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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 17-21

Foot care practices among patients with diabetes mellitus in South-Western Nigeria


Department of Medicine, Endocrinology Unit, University College Hospital, Ibadan, Nigeria

Date of Submission05-Jan-2021
Date of Decision19-May-2021
Date of Acceptance05-Jun-2021
Date of Web Publication06-Jan-2022

Correspondence Address:
Dr. Taoreed Adegoke Azeez
Department of Medicine, Endocrinology Unit, University College Hospital, Ibadan
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajim.ajim_2_21

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  Abstract 


Introduction: Diabetes foot care is an evidence-based means of preventing diabetes foot ulcer. The components of diabetic foot care include yearly comprehensive foot examination, prompt identification of risk factors to diabetic foot ulcer, diabetes foot education, and standard footwear practices. This study is aimed at evaluating the foot care practices of patients with diabetes in a tertiary hospital in South-Western Nigeria. Methods: It is a cross-sectional study that employed standardized pretested structured questionnaire to obtain data from 100 participants. The study was conducted at the diabetes clinic of a tertiary hospital in South-Western Nigeria. Ethical approval was obtained from the Institutional Review Board of the hospital. Data were presented in tables and charts. Descriptive and analytical statistics was done with Statistical Package for the Social Sciences (SPSS) version 22. Results: The mean age of the participants was 58.8 ± 11.8 years. There were 66 females and 34 males. The study showed that 77% of the participants were not having yearly comprehensive examination although 94% of the respondents did daily foot inspection at home. Only 16% had continuous foot education. Moreover, only 11% of the respondents wear recommended shoes, but 88% inspected their shoes before wearing them. Sadly, 11% of the respondents walked barefooted at home. The health-seeking behavior of respondents in an event of foot ulceration was significantly associated with their educational status. Conclusion: Foot care practices of the respondents were sub-standard. So, there is an urgent need to reinforce foot care education so as to improve these subpar practices.

Keywords: Diabetes care in South-Western Nigeria, diabetes mellitus, foot care education, foot care practices


How to cite this article:
Azeez TA, Emuze ME. Foot care practices among patients with diabetes mellitus in South-Western Nigeria. APIK J Int Med 2022;10:17-21

How to cite this URL:
Azeez TA, Emuze ME. Foot care practices among patients with diabetes mellitus in South-Western Nigeria. APIK J Int Med [serial online] 2022 [cited 2022 Jul 1];10:17-21. Available from: https://www.ajim.in/text.asp?2022/10/1/17/335078




  Introduction Top


Diabetes mellitus is a heterogeneous group of metabolic disorders of carbohydrate, lipids, and protein characterized by chronic hyperglycemia due to a defect in insulin secretion, insulin action or a variable mixture of both.[1] According to the World Health Organization (WHO), over 400 million people have diabetes globally, and over 1 million individuals die each year from causes directly attributable to diabetes mellitus.[2] According to the International Diabetes Federation, about 80% of adults living with diabetes live in low- and middle-income countries.[3] The prevalence of diabetes in Nigeria is 5.77%.[4] Foot care education and standard practice are integral components of an efficient and effective diabetes management.[5] In a study done in Nigeria, the prevalence of diabetic foot ulcer among patients attending the diabetes clinic of a secondary level hospital was 17.3%.[6]

The American Diabetes Association has stated categorically that foot ulceration and amputation contribute significantly to morbidity and cost of care in individuals living with diabetes mellitus.[7] Therefore, standard diabetes foot care practices are the best means to prevent foot ulceration and to promptly recognize risk factors so as to manage the risk factors appropriately and timely. These risk factors include peripheral neuropathy, lower extremity arterial disease, poor glycemic control, retinopathy, nephropathy, and foot deformities.[8]

Recommended foot care practices include regular foot examination (with at least yearly physician-conducted comprehensive foot examination), evaluation of the risk factors for ulceration/amputation, regular podiatric care (including callus debridement), patient education, professionally recommended footwear, and early detection and prompt treatment of diabetic foot ulcer.[9] Individuals with one or more identifiable risk factors for foot ulceration should undergo more frequent reviews to address the identified risk factors and detect other risk factors on time.[7]

The components of a comprehensive foot examination include taking a relevant history, general inspection (dermatological and musculoskeletal assessment), neurological assessment (10-g monofilament testing, 128 Hz tuning forks testing, pinprick sensation, ankle reflexes testing, and vibration perception threshold testing), and vascular assessment. Risk factors assessment should be followed by risk categorization.[10] [Table 1] shows the risk categories and the recommended lines of actions.[10]
Table 1: Risk categorization in diabetic foot care

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Aim

This study aims to evaluate the degree of foot care practice among patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria.

Objectives

  1. To identify the frequency of the yearly comprehensive foot examination among patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria
  2. To determine the frequency of daily foot inspection by patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria
  3. To evaluate the attitude of patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria towards foot education
  4. To assess footwear practices among patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria
  5. To determine the health-seeking behavior of patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria following a foot injury/ulceration.



  Methods Top


It was a cross-sectional study, and 100 participants were recruited consecutively after informed consent had been obtained. The study was carried out at the Diabetes clinic of University College Hospital, Ibadan, Nigeria. The University College Hospital is located in the South-Western part of the country, and patients are referred to the hospital from all the six states in the South-Western geopolitical zone of Nigeria. South-Western Nigeria is predominantly populated by the Yoruba Socio ethnic Group. One hundred patients with previously diagnosed diabetes were recruited into the study. Ethical clearance for the study was given by the Joint University of Ibadan/University College Hospital Institutional Review Board. Data were obtained using pretested structured questionnaires, which were administered by the attending physicians. The questions were to be answered with a “YES” or “NO.” Data as analyzed using Statistical Package for the Social Sciences (SPSS) version 22 IBM (Chicago, Illinois, United States) and are presented as tables and charts. The association between categorical variables was determined using Chi-square. Statistical significance was inferred when P < 0.05.


  Results Top


[Table 2] shows the sociodemographic characteristics of the participants. The mean age of the participants was 58.8 ± 11.8 years. The respondents are predominantly females, married, self-employed, Christians, and of Yoruba ethnic group.
Table 2: Sociodemographic characteristics of the respondents

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As shown in [Figure 1], 77% of the participants were not having yearly comprehensive examination. In contrast, as shown in [Figure 2], the vast majority (94%) of the respondents do daily foot inspection at home. Despite that foot education is supposedly a continuous process, [Figure 3] shows that only 16% of the respondents have had foot education by the trained health educators on more than one occasion. However, [Figure 4] shows that almost all the respondents agreed that continuous foot education is beneficial.
Figure 1: Frequency of yearly comprehensive foot examination

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Figure 2: Frequency of daily foot self-inspection

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Figure 3: Consultation with the food educator on more than 1 occasion

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Figure 4: Do you need to have continuous foot education?

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The footwear practices of the respondents are summarized in [Table 3]. The majority of the respondents do not wear recommended shoes, but whatever they wear, they ensure the shoes are carefully inspected before wearing them. Of a serious concern is the 11% of the respondents who walk barefooted at home. Twenty-three percent of the respondents stated that they would not be present in the health facility if they develop mild to moderate foot injury or ulceration.
Table 3: Footwear practices among patients with diabetes mellitus

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There was a statistically significant association between the health-seeking behavior of the respondents following mild-to-moderate foot injury or ulceration and their educational status (P = 0.024; χ2 = 9.43). However, there was no statistically significant association between the health-seeking behavior of the respondents following mild to moderate foot injury or ulceration and their level of annual income (P = 0.49; χ2 = 4.42). Furthermore, there was no statistically significant association between gender and the health-seeking behavior of the respondents following mild to moderate foot injury or ulceration (P = 0.68; χ2 = 0.169)


  Discussion Top


This study showed that about 4 out of every 5 patients with diabetes did not have yearly comprehensive foot examination. A similar study done in Tanzania also reported that about 3–4 out of every 5 patients with diabetes did not have a yearly comprehensive foot examination after the first visit in the hospital.[11] Poor clinic attendance was due to financial constraints as most of the patients pay for consultation out of pocket.[11],[12],[13] It has also been documented that the physicians tend to pay a closer attention at the first visit but may not have the ample time to do that again due to the congested clinics, as there are fewer physicians to patients.[11],[14],[15]

A vast majority of the patients (94%) did daily self-inspection of their feet, according to the findings of this study. Pollock et al. reported a similar finding in their study where 82% of the patients with diabetes did foot inspection daily.[16] Although lower than the finding in this study, Saurabh et al., working in India, documented that over 50% of the cohort of patients with diabetes in their study practiced daily foot inspection.[17] Another study in Iran reported that the majority (62%) of the participants with diabetes practiced daily foot inspection.[18] In contrast, a Nigerian study reported that a much lower (34%) percentage of the respondents practiced daily foot inspection.[19] In the Nigerian study, about 38% of the patients also inspected their footwear before wearing compared with 88% in this study. These differences in foot and footwear inspection may be due to the differences in the emphasis on inspection by the foot educators as patients tend to remember only things that are repeatedly emphasized.

In this study, it was also found out that despite that 96% of the patients with diabetes recognized the need for continuous foot care education, only 14% of the respondents have consulted the health/foot educators on more than 1 occasion. A previous multicentric study done in Nigeria also documented that only 25.9% of the participants have had foot care education prior to the study.[20] Okpe has suggested that poor foot care education is a common finding among Nigerian patients in different studies, and this calls for a major concern.[20],[21],[22],[23] Patients may not want to pay foot care consultation separately having already seen the physician. Furthermore, some tend to believe that as adults, they would be able to take care of their feet hence no need to seek continuous foot education.[19]

This study showed that 11% of the respondents wore recommended footwear. This is in keeping with the findings of a study that reported that only 13% of the subjects in the study wore specialist-recommended footwear.[24] This may be due to the lack of podiatrist at the health facility where the study was conducted. Ugwu et al. also corroborated this by reporting that there is paucity of podiatrists in Nigeria, and this may be affecting the initiation and adherence of appropriate footwear by patients with diabetes.[25] Moreover, 11% of the respondents also walked barefooted at home. This is in keeping with the findings of a study done in Ethiopia, which reported that about 16% of the patients with diabetes in their study walked barefooted at home regularly.[26]

There was a significant association between health-seeking behavior of the respondents and their educational status. Abidin et al. as well as Seid and Tsige working in different countries, also reported that health-seeking behavior of patients with diabetes, as regards foot injury, was significantly associated with educational status.[26],[27] The explanation for this is that educated individuals tend to earn more and make timely and appropriate decisions on their health.[26] However, foot care-seeking behavior, in the advent of a mild-to-moderate injury or ulceration of the foot, was not significantly associated with the annual income and gender.


  Conclusion Top


Foot care practices are largely suboptimal among Nigerian patients with diabetes. Yearly comprehensive foot examination is not being practiced, and consultation with the diabetic care educators on more than 1 occasion was an uncommon practice among patients with diabetes in Nigeria. Footwear practices are also short of the standard recommendations. There is an urgent need to improve foot care education and practices among patients with diabetes in Nigeria so as to alleviate the burden of diabetic foot disease.

Limitations of the study

The sample size was small and may not fully represent what is obtainable in the general diabetic population. In addition, it was a hospital-based study and may not reflect the true picture of foot care practices among people living with diabetes in the community.

Consent for publication

The authors hereby give the journal the consent to publish the article.

Declaration

Ethical approval and consent to participate: Ethical approval for the study was obtained from the Joint University of Ibadan/University College Hospital Institutional Review Board.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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