Diabetic Foot Amputations at Central and Provincial Hospital in Gauteng. A Signpost for Inadequate Foot Health Services at Primary Healthcare Level in South Africa

2021 ◽  
Author(s):  
Simiso M. Ntuli ◽  
D M Letswalo
Keyword(s):  
South Africa ◽  
Health Services ◽  
Clinical Outcomes ◽  
Primary Healthcare ◽  
Diabetic Foot ◽  
Healthcare Delivery ◽  
Public Healthcare ◽  
Diabetic Patients ◽  
Foot Health ◽  
Foot Complications

Abstract Background Diabetic foot amputations are the most devastating outcome for any diabetic patient and could be associated with failure to risk stratify the diabetic foot and create individualised treatment plans to lower risk at the primary healthcare level (PHC). In South Africa (RSA), PHC clinics are the first entry point to the public healthcare system. Failure to correctly identify, risk categorise, and refer diabetic foot complications may lead to poor clinical outcomes for diabetic patients. There is a need to highlight poor clinical outcomes and link them to limited access to foot health services at the PHC level. This approach may help drive the strategic allocation and deployment of limited podiatry force in RSA. This study looks at the incidence of diabetic-related amputations at central and tertiary hospitals in Gauteng to argue the case of the needed foot health services at the PHC level. Methods A cross-sectional retrospective study that reviewed theatre records. We reviewed records of all diabetic patients who had diabetic-related amputations between January 2017 and June 2019. Results There were 1862 diabetic-related amputations; however, only 1565 accurately recorded and met the inclusion criteria for the study. The first amputation was a major amputation in 73% of the cases, and an infected foot ulcer was a primary amputation cause in 75% of patients. Males had the most amputations, 62%. The majority, 71% of amputations, were in patients younger than 65 years. Nearly all patients (98%) came from a poor socio-economic background and are state-dependent; they earned ZAR 0.00- 70 000.00 or USD (0.00- 4754.41) per annum. Conclusion Amputations are a sign of poor clinical outcomes for diabetic patients and imply inadequate care of diabetic foot complications across the continuum of care, particularly at the PHC level in RSA. Due to the hierarchal nature of healthcare delivery in RSA, all patients in this study would have presented at a PHC facility to manage their diabetes and other chronic comorbidities. The findings show that most first amputations recorded in this study were major amputations. This finding is a significant signpost of the potential delay in recognising, treating and timely referral of diabetic-related foot complications. Arguably, a lack of access to structured foot health services at PHC levels impedes early identification of foot complication identification and appropriate referral resulting in the amputation in some of the patients.

scholarly journals Diabetic Foot Care - A Public Health Problem

2011 ◽  
Vol 12 (2) ◽  
pp. 109-114 ◽  
Author(s):  
Jamil Ahmed Somroo ◽  
Anjum Hashmi ◽  
Zafar Iqbal ◽  
Aslam Ghori
Keyword(s):  
Diabetic Foot ◽  
Fungal Infections ◽  
Public Health Problem ◽  
Global Scale ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Foot Care ◽  
Cross Sectional ◽  
Foot Health ◽  
Care Practices

Background: Diabetes is global epidemic with devastating human, social and economic consequences. The disease claims as many lives per year as HIV/AIDS and places a severe burden on healthcare systems and economies everywhere, with the heaviest burden falling on low- and middle-income countries. Despite this, awareness of the global scale of the diabetes threat remains pitifully low, inappropriate diabetic foot care affects, feet health leading to callosities, cracks, fissures, fungal infections, ingrown toe nails and patients end up in ulcers and amputations. Objectives: To assess diabetic patients taking proper foot care according to International Guidelines and its impact on their foot health. Methods: A cross sectional study was conducted at outdoor patients department of Medicine, Liaquat University of Medical Sciences Hospital Hyderabad from 17th January 2008 to 16th January 2009. 100 diabetic patients were selected by non probability convenience sampling according to Performa having questions regarding diabetic foot care derived from American Diabetic Association Guidelines for Diabetic Foot care. Results: Diabetic patients taking proper foot care was only 6%. There were 45(45%) males and 55(55%) females. Mean age was 51.57+10.72 years. 38% patients knew about foot care. 17% used to inspect their feet daily, 20% washed their feet daily, while 73% washed their feet more than once. 23% patients dried their feet after every foot wash, 27% applied emollients, 25% checked shoes before wearing, 24% used to wear correct shoes, 8% used to wear cotton socks and 36% used to walk bare feet. Foot care practices on foot health has statistically highly significant association (p<0.01) e.g. number of foot washes with foot hygiene, fungal infections with proper foot drying, emollient application with skin texture, cracks and fissures. Associations of proper foot care were statistically significant with literacy status of patients and foot care teachings (p<0.05). Conclusion: Few diabetic patients are taking proper foot care. Proper Foot care practices were associated with provision of education of foot care and literacy status of patients. Community health education programs regarding diabetic foot care will likely to reduce diabetic foot complications. Keyword: Diabetes, Foot care education, Diabetic foot care, Diabetic foot, Ulceration; Prevention. DOI: http://dx.doi.org/10.3329/jom.v12i2.7604 JOM 2011; 12(2): 109-114

scholarly journals Prevention and treatment of diabetic foot ulcers

2017 ◽  
Vol 110 (3) ◽  
pp. 104-109 ◽  
Author(s):  
Jonathan Zhang Ming Lim ◽  
Natasha Su Lynn Ng ◽  
Cecil Thomas
Keyword(s):  
Diabetic Foot ◽  
Healthcare Access ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Foot Care ◽  
Healthcare Provision ◽  
Foot Complications

The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

scholarly journals Diabetic foot self-care: awareness and practice among type 2 diabetic patients in primary healthcare centers, Dubai Health Authority

2018 ◽  
Vol 6 (1) ◽  
pp. 1
Author(s):  
Maira K. Mehmood ◽  
Almas Z. Parkar ◽  
Nayab T. Mustafa ◽  
Sarah S. Mustafa ◽  
Momina A. Makin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Healthcare ◽  
Health Authority ◽  
Diabetic Foot ◽  
Self Care ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Cumulative Score ◽  
Primary Healthcare Centers

Background: Diabetic foot disease is the most common complication of diabetes mellitus. With appropriate management, approximately 49-85% of diabetic foot complications can be prevented. This study was carried out due to lack of population-based studies on foot self-care in the U.A.E. The aim of this study is to assess the awareness and practice of foot self-care in patients with type 2 diabetes and study the factors affecting foot self-care.Methods: A cross-sectional study was conducted amongst patients of type-2 diabetes attending the diabetic clinics in primary healthcare centers under Dubai Health Authority. 488 participants were interviewed on a pre-tested structured questionnaire. The cumulative score of awareness and practice was classified into poor (<50 percentile), average (50-75 percentile) and good (>75 percentile).Results: 47% participants had an overall poor awareness and 46% had an overall poor practice of foot self-care. Compliance of medications to avoid complications had the highest awareness (83%) and practice (91%). Avoiding moisturizing between toes had the least awareness (40%) and practice (38%). Awareness was better in 59% of UAE nationals and 74% of postgraduates. Practice was better in 60% of males and 73% of participants with uncontrolled HbA1c. Participants who received prior information had better awareness (55%). Participants receiving information from Dubai Diabetes Centre (DDC) had better awareness (66%) and practice of foot self-care (66%).Conclusions: Almost half of the diabetic patients attending primary healthcare centers in Dubai have limited awareness and practice regarding diabetic foot self-care.

AN APPROACH TO DIAGNOSIS AND MANAGEMENT OF DIABETIC FOOT

2021 ◽  
pp. 21-23
Author(s):  
Anil Kumar ◽  
Md Aiman Khursheed ◽  
Debarshi Jana
Keyword(s):  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Patients ◽  
The West ◽  
Metabolic Complications ◽  
Medical College ◽  
The North ◽  
Foot Complications ◽  
Strict Glycemic Control ◽  
Peripheral Pulse

INTRODUCTION India has the dubious distinction of becoming the diabetic capital of the world within the next few years; with its attendant complications it is going to burden the resources of the country. In the past, the diabetics succumbed to the metabolic complications like ketoacidosis, but now they survive long enough to develop and succumb to the diabetic nephropathy and diabetic foot complications. AIMS AND OBJECTIVES The various predisposing factors for diabetic foot with respect to North Bihar population. To analyse the different ways of clinical presentation of diabetic foot in our hospital. To evaluate the usefulness of surgical management available with special emphasis on strict glycemic control. To determine commonest microorganism/s infecting the diabetic foot patients in the North Bihar Population. MATERIALS AND METHODS Department of General Surgery, DARBHANGA MEDICAL COLLEGE AND HOSPITAL, LAHERIASARAI. Diabetic patients with foot ulcers admitted in this hospital, according to the WHO criteria, were selected for this study for 1 Year 8 month (April 2019 to December 2020). RESULTS AND ANALYSIS We found peripheral Pulse of 37.9% of the patients was absent. Infection was present in 86.2% of the cases which was signicantly higher (Z=10.23;p<0.0001). Ulcers were mostly at dorsum (22.4%) (Z=1.58;p=0.11) followed by fore foot (13.8%) and great toe (13.8%). Ulcers were mostly right sided (67.2%) followed by left sided (31.0%) (Z=5.12;p<0.001). Only 1(1.7%) patients had bilateral infection. CONCLUSION The prevalence of risk factors for foot ulcer and infections, viz., neuropathy and vasculopathy, are different from the Western literature. Studies from India, suggest predominantly neuropathic ulcers unlike the West where neuroischemia is the most important predisposing factor.As compared to the West, which have predominant Gram-positive infections, centers throughout India have reported a consistent Gramnegative bacterial preponderance in DFI.

scholarly journals The analysis for time of referral to a medical center among patients with diabetic foot infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cheng-Wei Lin ◽  
Hui-Mei Yang ◽  
Shih-Yuan Hung ◽  
I-Wen Chen ◽  
Yu-Yao Huang
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Poor Prognosis ◽  
Medical Center ◽  
Comprehensive Treatment ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Diabetic Foot Infection ◽  
The Impact

Abstract Background Diabetic foot infection (DFI) is a limb- and life-threatening complication for diabetic patients needing immediate and comprehensive treatment. Early referral of DFI patients to a diabetic foot center is recommended but there appears limited validated evidence, with the association between referral time and clinical outcomes of limb- preservation or in-hospital mortality still lacking. Methods This retrospective research studied consecutive type 2 diabetic patients with DFI treated at the major diabetic foot center in Taiwan from 2014 to 2017. Six hundred and sixty-eight patients presented with limb-threatening DFI. After stratifying their referral days into quartiles, the demographic information and clinical outcomes were analyzed. Results One hundred and seventy-two patients were placed in the first quartile (Q1) with less than 9 days of referral time; 164 in the second quartile (Q2) with 9-21 days; 167 in the third quartile (Q3) with 21-59 days; and 165 in the fourth quartile (Q4) with >59 days. End-stage renal disease (ESRD), major adverse cardiac events (MACE) and peripheral arterial disease (PAD) were noted as being higher in the Q4 group compared with the Q1 group (25.45% vs 20.35% in ESRD, 47.27% vs 26.16% in MACE and 78.79% vs 52.33% in PAD respectively). The Q1 group had more patients presenting with systemic inflammatory responsive syndrome (SIRS) (29.07% in Q1 vs 25.45% in Q4 respectively, P=0.019). Regarding poor outcome (major lower-extremity amputation (LEA) or in-hospital mortality), the Q4 group had 21.21% of patients in this category and the Q1 group had 10.47%. The odds ratio of each increased referral day on poor prognosis was 1.006 with 95% confidence interval 1.003–1.010 (P=<0.001). In subgroups, the impact on poor prognosis by day was most obvious in patients with SIRS (OR 1.011, 95% CI 1.004–1.018, P=0.003) and those with PAD (OR 1.004, 95% CI 1.001–1.008, P=0.028). Conclusions The deferred referral of DFI patients to the diabetic foot center might be associated with poor treatment outcome either in major LEA or mortality, particularly in patients with SIRS or PAD. Both physician and patient awareness of disease severity and overcoming the referral barrier is suggested. Trial registration Not applicable.

scholarly journals An overview of the National Health Insurance and its possible impact on eye healthcare services in South Africa

2015 ◽  
Vol 74 (1) ◽  
Author(s):  
H. Lawrence Sithole
Keyword(s):  
South Africa ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Public Healthcare ◽  
Health Coverage ◽  
Care Providers ◽  
Eye Care

The National Health Insurance (NHI) is an important development that underpins democracy in South Africa. It aims to redress the inequities of public healthcare delivery by implementing transformational policies towards establishing inclusive public healthcare coverage for the entire population of South Africa, with more emphasis on health promotion. The implementation of this initiative has created some hope amongst primary eye healthcare professionals, such as optometrists, that their profession may finally be given the recognition it deserves. Although the government is contemplating introducing a new directorate for eye healthcare and forming an advisory committee on eye healthcare reporting to the Minister of Health, the extent to which eye healthcare will be incorporated into the NHI is currently not clear. It is believed that the white paper on the NHI will shed some light on these issues. Unfortunately, current indications are that the initiative has serious challenges to overcome such as poor infrastructure, budgetary constraints and lack of interest from other healthcare professionals. Furthermore, corruption issues may also need to be addressed if the NHI is to be implemented successfully. Nevertheless, the NHI remains a positive proposition for universal health coverage for the people of South Africa, and there is hope that primary eye care providers, such as optometrists and other eye care professionals, will also play a greater role in the NHI than they currently do in the public healthcare system.

scholarly journals Diabetic Foot Ulcers in a Kenyan Referral and Teaching Hospital: Risk Factors, Patient Characteristics and Clinical Outcomes

2019 ◽  
Vol 1 (2) ◽  
pp. 41-51
Author(s):  
Daniel Munyambu Mutonga ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Urban Areas ◽  
Hospital Admissions ◽  
Uncontrolled Hypertension ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Elevated Systolic Blood Pressure

Introduction: The burden of diabetes mellitus (DM) is increasing in resource-poor settings leading to a rise in diabetic complications. Foot complications result in almost half of all hospital admissions among diabetic patients and may result in amputations or death. Objective: To investigate the sociodemographic, clinic-laboratory characteristics and clinical outcomes of patients with diabetic foot ulcers (DFU) in a clinical setting. Materials and Methods: A cross-sectional study of 84 adult consecutive inpatients and outpatients at Kenyatta National Hospital (KNH) with any type of DM and having active DFU was conducted over 12 months. History and physical examinations findings were recorded through a structured questionnaire. Relevant data on the most recent blood tests and clinical outcomes for patients with foot ulcers were retrieved from the patients’ medical notes and analysed. Results: Majority (68%) were inpatients. The mean age was 60.30 years with 68% living in urban areas and 60% having minimal or no formal education. 8% were newly diagnosed with DM. The median duration of DM was 6.5 years. A majority (96%) had type 2 diabetes mellitus (T2DM). 45% were on insulin only, 18% on oral drugs only and 32% on a combination of both. The median random blood sugar was 9.60 mmol/L and glycated haemoglobin was 8.80%. Although 61% of patients had co-morbid hypertension, only about 40% had elevated systolic blood pressure (BP) while 23% had elevated diastolic pressures. A majority of the patients had good lipid profile, 85% with desirable total cholesterol and 70% having ideal low-density lipoproteins. The mortality rate among patients with DFU was 11%. Conclusion: There are poor outcomes for patients with DFU in this setting such as poor wound healing, high recurrence rates, increased amputations and mortality compared to previous studies. However, the prevalence of uncontrolled hypertension, dyslipidaemia and neuropathy was much lower than earlier local reports.

scholarly journals Evaluation of the Complementary Health Provision of the Podiatric Foot Care Program for Diabetic Patients in Catalonia (Spain)

2021 ◽  
Vol 18 (10) ◽  
pp. 5093
Author(s):  
Jessica Ruiz-Toledo ◽  
Antonio J. Zalacain-Vicuña ◽  
Elena de de Planell-Mas
Keyword(s):  
Diabetic Foot ◽  
Health Program ◽  
National Health System ◽  
Care Program ◽  
Diagnosis And Treatment ◽  
Diabetic Patients ◽  
Coding System ◽  
Foot Care ◽  
Foot Health ◽  
Number Of Patients

The Catalan diabetic foot health program was established in 2009 in order to prevent complications caused by type 2 diabetes. This study aims to describe its application from 2009 to 2018. The objective was to describe diabetic foot care provision in the National Health System of Catalonia between 2009 and 2018, including the number of patients and professionals involved, the causes behind patients’ visits, and the most demanded codes for diagnosis and treatment filled by the podiatrist in each consultation during 2018–2020. This description was addressed through an analysis of the database provided by the Association of Podiatrists to evaluate the implementation of the program. The results for the diabetic foot health program in Catalonia showed a growth in demand from 2009 (1,726) to 2018 (213,095) in terms of visits and from 2009 (1,541) to 2018 (104,629) in terms of patients. The number of registered podiatrists from 2009 to 2018 increased from 165 to 470. The most commonly used diagnosis codes were (a) without sensory alterations in control and treatment of grade 1 lesions; (b) grade 0 without neuropathic, vascular, structural, or biomechanical alteration; (c) no sensory structural alterations in the foot; (d) keratopathies. The treatments most commonly used were (a) conservative (chiropody), (b) without ortho-podiatric treatment, and (c) plantar supports. The conclusions show that the health program is in great demand amongst the population. Similarly, the coding system has made it possible to identify the diagnosis and treatment of such demand.

scholarly journals Financial burden of diabetic foot ulcers to world: a progressive topic to discuss always

2017 ◽  
Vol 9 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Alok Raghav ◽  
Zeeshan Ahmad Khan ◽  
Rajendra Kumar Labala ◽  
Jamal Ahmad ◽  
Saba Noor ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Developing Countries ◽  
Diabetic Foot ◽  
Social Impact ◽  
Financial Burden ◽  
Developed Countries ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Diabetic Foot Ulcers ◽  
Foot Complications

Diabetic foot complications are the most common occurring problems throughout the globe, resulting in devastating economic crises for the patients, families and society. Diabetic foot ulcers (DFUs) have a neuropathic origin with a progressive prevalence rate in developing countries compared with developed countries among diabetes mellitus patients. Diabetic patients that are of greatest risk of ulcers may easily be diagnosed with foot examination. Economic burden may be carefully examined. The budget costing must include both the clinical and social impact of the patients.

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