Experts Decry High Rate of Foot Ulcer, Amputation among Diabetics in Nigeria

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Martins Ifijeh

Experts in endocrinology and diabetes care have decried the high rate of foot ulcer and amputation among people living with diabetes in Nigeria, saying lack of awareness has played a major role.

Speaking at the sixth Rainbow Medical Centre Annual International Diabetes, Podiatry and Diabetes Foot Care Workshop held in Lagos recently, the National Desk Officer, Diabetes, Federal Ministry of Health (FMOH), Dr. Alayo Sopekan said in Nigeria, a large majority of people living with the disease have little or no knowledge of diabetes and its complications hence the inability to manage it properly.

He said between 8.3 per cent and 19 per cent of foot ulcer occur among Nigerians living with diabetes, adding that the rate of amputation among people living with foot ulcer in the country is as high as 53.2 per cent.

Sopekan, who was represented by a staff of Diabetes Desk, FMOH, Olanike Kehinde Akinkoye said this was making diabetes foot the most common cause of non-traumatic amputation in the lower extremities in Nigeria.

Sopekan said: “Diabetes foot disease is a leading cause of hospital admissions in Nigeria and the economic burden becomes quite significant knowing most of the health expenditure in the country is from out of pocket expenses.

“This disease was previously not very common in Nigeria and erroneously believed to be disease of the affluent. However, with globalisation and demographic transition, the disease has become prevalent in all parts of the world and affect all segments of the population, rich and poor alike.

“You will agree that hardly any day goes by without the sad news of a relative, friend or colleague who has died suddenly from diabetes. Sadly, most people are unaware and only get to know they have diabetes when irreversible and fatal complications leading to amputations, blindness, stroke, among others have set in.”

He stressed that the federal government was committed to providing leadership for the prevention and control of diabetes and other non-communicable diseases through the ministry of health’s strategic elimination of the risk factors and by improving the management of these diseases as well as preventing their complications.

On her part, the Medical Director, Rainbow Specialist Medical Centre, Dr. Afokoghene Isiavwe, who is also the convener of the workshop, said it is a sudden sad realisation that diabetes mellitus was a preventable, but leading cause of non-traumatic lower limb amputation, and also results in recurrent or creeping amputations in the same limb.

She said an individual with initial ray-amputation (a surgical removal of a dead diabetes toe) could end up with repeated surgeries on the same limb, sometimes ending with an above-knee amputation (a surgical procedure performed to remove the lower limb at or above the knee joint when that limb has been severely damaged) in this case by diabetes mellitus.

“There is the urgent need to implement change-ideas that would reduce the burden of diabetes related lower extremity amputations.
“This burden had been well researched and documented; of note is the work of Prof. Anthonia Okeoghene Ogbera on the diabetes foot burden in Nigeria.”

She said over the last six years, Rainbow Specialist Medical Centre has been building local capacity to improve management and prevention of diabetes foot complications and has raised awareness on proper foot care in persons living with diabetes mellitus; through much needed trainings like regular interactive workshop sessions.

She said among achievements of the regular workshops is the raising of awareness of podiatry in Nigeria; as prior to this initiative, there was nothing on podiatry in Nigeria in terms of capacity building trainings.

“We have also used this medium to get the attention of the federal government, who on December 6, 2016 invited us to make a presentation to them in Abuja on podiatry and diabetes foot care, among others,” she added.

Also sharing her thoughts, a Professor of Medicine and Endocrinology, University of Abuja Teaching Hospital, Prof. Felicia Anumah said doctors and nurses need to be empowered on diabetes care, adding that their knowledge of diabetes management by healthcare providers will help in reducing the high prevalence of diabetes complication, especially limb amputation.

On why amputations occur, she said: “You know blood is life, so when there is lack of blood supply to the limb, it is advisable to cut the limb above where the supply issue is. But if the diabetes is managed well, it may not get to the point where they will have sores in their foot requiring foot amputation.”

She called on the government to address issues around religion and ethnicity, as they are both having a toll on the political will to address healthcare issues.