Kampala International University, Western Campus, Kampala, Uganda.
Mengo Hospital, Kampala, Uganda.
BMC Public Health. 2023 Mar 10;23(1):463. doi: 10.1186/s12889-023-15383-7.
Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda.
This was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value < 0.2 at bivariate analysis were considered for multivariate analysis.
The right foot was affected in 47.9% (n = 56) of patients, 44.4% (n = 52) had the DFU on the plantar region of the foot and 47.9% (n = 56) had an ulcer of > 5 cm in diameter. The majority (50.4%, n = 59) of patients had one ulcer. 59.8% (n = 69) had severe DFU, 61.5% (n = 72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p = 0.011) and secondary (p < 0.001) school educational levels, moderate (p = 0.003) and severe visual loss (p = 0.011), 2 ulcers on one foot (p = 0.011), and eating vegetables regularly were protective against developing severe DFU (p = 0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p < 0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5-10 cm (p = 0.047) and in those with > 10 cm diameter (p = 0.002), respectively.
Most DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of > 5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.
糖尿病足溃疡（DFU）是糖尿病的一种严重并发症，与死亡率、发病率、截肢率和经济负担增加有关。本研究旨在确定乌干达 DFU 的解剖分布和严重程度相关因素。
这是一项多中心横断面研究，在乌干达的 7 家选定的转诊医院进行。2021 年 11 月至 2022 年 1 月期间，共有 117 例 DFU 患者纳入本研究。采用 95%置信区间进行描述性分析和修正泊松回归分析；在单变量分析中 p 值<0.2 的因素被认为是多变量分析的因素。
右脚受累占 47.9%（n=56），44.4%（n=52）足部跖侧有 DFU，47.9%（n=56）溃疡直径>5cm。大多数患者（50.4%，n=59）有一个溃疡。59.8%（n=69）有严重的 DFU，61.5%（n=72）为女性，76.9%的患者血糖控制不佳。平均年龄为 57.5 岁（标准差 15.2 岁）。小学（p=0.011）和中学（p<0.001）教育程度、中度（p=0.003）和重度视力丧失（p=0.011）、一只脚上有 2 个溃疡（p=0.011）以及定期吃蔬菜是预防严重 DFU 的保护因素（p=0.03）。DFU 患者轻度和中度神经病变的严重程度分别为 3.4 和 2.7 倍（p<0.01）。此外，DFU 直径为 5-10cm （p=0.047）和>10cm（p=0.002）的患者严重程度分别高出 1.5 和 2.5 倍。
大多数 DFU 位于右脚和足底。解剖部位与 DFU 严重程度无关。神经病变和直径>5cm 的溃疡与严重的 DFU 相关，但小学和中学教育水平以及吃蔬菜是预防因素。早期管理诱发因素对降低 DFU 负担很重要。
