Commentary on Assessing the Knowledge of Patients With Diabetes About Foot Care and Prevention of Foot Complications in Cameroon, West Africa
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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of Wounds or HMP Global, their employees, and affiliates.
The treatment of diabetes and its complications, especially diabetic foot ulcers, present many challenges if one is working in under-resourced countries. Data from 2019 showed that there were approximately 19 million people with diabetes in sub-Saharan Africa and that approximately 13% of them would develop a diabetic foot ulcer.1,2 Of these patients, about 15% to 33% would undergo major amputations for their disease with a mortality of near 14%.2,3 It has been estimated that up to 70% of patients with diabetes are undiagnosed until a major complication occurs.4 This is due to the large number of patients seeking health care from “traditional healers”5,6; the price and unavailability of health care⁵; the lack of trained health care personnel to recognize, diagnose, and treat diabetes7; and lack of patient understanding of the complications of diabetes and the need for self-care.8 One study showed that only 6% of health care facilities had the equipment to check blood sugar levels.9 Another showed that in 3 sub-Saharan African countries there were only 2 physicians who specialized in managing diabetes with only approximately 10 others who had any training in diabetes care at all.10 In addition, a World Health Organization survey showed that only 51% of African countries had oral medications for treatment of type 2 diabetes available while 40% had a regular supply of insulin.11 Historically, amputations of the lower extremities in Africa have been done for traumatic injuries. However recent studies have shown that currently most lower extremity amputations are due to complications of neglected diabetes.3,12
As can be seen, diabetes is a major public health problem in sub-Saharan Africa. Since most of the emphasis there has been on treatment of infectious diseases, little training and few resources have been directed towards treating chronic diseases. In an effort to address these problems, educational programs for the identification and treatment of diabetes are beginning all across the continent.4,13 In the February issue of Wounds, we have the honor of being part of that program.
Carolyn Brown, BSN, RN, CWCN, and her husband, Jim Brown, MD, FACS, have been medical missionaries in Mbingo, Cameroon, West Africa for the past 15 years. Mrs Brown has provided nursing care as well as wound care in a small, rural, referral hospital while Dr Brown has provided surgical care and education. To provide wound care to the patients there, Mrs Brown established a wound center but quickly found that there was little knowledge as to how to manage wounds among all the providers. As a result, she began a wound training program for nurses and others providing care in the hospital. She developed a 1-year wound care trainer course to teach wound care to those who will later teach others, and a second, 6-month wound care nurse course taught by the wound care trainer nurses for those needing information about basic wound care. To emphasize the need for these programs, she and her students have evaluated the knowledge of their patients regarding diabetic foot care and how to prevent complications related to diabetes. Their study in this issue reinforces the need for diabetic foot care education among patients as well as health care providers. By reading this study, you will gain an understanding of the issues and realize the excellent work Mrs Brown and her group are doing to help this greatly underserved group of patients.
Terry Treadwell, MD
Editor-in-Chief Emeritus, Wounds
woundseditor@hmpglobal.com
References
1. International Diabetes Federation. IDF Diabetes Atlas. 9th ed. International Diabetes Federation; 2019. https://www.diabetesatlas.org/en/resources
2. Rigato M, Pizzol D, Tago A, et al. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2018;142:63-73. doi:10.1016/j.diabres.2018.05.016
3. Salad AM, Duale HA, Sheikh IM, et al. Prevalence of diabetic foot ulcer and associated factors among adult diabetic patients in three referral hospitals in Mogadishu, Somalia. Front Public Health. 2023;11:1195483. doi:10.3389/fpubh.2023.1195483
4. Pastakia SD, Pekny CR, Manyara SM, Pischer I. Diabetes in sub-Saharan Africa: from policy to practice to progress targeting the existing gaps for future care of diabetes. Diabetes Metab Syndr Obes. 2017;10:247-263. doi:10.2147/DMSO.S126314
5. World Health Organization. Traditional Medicine Strategy 2002-2005. WHO; 2002.
6. Awah P. Diabetes and traditional medicine in Africa. Diabetes Voice. 2006;5(3):24-26.
7. Abbas ZG. Managing the diabetic foot in resource-poor settings: challenges and solutions. Chronic Wound Care Manag Res. 2017;4:135-142.
9. Beran D, Yudkin JS, de Courten M. Access to care for patients with insulin-requiring diabetes in developing countries. Diabetes Care. 2005;28(9):2281-2283. doi:10.2337/diacare.28.9.2136
10. International Insulin Foundation. Fact sheet on diabetes in sub-Saharan Africa. www.access2insulin.org
11. Atun R, Davies JL, Gale EA, et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol. 2017;5(8):622-667. doi:10.1016/S2213-8587(17)30181-X
12. Forrester JD, Teslovich NC, Nigo L, Brown JA, Wren SM. Undertreated medical conditions vs trauma as primary indications for amputation at a referral hospital in Cameroon. JAMA Surg. 2018;153(9):858-860. doi:10.1001/jamasurg.2018.1059
13. Abbas ZG, Boulton AJM. Diabetic foot ulcer disease in African continent: ‘from clinical care to implementation’—review of diabetic foot in last 60 years (1960 to 2000). Diabetes Res Clin Pract. 2021;183:109155. doi:10.1016/j.diabres.2021.109155
Recommended Citation: Treadwell T. Commentary on assessing the knowledge of patients with diabetes about foot care and prevention of foot complications in Cameroon, West Africa. Wounds. 2025;37(2):A4. doi:10.25270/wnds/0225-02
Read the Full Study on Wounds: Brown C, Kejeh C, Lemnyuy C, et al. Assessing the knowledge of patients with diabetes about foot care and prevention of foot complications in Cameroon, West Africa. Wounds. 2025;37(2):51-55. doi:10.25270/wnds/24160
