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 ∼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%).

Keywords

diabetic foot disease prevalence amputation

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References

Nathan DM. Long term complications of diabetes mellitus. N Engl J Med 1993;328: 1676-1685.

The Editorial Board of the International Working Group on the Diabetic Foot . International Consensus of the diabetic foot. Brussels: The International Working Group on the Diabetic Foot; 1999.

Wolfgang G , Lander T , Leese B , Songer T , Williams R. The economics of diabetes and diabetes care. A report of the Diabetes Health Economics Study Group. Belgium: Diabetes Health Economics Study Group.

De P , Scarpello JHB. What is the evidence for effective treatment of diabetic foot ulceration? Pract Diabetes Int 1999;16: 179-180.

Lester FT. Ketoacidosis in Ethiopian diabetics. Diabetologia 1980;18: 375-377.

Reiber GE , Lipsky BA , Gibbons GW. The burden of diabetic foot ulcers. Am J Surg 1998;176: 5S-10S.

McLigeyo SO , Oumah S , Otieno A , and Saul L. Diabetic ulcers—a clinical and bacteriological study. West Afr J Med 1990;9: 135-138.

Dagogo JS. Pattern of diabetes foot ulcer in Port Harcourt, Nigeria. Pract Diabetes Digest 1991;2: 75-80.

Ehusani FE , Giwa SO , Ohwovoriole AE. Retrospective study of diabetic foot lesions in Lagos. Nigerian J Intern Med 1999;2: 10-12.

10.

Novartis Pharma AG. FDA approves Apligraf for treatment of diabetic foot ulcers. Available from: http://www.docguide.com.

11.

Apelqvist J , Ragnarson-Tennvall G , Larsson J , Paersson U. Long term costs for foot ulcers in diabetic patients in a multidisciplinary setting. Foot Ankle Int 1995;16: 388-394.

12.

Chale SS , Swai AB , Mujinja PG , McLarty DG. Must diabetes be a fatal disease in Africa? Study of costs of treatment. Br Med J 1992;304: 1215-1218.

13.

Chale SS , McLarty DG. The economics of diabetes care: Africa. In: Alberti KGMM , Zimmet P , DeFronzo RA , Keen H , editors. International textbook of diabetes mellitus. 2nd ed. Chichester (UK): Wiley; 1997. p. 1787-1789.

14.

Ghana Health Assessment Project Team . A quantitative method of assessing the health impact of different diseases in less developed countries. Int J Epidemiol 1981;10: 73-80.

15.

Adetuyubi AA. Socio-economic aspects of diabetes mellitus in Nigerians. Trop Geograph Med J 1970;28: 105-168.

16.

Bruno G , LaPorte RE , Merletti F , Biggeri A , McCarty D , Pagano G. National diabetes programs. Application of capture-recapture to count diabetes? Diabetes Care 1994;17: 548-556.

17.

Akanji AO , Adetuyubi A. The pattern of presentation of foot lesions in Nigerian diabetic patients. West Afr J Med 1990;9: 1-5.

18.

Kengne AP , Dzudie AI , Fezeu LL , Mbanya JC. Impact of secondary foot complications on the Inpatient Department of the Diabetes Unit of the Yaounde Central Hospital. Lower Extremity Wounds 2006;5(1): 65-68.

19.

Population Reference Bureau . World population data sheet 2001. Washington (DC): Population Reference Bureau. Available from: www.prb.org.

20.

WHO International Statistical Classification of Diseases and Related Health Problems . Tenth Revision. Geneva: World Health Organization; 1992. p. 1276-1279.

21.

Ahmed MA , Ahmed NH. Hospitalization patterns in Sudan. Diabetes Int 2000;10: 18-19.