Factors associated with severity and anatomical distribution of Diabetic Foot Ulcer in Uganda: A multicenter cross-sectional study

Abstract Background: Diabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) associated with high mortality and morbidity including amputations of lower extremities; and a high economic burden especially in low-income countries like Uganda. The aim of this study was to identify the factors associated with severity of DFU and assess the anatomical distribution of DFU among patients in Uganda. Methodology: This was a multicenter cross-sectional study conducted in 7 selected referral hospitals in Uganda. 117 patients with DM type 1 and 2 and foot ulcers were enrolled for this study from January to March 2021. Using the Wagner classification, patients were categorized as less severe DFU (grade 1 and grade 2) and severe DFU for grade 3 and above. A pre tested questionnaire was used to collect data. Data were analyzed using STATA Version 14 with significance at 95% and p-value of <0.05. Results: Out of 117 patients with DFU, 70 (59.8%) had severe DFU and 47 (40.2%) had less severe DFU. Mean age in years was 57.5 (SD15.2) among all study participants in general. The right foot was affected in (47.9%) of cases and the most frequent ulcer was found on the plantar of the foot (44.4%). Majority of the patients had one ulcer (50.4%) and the most frequent ulcer size was >5 cm (47.9%). Majority (61.5%) of the participants were female. Majority of participants, 90 (76.9%) also had uncontrolled blood sugars and 27(29.1%) had normal glycemia Severity of DFU was 3.4 more prevalent among patients with mild neuropathies (p=0.003), and 2.7 more prevalent for those with moderate neuropathies (p=0.005). Also, severity of DFU was 1.5 more prevalent in patients with an ulcer 5-10 cm of diameter (p=0.047) and 2.5 more prevalent in those with foot ulcer of more than 10 cm of diameter (p=.000). Conclusion:The study showed that most of the DFU patients have severe diabetic foot ulcer and uncontrolled glycemia. Neuropathies and ulcers more than 5cm wide are precipitating factors to severity of DFU and, therefore, early management is important to reduce the burden of the disease.