Recent epidemiological surveys have found that, compared to national averages, the incidence of diabetes in both urban and rural areas is high in the four districts of Andhra Pradesh targeted in this project. Although the incidence is high, people are ignoring diabetes and diabetes foot care because awareness is lacking. Therefore, it is important to raise awareness in order to avoid severe complications such as foot ulcers and subsequent amputation of limbs.The project objective is to create awareness and enhance care for the diabetic foot in four districts in Andhra Pradesh, India.
This project will complement another WDF funded project, namely "Diabetes awareness camps" (WDF04-078), also implemented by R. R. Lions Eye Hospital. Together the two projects will create a diabetic unit covering major complications of diabetes e.g. diabetic foot and diabetic retinopathy.The focus of this present project is to create awareness of diabetes among the general public and people with diabetes as well as education of health care professionals in prevention and treatment of diabetes and diabetic foot problems.Initially, 3-day basic training courses will be conducted for 480 foot care teams consisting of a doctor and a nurse. The programme will include 1 day for diabetes care, 1 day for theoretical and 1 day for practical diabetes foot care.One year after the basic training course, a 1-week advanced course will be held for 36 of the trained teams. Selection will be based on implementation performance during the year in between the basic and advanced programme.The approach takes inspiration from the WDF supported Step-by-Step model which was developed and implemented under WDF03-056.In addition, seminars will be held for general practitioners, physicians, diabetologists and orthopaedic surgeons and nurses. A total of 1,400 health care professionals are trained.The aim of the training courses is to make the participants able to identify and treat diabetic foot patients. It is also expected that the training of health care professionals will create awareness and increase motivation among doctors to be trained in diabetic foot care.Moreover, about 10-20% of the trained doctors are expected to train their colleagues upon return to their home health facilities; thereby further disseminating the effect of the training courses.The training takes place at the Diabetic Foot Care Centre, which will also conduct awareness programmes aimed at the general public. This will be done through diabetic foot awareness camps held twice a month.At the camps, people are counselled about healthy life style, diabetes and its complications especially the diabetic foot and how to prevent it. People with high risk of diabetic foot will be identified.A mobile foot care unit takes part in the foot care camps, providing care and patient education on-site. Follow-ups of all diabetic foot patients are carried out continuously and, if necessary, the patients are referred to the Diabetic Foot Care Centre.
• 5,111 health care professionals (1,264 doctors, 3,055 nurses, 792 paramedics) have been trained at seminars.• 480 foot care teams consisting of a nurse and a doctor each have been trained. 36 teams underwent one-week advanced training.• 240 screening/awareness camps have been conducted, reaching 4,500,000 people.• 19,210 people have been screened both for DM and diabetic foot.• 3,331 patients undergone treatment for foot ulcer were saved from lower limb amputations• 2,573 patients have been trained in diabetic foot facilities.A cost-benefit analysis of the project revealed that it costs USD 42 to train one health care professional in diagnosis, treatment and counselling for diabetic foot patients.Furthermore, the project analysis revealed that the costs to screen a patient for diabetic foot complications was USD 0.82 and USD 7 to treat a patient with diabetic foot complications. Comparatively, it costs around USD 550 for a below knee amputation, which in most cases can be avoided with proper treatment.