Toe web disease and lower limb cellulms at Kenyatia National Hospital

Abstract

The purpose of this study was to determine the factors associated with lower limb cellulitisin patients admitted with acute cellulitis of the lower limb in Kenyatta National hospital(KNH), with particular emphasis on toe web disease. Thestudy was guided by the following specific objectives: 1. To determine the factors commonly associated with lower limb cellulitis in KNH. 2. To determine the physical status of ipsilateral toe webs in the patients with lower limb cellulitis. 3. To determine the relative significance of toe web intertrigo as an associated factor in lower limb cellulitis in KNH. The research design was a prospective case control study and the study population comprisedpatients admitted in KNH due to lower limb cellulitis. A total of 94 patients were sampled consecutively, as per the calculated sample size, upon an assumed risk factor frequency of 25% for toe web intertrigo at SO% power. A researcher developed questionnaire was administered to all patients recruited and blood for blood sugar, total bloodcount and HIV taken for analysis in the KNH laboratories. Data was collected over a 9 month period from July 200S' to march 2009. The study findings were coded and entered into Excel worksheets and then analysed > using SPSS Ver. 14.0 software. Chi square test was used to test the significance of differences found between categorical variables. Odds ratios were calculated for Identified risk factors. Independent t-test was used for continuous data. Data for all the 94 recruited cases and controls was analysed. The study found that lower limb cellulitis affected the young and middle aged with a mean age of 43.3 years. There was equal representation of the sexes. The commonest site of cellulitis was the leg (76.6%). HIV was identified as a significant systemic condition predisposing to lower limb cellulitis p=0.017, O.R 0.2 (95%CI 0-0.7). Diabetes was found not to be an Independentrisk factor for lower limb cellulitis p=0.105 for the difference between casesand controls. The main local limb factor predisposing to lower limb cellulitis was Identifiedas presence of a wound/ulcer/injury p<O.OOl, O.R 50.1 (95%C1 11.7-215.3), followedby dermatitis p=0.051 O.R 4.3 (95%CI 0.9-20.7). Lymphoedema had p<O.OOl for the difference between cases and controls but the Odds Ratio could not be calculatedsince the incidence in controls was nil. Finally toe web intertrigo was found to be a significant risk factor for lower limb cellulitis p<O.OOl O.R 3.5 (95%C1 1.7-7.3), occurringin 86.2% of the cases and 63.8% of the controls. From the study it was recommended that lower limb injuries should be managed promptly and appropriately to avert the risk of lower limb cellulitis. Healthcare professionalsshould be alert to the increased risk of cellulitis in patients with dermatitis or lymphoedema of the lower limb. Health education for the H1V positive should incorporate information on the need for examination for and management of toe web intertrigo, and also prevention of and prompt care for lower limb injuries however minor. It was further recommended that all healthcare professionals should actively

examinefor toe web intertrigo in all patients and manage it accordingly.