An explorative review of the distribution, incidence, prevalence, diabetes related amputations and defaulters of patients with diabetes mellitus and podiatrists in the public health care sector of KwaZulu-Natal.

Abstract

The prevalence of diabetes is increasing globally, especially in African countries, where 62% of cases are undiagnosed and are seen by a medical professional only once complications have manifested. Among the tangle of complications, the diabetic foot is a cause of morbidity and mortality. The management of foot ulcerations, non-ulcerative pathologies and the prevention of subsequent amputation is a challenge, resulting in physiological, psychological and economic consequences. Including a podiatrist in the multidisciplinary healthcare team involved in the care of the lower limbs of the diabetic patient has the potential to improve patient outcomes and reduce the economic burden incurred by both the patient and the state. The global increase in the prevalence of diabetes is most marked in African countries. The District Health Information System (DHIS) is the primary data collection system of the Department of Health in KwaZulu- Natal (KZN). Data is routinely collected at all public healthcare facilities in the province and is aggregated per facility. This study aimed to investigate the distribution of diabetic patients and podiatrists in the public health sector of the eleven KZN districts. A retrospective audit was conducted of the KZN Department of Health databases on diabetes in and between the years 2010 and 2014. The data was cleaned, tested for capture errors, verified and analysed. Using pivot tables, derived metrics, and graphs using Microsoft Excel were constructed. Additional open source databases were accessed to allow further exploration of the data collected. The prevalence of diabetes in the public health sector of KwaZulu-Natal was found to be 14.3% higher than national prevalence estimates. Thirty-eight per cent of the cases were found in the highly urbanised district of eThekwini. A total of 1 329 275 diabetic patients were recorded and, according to national guidelines for the treatment of diabetes, required podiatric care. However, only two podiatrists work in the KwaZulu-Natal public health sector. The number of podiatrists is totally insufficient to serve the growing diabetic population in this province’s public health sector. A major infusion of more podiatry graduates, appropriate distribution and inclusion of podiatric services into the diabetic foot care team needs to therefore be considered to enable compliance with national and international diabetic foot care guidelines. In the interim, existing public health care practitioners can be educated to offer diabetic foot care information to the patient and on the correct referral patterns to allow the patient access to a podiatrist. The findings of this study are consistent with the well-established relationship between diabetes and urbanisation. Correlation calculations support the assumption of a directly proportional relationship between diabetes prevalence and the number of diabetes-related amputations. This study highlights the need for at least 319 podiatrists in the province of KwaZulu-Natal to satisfy the national guidelines for minimal diabetic care regarding assessment, screening and education of patients only; not considering the treatment of existing and future foot complications. Short and long term recommendations such as changes in the data collection process at public health facilities and the assessment of existing tertiary medical institutions for the establishment of additional departments of podiatric medicine can greatly contribute to addressing the calculated shortage of podiatric practitioners in the public health sector.