|Year : 2022 | Volume
| Issue : 1 | Page : 17-21
Foot care practices among patients with diabetes mellitus in South-Western Nigeria
Taoreed Adegoke Azeez, Martins Ehizode Emuze
Department of Medicine, Endocrinology Unit, University College Hospital, Ibadan, Nigeria
|Date of Submission||05-Jan-2021|
|Date of Decision||19-May-2021|
|Date of Acceptance||05-Jun-2021|
|Date of Web Publication||06-Jan-2022|
Dr. Taoreed Adegoke Azeez
Department of Medicine, Endocrinology Unit, University College Hospital, Ibadan
Source of Support: None, Conflict of Interest: None
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 Jan 24];10:17-21. Available from: https://www.ajim.in/text.asp?2022/10/1/17/335078
| Introduction|| |
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. 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. According to the International Diabetes Federation, about 80% of adults living with diabetes live in low- and middle-income countries. The prevalence of diabetes in Nigeria is 5.77%. Foot care education and standard practice are integral components of an efficient and effective diabetes management. 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%.
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. 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.
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. 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.
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. [Table 1] shows the risk categories and the recommended lines of actions.
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.
- To identify the frequency of the yearly comprehensive foot examination among patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria
- To determine the frequency of daily foot inspection by patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria
- To evaluate the attitude of patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria towards foot education
- To assess footwear practices among patients with diabetes mellitus attending a tertiary health facility in South-Western Nigeria
- 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|| |
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|| |
[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.
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.
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.
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|| |
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. Poor clinic attendance was due to financial constraints as most of the patients pay for consultation out of pocket.,, 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.,,
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. 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. Another study in Iran reported that the majority (62%) of the participants with diabetes practiced daily foot inspection. In contrast, a Nigerian study reported that a much lower (34%) percentage of the respondents practiced daily foot inspection. 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. 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.,,, 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.
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. 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. 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.
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., The explanation for this is that educated individuals tend to earn more and make timely and appropriate decisions on their health. 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|| |
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.
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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Diabetes Canada Clinical Practice Guidelines Expert Committee; Punthakee Z, Goldenberg R, Katz P. Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Can J Diabetes 2018;42 Suppl 1:S10-5.
Uloko AE, Musa BM, Ramalan MA, Gezawa ID, Puepet FH, Uloko AT, et al
. Prevalence and risk factors for diabetes mellitus in Nigeria: A systematic review and meta-analysis. Diabetes Ther 2018;9:1307-16.
McInnes A, Jeffcoate W, Vileikyte L, Game F, Lucas K, Higson N, et al.
Foot care education in patients with diabetes at low risk of complications: A consensus statement. Diabet Med 2011;28:162-7.
Odusan O, AMoran OE, Salami O. Prevalence and patterns of diabetic foot ulcers among adults with diabetes mellitus in a secondary health facility in Lagos, Nigeria. Ann Health Res 2017;3:70.
Mayfield JA, Reiber GE, Sanders LJ, Janisse D, Pogach LM; American Diabetes Association. Preventive foot care in people with diabetes. Diabetes Care 2003;26 Suppl 1:S78-9.
Al-Rubeaan K, Al Derwish M, Ouizi S, Youssef AM, Subhani SN, Ibrahim HM, et al.
Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS One 2015;10:e0124446.
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Bowering K, Embil JM. Foot care. Can J Diabetes 2013;37 Suppl 1:S145-9.
Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al.
Comprehensive foot examination and risk assessment: A report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 2008;31:1679-85.
Chiwanga FS, Njelekela MA. Diabetic foot: Prevalence, knowledge, and foot self-care practices among diabetic patients in Dar es Salaam, Tanzania – A cross-sectional study. J Foot Ankle Res 2015;8:20.
Lee RR, Samsudin MI, Thirumoorthy T, Low LL, Kwan YH. Factors affecting follow-up non-attendance in patients with Type 2 diabetes mellitus and hypertension: A systematic review. Singapore Med J 2019;60:216-23.
Okoronkwo IL, Ekpemiro JN, Okwor EU, Okpala PU, Adeyemo FO. Economic burden and catastrophic cost among people living with Type 2 diabetes mellitus attending a tertiary health institution in south-east zone, Nigeria. BMC Res Notes 2015;8:527.
Bahadori M, Teymourzadeh E, Ravangard R, Raadabadi M. Factors affecting the overcrowding in outpatient healthcare. J Educ Health Promot 2017;6:21.
Fasanmade OA, Dagogo-Jack S. Diabetes care in Nigeria. Ann Glob Health 2015;81:821-9.
Pollock RD, Unwin NC, Connolly V. Knowledge and practice of foot care in people with diabetes. Diabetes Res Clin Pract 2004;64:117-22.
Saurabh S, Sarkar S, Selvaraj K, Kar SS, Kumar SG, Roy G. Effectiveness of foot care education among people with Type 2 diabetes in rural Puducherry, India. Indian J Endocrinol Metab 2014;18:106-10.
Khamseh ME, Vatankhah N, Baradaran HR. Knowledge and practice of foot care in Iranian people with Type 2 diabetes. Int Wound J 2007;4:298-302.
Desalu OO, Salawu FK, Jimoh AK, Adekoya AO, Busari OA, Olokoba AB. Diabetic foot care: Self reported knowledge and practice among patients attending three tertiary hospital in Nigeria. Ghana Med J 2011;45:60-5.
Okpe I, Ugwu E, Adeleye O, Gezawa I, Enamino M, Ezeani I. Foot care education, health seeking behaviour and disease outcomes in patients with diabetic foot ulcer: Results from the multi-centre evaluation of diabetic foot ulcer in Nigerian study. Int J Foot Ankle 2019;3:038.
Unachukwu C, Babatunde S, Ihekwaba AE. Diabetes, hand and/or foot ulcers: A cross-sectional hospital-based study in Port Harcourt, Nigeria. Diabetes Res Clin Pract 2007;75:148-52.
Edo AE, Edo GO, Ezeani IU. Risk factors, ulcer grade and management outcome of diabetic foot ulcers in a Tropical Tertiary Care Hospital. Niger Med J 2013;54:59-63.
] [Full text]
Anumah FO, Mshelia-Reng R, Abubakar A, Sough T, Asudo F, et al.
Management outcome of diabetic foot ulcers in a teaching hospital in Abuja, Nigeria. J Diabet Complications 2017;9:15-20.
Gayle KA, Tulloch Reid MK, Younger NO, Francis DK, McFarlane SR, Wright-Pascoe RA, et al.
Foot care and footwear practices among patients attending a specialist diabetes clinic in Jamaica. Clin Pract 2012;2:e85.
Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria. World J Diabetes 2019;10:200-11.
Seid A, Tsige Y. Knowledge, practice and barriers of foot care among diabetic patients attending Felege Hiwot referral hospital, Bahir Dar, Northwest Ethiopia. Adv Nurs 2015;Volume 2015:934623.
Abidin SI, Sutan R, Shanssudin K. Prevalence and determinants of appropriate health seeking behaviour among known diabetics: Results from a community based survey. Adv Epidemiol 2014;Volume 2014:793286.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]