Prevalence and determinants of diabetic foot ulcer among diabetic patients in Ethiopia. A systematic review and meta-analysis.

Henok Mulugeta*¹, Fasil Wagnew¹, Haymanot Zeleke¹, Bekele Tesfaye¹, Cheru Tesema Leshargie², Henok Biresaw³, Getenet Dessie⁴

Abstract

Background: Diabetic foot ulcer, one of the complications of diabetes mellitus, is a major health problem and is one of among the leading reasons for admission, amputation, morbidity, and mortality among diabetic patients in Ethiopia. The objective of this systematic review and meta-analysis is to estimate the pooled prevalence of diabetic foot ulcer among diabetic patients in Ethiopia.

Methods: We searched PebMed, Google Scholar, Cochrane Library CINAHL, Embase, and PsycINFO databases for studies of diabetic foot ulcer prevalence published up to August 30, 2018. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed during this meta-analysis. Qualities of each article were assessed by using a modified version of the Newcastle-Ottawa Scale. All statistical analyses were done using STATA version 14 software. The pooled estimated prevalence of foot ulceration was presented using a forest plot.

Results: A total of 13 studies with 4077 participants were included in this study. The overall pooled prevalence of diabetic foot ulcer among diabetic patients in Ethiopia was 13.97% (95% CI (9.46, 18.49%)) with significant heterogeneity between studies (I²=96.3, P=0.001). Based on the subgroup analysis, the highest prevalence [19.02% (95%CI: 44.49, 79.2), 𝐼² = 98.9%)] was found in Addis Ababa. Participants’ residence [OR: 3.40, (95%CI (2.09, 5.54))] and duration of the disease [OR: 3.91, (95%CI (2.03, 7.52))] had a significant association with a diabetic foot ulcer.

Conclusion: The analysis revealed that the overall prevalence of diabetic foot ulcer among diabetic patients in Ethiopia was high. Therefore, the ministry of health should design a concerted multi-sectoral approach and strategies to reduce the risk of foot ulceration and to improve the health care delivery for people with diabetes.

Keywords: Diabetes mellitus, foot ulcer, prevalence, Ethiopia.