Absence of effect of post-discharge socioeconomic circumstances on the outcome of dysvascular lower limb amputees: a prospective cohort study

Background: Significant mortality and morbidity occur after major lower limb amputation for diabetes-related footcomplications and peripheral arterial disease. Risk factors for atherosclerosis and medical comorbidities are common in amputation for diabetes-related foot complications and are major determinants of outcome. Conversely, the effect of post-hospitalisation circumstances on outcome has not been systematically studied. We hypothesised that poor socioeconomic circumstances after discharge would have an adverse effect on the outcome of major amputation in a developing country.Objectives: To determine the association of the status of post discharge socioeconomic circumstances on the outcome of dysvascular amputation. Methods: This was a prospective cohort study. Patients scheduled for major dysvascular lower limb amputation were recruited. Data were collected regarding the socioeconomic circumstances to which patients would be discharged, such as housing, income and personal care. Patients were followed up at our hospital, at clinics and later telephonically for three years. Mortality and wound morbidity were documented. Association of differences in status of socioeconomic factors and outcomes was analysed statistically.Results: Ninety nine patients were enrolled. Eight patients died in hospital and 91 were discharged. The socioeconomic circumstances of discharged patients were relatively favourable, the majority living in brick houses (92%) with running water (87%). Most patients had a regular income (86%), more than half had state/government grants. The availability of co-habitants, care givers and accessible medical facilities was also favourable. None of the different socioeconomic status levels demonstrated an effect on morbidity or mortality, all associations having a p-value greater than 0.05 (Chi-squared Fisher's exact and Spearman's rank correlation tests).Conclusion: No association between socioeconomic status factors and post-discharge outcome of amputees was demonstrated. This is probably because the dysvascular amputees in this study cohort were living in relatively favourable circumstances

Prevalence of diabetes and its associated risk factors in south-western Uganda

Diabetes mellitus is a major pandemic disease globally with both high morbidity and mortality and a high health cost, especially in developing countries. Hence there is a need to establish its prevalence and risk factors. This article reports on a group of diabetic patients in Sheema district, south-western Uganda. The records of 701 adult diabetic out-patients were reviewed, as well as a cross-sectional study of 100 in-patients (both diabetic and non-diabetic) at Kitagata Hospital, Sheema District, south-western Uganda. Questionnaires were used for data collection and data analysis was done using the Statistical Package for Social Sciences (SPSS) version 16. The differences in proportion were tested using the Chi-square test, and p value significance was set at p<0.05. The prevalence of diabetes in the hospital was 2.5%. Type 2 diabetes was the most predominant (79%), having an increased prevalence in those >30 years old; women were mostly affected (60%). There was a strong relationship between diabetes type and age (p<0.001) and gender (p=0.035). Risk factors included family history (74%, p<0.001), smoking (48%, p=0.002), hypertension (45%, p<0.001), and alcohol intake (36%, p=0.795). We conclude that diabetes is common in our hospital population, and major risk factors identified include family history, smoking, and hypertension. Everyone above the age of 35 years with a diabetic relative and/or with hypertension should be routinely screened for diabetes

A 7-year retrospective study of diabetesrelated deaths in a Nigerian tertiary hospital

A total of 362 diabetics were admitted over a 7-year period (January 1995 to December 2002) to a Nigerian tertiary hospital. Forty (40) of these (8.8%) died as in-patients. Twenty-six (26) were male and 14 were female. Thirteen (32%) were newly diagnosed with diabetes. Seventy percent (70%) of deaths occurred within 1 week of admission. A case-controlled study of the diabetic deaths revealed that presentation with any of the following were associated with in-patient death: diabetic emergencies (p<0.001), infective process (p<0.001), fever (p<0.001), systolic hypertension (p=0.001), and short duration of hospitalisation (p=0.001). It is suggested that greater awareness of diabetes and education of newly diagnosed cases may reduce this high mortality. In addition, the national health insurance system should cover all disease care, including diabetes