Baseline Characteristics Severity and Management of Diabetic Foot Ulcers at Presentation at the Kenyatta National Hospital, Nairobi, Kenya

Abstract

Background: Diabetes mellitus affects around 360 million individuals globally, with 2-4% developing active foot ulcers, a complication often leading to severe consequences, including infections and lower limb amputations. Understanding the clinical presentation of diabetic foot ulcers (DFUs) is vital for effective treatment protocols and resource allocation. However, there is a lack of data on DFU characteristics in Kenya. Objective: This study aimed to determine the baseline characteristics severity and management of DFUs at presentation in patients at Kenyatta National Hospital, offering valuable insights into the epidemiology and clinical features of this condition in the Kenyan context. Study Design and Population: A cross-sectional study involving 214 patients presenting to Kenyatta National Hospital with DFUs was conducted from May 2023 to December 2023. Materials and Methods: Participants meeting inclusion criteria underwent a questionnaire-based assessment, including interviews, physical examinations, and chart reviews. Collected exposure data encompassed age, gender, diabetes type, disease duration, ulceration duration, history of diabetes control, and DFU management. DFU characteristics were assessed using the PEDIS ulcer tool, severity was graded according to the Wagner-Meggitt system, and infection assessed on the IDSA / IWGDF classification system. Radiological patterns, microbiological data, and treatment approaches were documented.

Results: Of the 214 participants, the majority had type II diabetes (88.8%), with a mean age of 54.94 years. Common treatments included pressure offloading and debridement, with 39.3% reporting prior DFU treatment. Radiological tests were performed in 45.3% of cases, predominantly using CT angiograms. Microbiological data were limited, with only 6.5% undergoing wound cultures, revealing Klebsiella pneumoniae as the predominant organism. Wound dressing (92.1%) and surgical debridement (48.6%) were frequently employed, while microsurgical reconstruction was not utilized. Conclusion: Managing DFUs at Kenyatta National Hospital highlights the complexities in addressing this common complication in a developing country like Kenya. The study underscores the significant burden of diabetes, with DFUs contributing to 11.4% of diabetic admissions. Demographic and clinical characteristics reveal potential challenges in treatment access or compliance, emphasizing the critical role of early detection. Radiological patterns, microbiological profiles, and treatment approaches illuminate the multifaceted nature of DFU management, while challenges in obtaining comprehensive data underscore potential healthcare infrastructure limitations. The findings provide crucial insights for developing targeted interventions and improving overall DFU management in Kenya, contributing to the global understanding of diabetic complications in diverse healthcare settings