An Assessment of the Disease Burden of Foot Ulcers in Patients With Diabetes Mellitus Attending a Teaching Hospital in Lagos, Nigeria

Abstract

The major part of the burden of people with diabetes mellitus (DM) is their impaired quantity and quality of life. This is due to acute and chronic complications of which diabetic foot ulceration (DFU) takes the greatest toll. Most studies on the disease burden of DFU were carried out in developed countries, and to date, no indigenous study has addressed the burden of foot ulceration in Nigerians with DM. This study attempted to determine the disease burden of this important DM complication. The study was carried out at the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. The working definition of disease burden encompassed prevalence, morbidity, mortality, and the direct economic costs of diabetes mellitus foot syndrome (DMFS). For determination of the estimates of prevalence, the "capture-recapture" and intensive case-counting methods were used, mortality and morbidity were determined from records of admissions, and associated deaths over a 3-year period (1998-2000). The direct economic costs of foot ulceration were derived from the costs incurred from in-patient days, tests, drugs/medications, surgery, and other miscellaneous units of services. The total number of people with DM seen in LUTH from 1998 to 2000 was 1500, the hospital prevalence of DFU using the capture-recapture method being 9.5%. A total of 7253 medical admissions were made in this 3-year period, and of this number 827 (11.4%) were DM related. DFU-related admissions were 97 in number, and this made up 1.3% and 11.7% of the total medical and diabetes admissions, respectively. During this period, a total of 61 lower limb amputations were carried out and 26 (42.6%) of these were DM related. The proportion of medical deaths due to DMFS deaths was greater than the proportion of medical admissions due to DFU (P = .007). The case fatality of individuals with DFU was approximately 53%. A total number of 20 patients with DM foot ulcers were hospitalized during a 1-year period of the study (2003-2004). The majority had type 2 DM. A large majority (65%) of these patients had some form of surgery in addition to medical management of their condition. Mean costs for successfully treating a patient with DMFS was Nigerian Naira (NGN) 180,581.60. The total costs incurred ranged from NGN 20,400.00 to NGN 278,029.00. Drugs or medications accounted for the majority of the total costs incurred by the patients (46.9%).

Cost of Illness of Diabetic Foot Ulcer in a Resource Limited Setting: A Study from Northwestern Nigeria

“…Also a review of studies from these developing countries show variation in the cost spent on managing diabetic foot with no homogeneity unlike what was obtained in developed nations [19]. The cost obtained from this study was however higher than what was found in a similar study done in Lagos, Southwestern Nigeria in 2006 where the total cost of illness of diabetic foot ulcer was estimated at 180,581.60 Nigerian naira or $1003.26 [20]. The higher cost from our study could be attributed to inflation that has being rising over the years and it could also be attributed to improvement in the health care system with use of high tech machines for diagnosis and treatment which will cost more.…”

“…The estimated cost from our study is much lower than what was found in advanced countries like the United States. Holzer et al in 1998 estimated the [20]. Harrington in 2000 from his study also found that 73.7% of the total cost of illness was attributable to direct cost of illness [23].…”

Prevalence of diabetic foot ulceration and associated risk factors: an old and still major public health problem in Khartoum, Sudan?

“…This due to the fact, that these variables are present in high levels in non-diabetic ulcer foot group. Several studies have shown association between diabetic foot and hypertension, albuminuria, retinopathy, neuropathy, HbA1c, cholesterol, HDL, LDL and triglyceride (8,(11)(12)(13)(14)(15)(16). Peripheral vascular disease is another important contributor in pathogenesis of diabetic foot, and prevalence of peripheral vascular disease in Sudan in 1989 was estimated to be 6.2% and this increased to 10% in 1995 (18,20).…”

“…Increase in prevalence of diabetes complications in Africa was attributed to rise in financial health expenditure, poor medical facility and lack of adequate diabetes service in urban and rural areas (9,10). The prevalence of diabetic foot in Cameroon, Nigeria and Tanzania were estimated to be 13%, 9.5% and 15% respectively (11)(12)(13). The cost associated with diabetic foot is enormous.…”

Diabetic foot care: Self reported knowledge and practice among patients attending three tertiary hospital in Nigeria

“…The prevalence of diabetic foot ulcer (DFU) ranged between 1.0% and 4.1% in the United States (US), 4.6% in Kenya, and 20.4% in Netherlands. 5,6,7 Hospital-based studies demonstrated that the prevalence of limb ulceration were between 11.7% and 19.1% among individuals with diabetes in Nigeria. 8,9 The prevalence of DFU among hospitalized patients with diabetes in Iran was 20%.…”