Predictors of lower limb amputation in diabetic foot ulcer among adults in Dar-es-salaam regional referral hospitals, Tanzania
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Date
2023-11
Authors
Journal Title
Journal ISSN
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Publisher
Hubert Kairuki Memorial University
Abstract
Background: Risk factors for Lower Extremity Amputation (LEA) in Diabetic Foot Ulcer
(DFU) patients are peripheral arterial disease, peripheral neuropathy, uncontrolled blood
glucose level, and a history of diabetic foot ulcers or amputations. However, DFU is the
main cause of prolonged hospital stays because of late presentation, but the prognosis of
the patients will be good if the problem is identified early and optimal treatment is
initiated.
Objectives: To determine the predictors of LEA in DFU among adults in Dar-es-Salaam
RRH, Tanzania.
Methods: An observational prospective hospital-based study was conducted in Amana,
Mwananyamala, and Temeke in Dar-es-Salaam (RRH), Tanzania. Between February 2023
and July 2023, patients' details and data were collected using a questionnaire form from
each participant who was admitted with a diagnosis of DFU. Written informed consent
was sought from all patients who were eligible for the study before including them in the
study. A total of 195 adult patients with DFUs were included in this study. Logistic
regression was used to evaluate the associations between risk factors and amputation.
Results: The study recruited and followed up on 195 adult diabetics. The median age
was 53 (IQR: 47–57) years, with female preponderance (54.9%). The median random
blood glucose level (mmol/L) of participants was 15 (IQR: 12–18) mmol/L, with a median
duration since diabetes mellitus diagnosis of 7 (IQR: 3–10) years. About three-fifths
(59.5%) of study participants ended up with LEA. Post-tibial artery pulse (A.O.R.: 0.01,
95% C.I.: 0.00–0.021), dorsalis pedis artery pulse (A.O.R.: 0.005, 95% C.I.: 0.001
0.045), as well as the Ipswich test (A.O.R.: 0.001, 95% C.I.: 0.000–0.342) were
significant factors associated with lower extremity amputation. More than half (55.9%) of
study participants had Wagner-grade 4- or 5-foot ulcers. Dorsalis pedis artery pulse had
an almost perfect negative correlation with LEA (r =-0.928, p = 0.000).
Conclusion: Amputation rates were high in this study population. On average, most
study participants were in the 4th grade Wagner classification. Undetectable of Ipswich
tests, absence of posterior tibia artery pulse and absence dorsalis pedis artery pulse were
significant risk factors associated with amputation in this study population.
Recommendations: Glycaemic control strategies need to be emphasized in order to
achieve wound healing and reduce the amputation rate among adult diabetic foot ulcers
in Dar-es-Salaam.
Description
A Dissertation Submitted in Partial Fulfillment of the
Requirements for the Award of the Degree of Master of
Medicine in General Surgery of Hubert Kairuki Memorial
University
Keywords
Diabetic foot ulcer, Risk Factor, Dar es salaam Tanzania
Citation
Salim,K.R.,2023.Predictors of lower limb amputation in diabetic foot ulcer among adults in Dar-es-salaam regional referral hospitals, Tanzania.HKMU