Department of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mazowe Street, Harare, Zimbabwe.
Department of Primary Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
BMC Public Health. 2024 Mar 4;24(1):677. doi: 10.1186/s12889-023-17610-7.
Diabetic foot disease (DF) is a common diabetes-related complication; however, the prevalence and associated risk factors for DF are not well characterised among people living with diabetes (PLWD) in Zimbabwe. This may suggest the unavailability of adequate strategies to diagnose and treat DF in the country. This study aimed to determine the prevalence of DF and associated risk factors for PLWD in Harare, Zimbabwe.
This was a cross-sectional study, employing a quantitative approach. In total, 352 PLWD were recruited from 16 primary care clinics in Harare. Sociodemographic and clinical data were collected via face-to-face interviews and clinical records reviews. The DF screening included an evaluation for peripheral neuropathy, ankle-brachial index (ABI), ulceration, and amputation. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs), and KAP was scored using Bloom's cut-off. Chi-Square goodness-of-fit tests were performed, and regression analyses were used for association analysis. The threshold for significance was p < 0.05.
This group included 82 men and 279 women, with a combined mean age of 57.9 ± 14 years. Twenty one (~ 26%) men and 41 (15%) women had type 1 diabetes. The diabetes type distribution significantly differed by gender (p < 0.001). Oral hypoglycaemics (71%) were most commonly administered for management. DF was observed in 53% (95% CI = 50-56) of PLWD. Other DF symptoms observed were abnormal ABI (53%), peripheral neuropathy (53%), foot ulceration (17%) and amputation (3%). Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1-2.6; p = 0.019), while insulin use was protective against amputation (OR = 0.1; 95% CI = 0.1-0.9; p = 0.049). Most (87%) of the participants demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk factor for DF. Nearly two-thirds (63%) demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of DF ulceration risk (p > 0.05).
This study showed that there was a high prevalence of DF (53%) in PLWD in Zimbabwe, and insulin use was protective against DF. There is an urgent need for policy revisions to include foot screening in routine primary care and increasing insulin use for PLWD to prevent complications such as DF as an integral part of primary care.
糖尿病足病（DF）是一种常见的糖尿病相关并发症；然而，津巴布韦的糖尿病患者（PLWD）中，DF 的患病率及其相关危险因素尚不清楚。这可能表明该国缺乏诊断和治疗 DF 的充分策略。本研究旨在确定津巴布韦哈拉雷地区 PLWD 的 DF 患病率及其相关危险因素。
这是一项横断面研究，采用定量方法。总共从哈拉雷的 16 个初级保健诊所招募了 352 名 PLWD。通过面对面访谈和临床记录回顾收集社会人口统计学和临床数据。DF 筛查包括评估周围神经病变、踝肱指数（ABI）、溃疡和截肢。使用自我管理问卷评估知识、态度和实践（KAP），并使用布鲁姆的截止值对 KAP 进行评分。进行了卡方拟合优度检验，并进行了回归分析以进行关联分析。显著性阈值为 p < 0.05。
该组包括 82 名男性和 279 名女性，平均年龄为 57.9 ± 14 岁。21 名（约 26%）男性和 41 名（15%）女性患有 1 型糖尿病。糖尿病类型的分布在性别上存在显著差异（p < 0.001）。最常使用口服降糖药（71%）进行治疗。53%（95%CI=50-56）的 PLWD 患有 DF。观察到的其他 DF 症状包括异常 ABI（53%）、周围神经病变（53%）、足部溃疡（17%）和截肢（3%）。周围神经病变增加了溃疡的风险（OR=1.7；95%CI=1.1-2.6；p=0.019），而胰岛素的使用可预防截肢（OR=0.1；95%CI=0.1-0.9；p=0.049）。大多数（87%）参与者表现出良好的 DF 知识，并且了解坚持用药预防 DF 的重要性。然而，96%的人不知道吸烟是 DF 的一个危险因素。近三分之二（63%）的人表现出不良的态度和做法。不良的态度和做法不是 DF 溃疡风险的预测因素（p>0.05）。
本研究表明，津巴布韦 PLWD 中 DF 的患病率很高（53%），胰岛素的使用可预防 DF。迫切需要政策修订，将足部筛查纳入常规初级保健，并增加胰岛素在 PLWD 中的使用，以预防 DF 等并发症，将其作为初级保健的一个组成部分。
