Prevalence and risk factors for diabetic foot complications among people living with diabetes in Harare, Zimbabwe

Abstract

Abstract Background Diabetic foot (DF) is one of the most common diabetes-related complications, however, the prevalence and associated risk factors of DF are not well characterized among people living with diabetes (PLWD) in Zimbabwe. This study aims to determine the prevalence of diabetic foot and associated risk factors in PLWD in Zimbabwe. Methods This was a cross-sectional study, employing a mixed-methods approach was used to obtain data. A total of 352 PLWD were recruited from 16 primary care clinics across Harare. Face-to-face interviews and patient record reviews were used to collect sociodemographic and clinical data. Screening for DF included sole pressure, peripheral neuropathy, ankle-brachial index, deep tendon reflexes, ulceration, and amputation were performed. Self-administered questionnaires were used to assess knowledge, attitudes, and practices (KAPs). Scoring for KAPs was done using Bloom’s cutoff, and regression analyses were used to associate variables with DF risk. Results This group was made up of 82 men and 279 women. The combined mean age was 57.9 ± 14 years, and the age was comparable by gender (p > 0.05). More than a quarter (n = 21) of men and 15% (n = 41) ofwomen had Type 1 diabetes. The distribution of diabetes type significantly differed by gender (p < 0.001). DF was observed in 53% of PLWD. Abnormal ankle-brachial index (53%) and peripheral neuropathy (53%), foot ulceration (17%) and amputations (3%) were observed. Peripheral neuropathy increased the risk of ulceration (OR = 1.7; 95% CI = 1.1–2.6; p = 0.019), while insulin adherence was protective against amputation (OR = 0.1; 95% CI = 0.1–0.9; p = 0.049). Most (87%) of the group demonstrated good DF knowledge and the importance of adhering to medication to prevent DF. However, 96% did not know that smoking was a risk of DF. Nearly two-thirds (63%) of the group demonstrated poor attitudes and practices. Poor attitudes and practices were not predictors of diabetic foot ulceration risk (p > 0.05). Conclusion Our findings report a high prevalence of DF (53%) in PLWD in Zimbabwe. However, DF is not routinely assessed in Zimbabwe. Adherence to insulin was found to protect against DF, underscoring the need for policy revisions to include screening and increasing insulin adherence to prevent DF as integral primary care for PLWD.