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Zulfiqarali Abbas, Lennox Archibald
Med Sci Monit 2005; 11(8): RA262-270
Diabetes mellitus is the most common, non-communicable chronic diseaseglobally. In African countries, peripheral neuropathy underlies most diabetic foot complications; however,peripheral vascular disease appears to be increasing, presumably a reflection of increasing urbanisation.We conducted this study to ascertain the occurrence of foot complications among diabetes patients inthe African continent. Using various keyword combinations, we searched Medline (PubMed) databases andthe archives of Muhimbili National Hospital, the major teaching hospital in Tanzania, for obscure diabetesliterature on diabetes in Africa. We also reviewed available non-English literature and obtained relevanttranslations where appropriate. We found articles encompassing years 1960-2003. Foot complications suchas ulceration, infection, or gangrene were generally associated with considerable long-term disabilityand pre-mature mortality. Rates of complications varied by country-foot ulcers: 4-19%; peripheral neuropathy:4-84.4%; peripheral vascular disease: 2.9-78.7%; frequency of patients presenting with gangrenous footulcers: 0.6-69%; foot amputation rates: 0.3-45%. A study of diabetic patients in Tanzania showed mortalityrates >50% among patients with severe foot ulcers, who did not undergo surgery. Other published datafrom Tanzania suggest that surgical intervention after the onset of gangrene may be too late to preventdeath. Prevention and control programmes are needed to stem the rising occurrence of diabetic foot complicationsin Africa. Gangrenous diabetic feet require aggressive management and early surgical intervention. Earlypresentation by patients and prompt surgical intervention during less severe rather than during laterstages of an ulcer may improve patients outcome and reduce mortality rates.