By Sola Ogundipe

Worried by the gaps in training of specialists to effectively tackle the high prevalence of diabetes and its complications among Nigerians, a group of medical experts under the aegis of the Podiatry Initiative Nigeria, PIN, have initiated a pilot training workshop in Lagos in the area of Podiatric medicine.

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The training is to help bridge the training gap and raise awareness on the subspecialty of podiatry or Podiatric medicine, a branch of medicine dedicated to the study of diagnosis, medical and surgical treatment of disorders of the foot, ankle, and lower extremity.

Local data of diabetes foot ulcers show alarming amputation rate of over 50 per cent in some cohorts and mortality of up to 40.5 per cent. Data from the International Diabetes Federation, IDF, show that the number of persons with type 2 diabetes is increasing in every country even though 80 percent of people with diabetes live in the low and middle income countries. Every six seconds, one person dies of diabetes.

In 2013, there were 5.1 million diabetes-related deaths and more than 21 million complications. Also last year, diabetes caused at least USD 548 billion in health expenditure which is 11 percent of total spending on adults. Findings show that at least 175 million people with diabetes are undiagnosed while the greatest number of persons with diabetes are aged 40-59.

Disclosing all these to Good Health Weekly in a chat, Head of the team, Dr. Afokoghene Rita Isaivwe, said increase in knowledge of proper foot care in persons with diabetes and training of the physicians looking after them to enable them detect early signs of diabetes foot and properly manage the condition, is key in preventing and reducing the scourge of the diabetes foot in Nigeria.

Isiavwe recounted that in a tertiary hospital in Lagos, diabetes mellitus foot syndrome was responsible for most amputations in the surgical unit (55.14 per cent of all amputations)

Socioeconomic consequences

“The direct socioeconomic cost of successfully treating the diabetic foot ulcer is about 1000 Euros, whereas average monthly wage is about 46 Euros. The people most affected are at the lower class; persons already burdened by poverty, illiteracy and inability to care for their daily needs.

“Unfortunately there is a dearth of podiatry knowledge/practice in the country as there is no Podiatry curriculum currently operating in the medical schools in Nigeria.

Much needed information on basic podiatry education is lacking amongst our medical practitioners. This has a resulting negative effect on the care of persons with diabetes foot and outcome of persons with diabetes foot ulcers,” Isaivwe remarked.

Podiatry services needs in Nigeria/Lagos as well as data from the International Diabetes Federation, IDF show that in Africa, Nigeria has the highest number of people with diabetes and likewise also has the highest number of persons with impaired glucose tolerance.

Prevalence of diabetes in Nigeria was put at 2.2 per cent in 1997. Different studies across the nation give prevalence from about 2.8 per cent to about 6.8 per cent and as high as 23.4 per cent in the oil rich Niger Deltaregion in some cohorts.

In Lagos state, diabetes prevalence was estimated to be 6 per cent by the Lagos state ministry of health in 2011. Studies in Nigeria give a prevalence of as low as 0.9 per cent to 8.3 per cent to as much as 16 per cent in a multicentre diabetes outpatients population study to 19.5 per cent amongst diabetes patients on admission.

A 2005 publication showed diabetes related foot ulcerations accounted for 12 per cent of total hospital admissions in a Lagos based study and diabetes mellitus foot is the second leading cause of diabetes related deaths in Nigeria accounting for 19.5 to 24 per cent of all diabetes mortality.

Also, a study on diabetes mellitus foot ulcer in Midwestern Nigeria showed an amputation rate of 52.2 per cent and mortality rate of 14.3 per cent in a cohort of diabetes patients with foot ulcers.