Risk factors and prevalence of diabetic foot ulcers at Kenyatta National Hospital, Nairobi.
BACKGROUND
Diabetic foot ulcers contribute significantly to the morbidity and mortality of patients with diabetes mellitus. The diabetic patients with foot ulcers require long hospitalisation and carry risk of limb amputation. The risk factors for developing diabetic foot ulcers are manageable. In Kenya there is paucity of data on such risk factors.


OBJECTIVE
To determine the prevalence of diabetic foot ulcers and the risk factors in a clinic-based setting.


METHODS
Cross-sectional study.


METHODS
Kenyatta National Hospital, Kenya.


METHODS
Patients with both type 1 and 2 diabetes mellitus who had active foot ulcers in both outpatient and inpatient units.


METHODS
Diabetic foot ulcers glycated haemoglobin, neuropathy, peripheral vascular disease and fasting lipid profile.


RESULTS
One thousand seven hundred and eighty eight patients with diabetes mellitus were screened and 82 (4.6%) were found to have foot ulcers. The males and females with diabetic foot ulcers were compared in age, duration of foot ulcers, blood pressure, glycaemic control, neurological disability score and their proportion. Diabetic foot ulcers occurred mostly in patients who had had diabetes for a long duration. The types of (occurence) ulcers were neuropathic (47.5%), neuroischaemic (30.5%) and ischaemic (18%). The neuropathic ulcers had significantly poorer glycaemic control compared to other types and the longest duration (23.3 weeks). Ischaemic ulcers had significantly higher total cholesterol and diastolic blood pressure compared to other ulcer types. Wagner stage 2 ulcers were the commonest (49.4%) but stage 4 ulcers had their highest neuropathic score (7.8/10) and longest duration (23.6 weeks). Aerobic infective pathogens were isolated from 73.2% of the ulcers.


CONCLUSIONS
The prevalence of diabetic foot ulcers was 4.6% in this tertiary clinic. The risk factors of diabetic foot ulcers in the study were poor glycaemic control, diastolic hypertension, dyslipidaemia, infection and poor self-care. These findings are similar to studies done in other environments and they are modifiable to achieve prevention, delay in formation or improved healing of foot ulcers in patients with diabetes. Therefore, specific attention should be paid to the management of these risk factors in patients with or without diabetes foot ulcers in this clinic.
Nyamu
P N
PN
Department of Medicine, College of Health Sciences, University of Nairobi, PO. Box 19676, Nairobi, Kenya.
Otieno
C F
CF
Amayo
E O
EO
McLigeyo
S O
SO
D003430:Cross-Sectional Studies; D017719:Diabetic Foot / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015985:Precipitating Factors; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors