasien diabetes dengan komplikasi ulkus kaki menggunakan metode pengukuran skor PEDIS yang teridiri dari pemeriksaan perfusi, luas luka, kedalaman luka, keberadaan infeksi dan sensasi kaki.Metode: Penelitian ini termasuk penelitian kuantitatif, dimana penentuan responden menggunakan teknik Convenience sampling dengan jumlah sampel adalah 125, analisa data yang digunakan dengan metode deskriptif.Hasil: Pada penelitian ini 53,8 % reponden memiliki diabetes self-care yang adekuat dan rata- rata responden memiliki Skor PEDIS 2,08.Kesimpulan: dalam penelitian ini sebagian besar responden memiliki diabetes self-care yang tidak adekuat. Nilai Diabetes self-care dapat digunakan oleh perawat untuk mengetahui tingkat kualitas perawatan diri pasien selama ini sehingga memudahkan dalam menentukan intervensi yang tepat untuk mencegah terajadinya perburukan ulkus kaki. Kata kunci: diabetes mellitus tipe 2, diabetes self-care, dan ulkus kaki diabetik. ABSTRACTBackground: Diabetes self-care is a diabetes patient self-care behavior that includes diet management, insulin use, exercise and foot care. Diabetes self-care has a direct effect on glycemic control in the occurrence of diabetic foot ulcers. The PEDIS score is an examination form that nurses use in assessing the severity of foot ulcers. The limitations of the foot ulcer intervention given by nurses at this time are due to limited data on self-care in diabetic patients. The aim of this study was to determine the self-care of diabetic patients with complications of foot ulcers using the PEDIS score measurement method which consists of examination of perfusion, wound area, wound depth, presence of infection and foot sensation.Methods: This research is a quantitative study, where the determination of the respondents using the convenience sampling technique with a sample size of 125, the data analysis used is the descriptive method.Results: In this study 53.8% of respondents had adequate diabetes self-care and the mean of respondents had a PEDIS score of 2.08. Conclusion: in this study most of the respondents had inadequate self-care diabetes. The value of diabetes self-care can be used by nurses to determine the level of quality of patient self-care so far, making it easier to determine the right intervention to prevent worsening of foot ulcers. Keywords: type 2 diabetes mellitus, diabetes self-care, and diabetic foot ulcers.

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Prevalence of diabetic foot ulcer and its association with duration of illness and residence in Ethiopia: a systematic review and meta-analysis

10.1101/19003061 ◽

2019 ◽

Author(s):

Henok Mulugeta ◽

Fasil Wagnew ◽

Haymanot Zeleke ◽

Bekele Tesfaye ◽

Haile Amha ◽

...

Keyword(s):

Systematic Review ◽

Diabetic Foot ◽

Meta Analysis ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Duration Of Illness ◽

National Prevalence

AbstractBackgroundDiabetic foot ulcer (DFU), devastating complications of diabetes mellitus, is a major public health problem, and one of the leading reasons for hospital admission, amputations, and even death among diabetic patients in Ethiopia. Despite its catastrophic health consequences, the national burden of diabetic foot ulcer remains unknown in Ethiopia. Hence, the objective of this systematic review and meta-analysis was to estimate the national prevalence of diabetic foot ulcer and investigate the association with duration of illness and patient residence among diabetic patients.MethodsWe searched PubMed, Google Scholar, Cochrane Library, CINAHL, EMBASE, and PsycINFO databases for studies of diabetic foot ulcers prevalence that published from conception up to June 30, 2019. Quality of each article was assessed using a modified version of the Newcastle-Ottawa Scale for cross-sectional studies. All statistical analyses were done using STATA version 14 software for Windows, and meta-analysis was carried out using a random-effects method. The pooled national prevalence of diabetic foot ulcers was presented using a forest plot.ResultsA total of 10 studies with 3,029 diabetic patients were included. The pooled national prevalence of diabetic foot ulcers among Ethiopian diabetic patients was 11.27% (95% CI 7.22, 15.31%, I2=94.6). Duration of illness (OR: 3.91, 95%CI 2.03, 7.52, I2=63.4%) and patients’ residence (OR: 3.40, 95%CI 2.09, 5.54, I2=0.0%) were significantly associated with a diabetic foot ulcer.ConclusionIn Ethiopia, at least one out of ten diabetic patients had diabetic foot ulcers. Healthcare policymakers (FMoH) need to improve the standard of diabetic care and should design effective preventive strategies to improve health care delivery for people with diabetes and reduce the risk of foot ulceration.

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Staphylococcus aureus strains isolated from diabetic foot ulcers. Identification of the antibiotic resistant phenotypes

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2013-0038 ◽

2013 ◽

Vol 20 (4) ◽

pp. 389-393 ◽

Cited By ~ 2

Author(s):

Teodora Chiţă ◽

Delia Muntean ◽

Luminiţa Badiţoiu ◽

Bogdan Timar ◽

Roxana Moldovan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Staphylococcus Aureus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Foot Ulcers ◽

Resistance Pattern ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Bacterial Strains ◽

Diabetes Clinic

Abstract Background and aims: Infected foot ulcer is one of the most feared complications of diabetes mellitus. Staphylococcus aureus is the most frequently isolated pathogen in diabetic foot infections. The aim of this study was to evaluate the prevalence of S. aureus strains involved in producing foot infections in diabetic patients and the antibiotic resistance pattern of these strains. Material and methods: The study included 33 S. aureus strains isolated from 55 diabetic foot ulcers. The subjects were selected from the 2465 patients with diabetes mellitus hospitalized in the Timişoara Diabetes Clinic, between 2011 and 2013. Germs’ identification relied on cultural and biochemical characteristics. Final identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France) automatic analyzer. Results: All the 55 samples collected from diabetic foot ulcers were positive. We isolated 64 bacterial strains (some samples were positive for 2 microorganisms). The most frequently isolated germ was S. aureus, in 33 samples (51.56%). All these S. aureus strains showed resistance to benzylpenicillin, while only 33.33% were methicillin-resistant (MRSA). Conclusions: The most frequently isolated germ in the wound secretions from diabetic foot ulcers was S. aureus. The highest percentage of antimicrobial resistance was recorded to benzylpenicillin and erythromycin.

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Diabetics’ self-care practice and its determinants among Adult diabetic patients in Ethiopia: A systematic review and meta-analysis.Diabetics’ self-care practice and its determinants among Adult diabetic patients in Ethiopia: A systematic review and meta-analysis

10.21203/rs.2.18987/v2 ◽

2019 ◽

Author(s):

Fikadu Ambaw Yehualashet ◽

Wuber Worku Takele ◽

Eleni Tesfaye Tegegne ◽

Amare Demsie Ayele

Keyword(s):

Diabetes Mellitus ◽

Social Support ◽

Systematic Review ◽

Meta Analysis ◽

National Level ◽

Self Care ◽

Care Practice ◽

Diabetic Patients ◽

Qualitative Synthesis ◽

Complications Of Diabetes

Abstract Background Appropriate diabetic self-care is indispensable to prevent and limit diabetic associated short and long term complications including death. Despite the well-recorded devastating complications of diabetes mellitus, a pooled percentage of diabetic patients applying self-care and its determinants at the national level have remained unknown. Therefore, this comprehensive systematic review and meta-analysis is aimed at determining the pooled national percentage of diabetic self-care practice and its determinants among adult diabetic patients in Ethiopian. Methods: Different electronic databases including PubMed/Medline and search engines such as Google scholar were used to retrieve published studies. The Joanna Briggs Institute quality appraisal checklists were used to appraise the quality of studies. Data were extracted using excel spreadsheets and analyses were done by STATA 14. Heterogeneity among studies was diagnosed using the I2 test. The DerSimonian and Laird random-effects model was employed for substantial heterogeneity (I2>50%). The pooled estimate of diabetic self-care and odds ratio was reported based on the 95% CI. Results: A total of 3861 studies were identified, of which only 19 studies have reached the final qualitative synthesis and quantitative analysis. Well over half of the Ethiopian diabetic patients have good self-care 54.04% (47.07-61.01, I2 =97.3, P<0.001). Subgroup analysis showed that the highest pooled estimate was in Southern Nations Nationalities and Peoples 81.96(71.85-92.04), I2=89.1, P<0.002) while the lowest was from the Hareri region 44.53(32.16-56.89) I2=94%%, P<0.001). Being knowledgeable about diabetes mellitus 2.69 (1.62, 4.46; I2 =99%, P<0.001), having good social support 2.25(1.49-3.39; I2=99%, P=0.00), owning private glucometer 3.04(1.64, 5.65; I2=97.4, P<0.001), and being urban residents 3.26(2.24, 4.74; I2=96.3%, P<0.001) have promoted diabetic victims to apply self-care practice. Conclusions: Despite the life-threatening complications of diabetes mellitus, the percentage of patients applying self-care has remained low in Ethiopia, depicting the high proportion of diabetic patients are prone to develop long and short term complications of diabetes mellitus. Therefore, improving the client’s awareness about the disease and counseling clients about the significance of social support are believed to be possible strategies to improve self-care practice and policymakers are strongly recommended to combat complications to attain sustainable development goal 3.4 aims to reduce premature death.

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Diabetics’ self-care practice and its determinants among Adult diabetic patients in Ethiopia: A systematic review and meta-analysis.

10.21203/rs.2.18987/v1 ◽

2019 ◽

Author(s):

Fikadu Ambaw Yehualashet ◽

Wuber Worku Takele ◽

Eleni Tesfaye Tegegne ◽

Amare Demsie Ayele

Keyword(s):

Diabetes Mellitus ◽

Social Support ◽

Systematic Review ◽

Meta Analysis ◽

Self Care ◽

Care Practice ◽

Diabetic Patients ◽

Asymmetric Distribution ◽

Funnel Plot ◽

Life Threatening

Abstract Background: Appropriate diabetic self-care is indispensable to prevent and limit diabetic associated short and long term complications including death. Therefore, this comprehensive systematic review and meta-analysis were aimed at exploring and determining the pooled national percentage of diabetic self-care and its determinants among adult diabetic patients in Ethiopian. Methods: Different electronic databases including PubMed/Medline and search engines such as Google scholar were used to retrieve published studies. The Joanna Briggs Institute (JBI) quality appraisal checklists were used to appraise the quality of studies. Data were extracted using excel spreadsheets and analyses were done by STATA 14. Heterogeneity among studies was diagnosed using the I2. The DerSimonian and Laird random-effects model was employed for substantial heterogeneity (I2>50%). Sensitivity and subgroup analyses were carried out. The funnel plot and Egger’s regression test was used to identify publication bias. Moreover, the nonparametric trim and fill analysis was done for findings with significant Egger’s test (p<0.05) and asymmetric distribution of studies in the funnel plot. The pooled estimate of diabetic self-care and odds ratio was reported based on the 95% CI. Results: Well over half of the Ethiopian diabetic patients have good self-care 54.04% (47.07-61.01, I2 =97.3, P<0.001). Subgroup analysis showed that the highest and the lowest pooled estimate of self-care was detected in Southern Nations Nationalities and Peoples and Hareri region with 81.96% and 44.53% respectively. Being knowledgeable about diabetes mellitus 2.69%, having good social support 2.25%, owning private glucometer 3.04%, and being urban residents 3.26% have promoted diabetic victims to apply self-care practice. Conclusions: Despite the life-threatening complications of diabetes mellitus, the percentage of patients applying self-care has remained low in Ethiopia, depicting the high proportion of diabetic patients are prone to develop long and short term life-threatening consequences of diabetes mellitus. Therefore, improving the client’s awareness about the disease and counseling clients about the significance of social support are believed to be possible strategies to improve self-care practice and policymakers are strongly recommended to combat diabetic associated complications to attain sustainable development goal 3.4 aims to reduce premature death.

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Emerging Diabetic Foot Ulcer Microbiome Analysis using Cutting Edge Technologies

Journal of Diabetes Science and Technology ◽

10.1177/1932296821990097 ◽

2021 ◽

pp. 193229682199009

Author(s):

Brian M. Schmidt

Keyword(s):

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Standard Of Care ◽

Molecular Techniques ◽

Foot Ulcers ◽

Care Practice ◽

Antibiotic Administration ◽

Diabetic Foot Ulcers ◽

Conventional Culture

One of the most prevalent complications of diabetes mellitus are diabetic foot ulcers (DFU). Diabetic foot ulcers represent a complex condition placing individuals at-risk for major lower extremity amputations and are an independent predictor of patient mortality. DFU heal poorly when standard of care therapy is applied. In fact, wound healing occurs only approximately 30% within 12 weeks and only 45% regardless of time when standard of care is utilized. Similarly, diabetic foot infections occur in half of all DFU and conventional microbiologic cultures can take several days to process before a result is known. DFU represent a significant challenge in this regard because DFU often demonstrate polymicrobial growth, become resistant to preferred antibiotic therapy, and do not inform providers about long-term prognosis. In addition, conventional culture yields may be affected by the timing of antibiotic administration and collection of tissue for analysis. This may lead to suboptimal antibiotic administration or debilitating amputations. The microbiome of DFU is a new frontier to better understand the interactions between host organisms and pathogenic ones. Newer molecular techniques are readily available to assist in analyzing the constituency of the microbiome of DFU. These emerging techniques have already been used to study the microbiome of DFU and have clinical implications that may alter standard of care practice in the near future. Here emerging molecular techniques that can provide clinicians with rapid DFU-related-information and help prognosticate outcomes in this vulnerable patient population are presented.

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Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study

Journal of Diabetes Research ◽

10.1155/2017/2879249 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 22

Author(s):

Tesfamichael G. Mariam ◽

Abebaw Alemayehu ◽

Eleni Tesfaye ◽

Worku Mequannt ◽

Kiber Temesgen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Cross Sectional Study ◽

Care Practice ◽

Diabetic Patients ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

Diabetes mellitus is a metabolic disorder which is characterized by multiple long-term complications that affect almost every system in the body. Foot ulcers are one of the main complications of diabetes mellitus. However, there is limited evidence on the occurrence of foot ulcer and influencing factors in Ethiopia. An institutional-based cross-sectional study was conducted in Gondar University Hospital, Ethiopia, to investigate foot ulcer occurrence in diabetic patients. Systematic random sampling was used to select 279 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. Odds ratio with 95% confidence interval was computed to determine the level of significance. Diabetic foot ulcer was found to be 13.6%. Rural residence [AOR = 2.57; 95% CI: 1.42, 5.93], type II diabetes mellitus [AOR = 2.58; 95% CI: 1.22, 6.45], overweight [AOR = 2.12; 95% CI: 1.15, 3.10], obesity [AOR = 2.65; 95% CI: 1.25, 5.83], poor foot self-care practice [AOR = 2.52; 95% CI: 1.21, 6.53], and neuropathy [AOR = 21.76; 95% CI: 8.43, 57.47] were factors associated with diabetic foot ulcer. Diabetic foot ulcer was found to be high. Provision of special emphasis for rural residence, decreasing excessive weight gain, managing neuropathy, and promoting foot self-care practice would decrease diabetic foot ulcer.

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