Nigeria is the most populous and fastest growing country in Africa. Diabetes constitutes a major problem and the epidemic will be intensified due to population growth. According to IDF Atlas 2013, Nigeria has the highest number of people with diabetes in Africa.At a tertiary hospital in Lagos, diabetes foot ulcers were responsible for most amputations in the surgical unit. The cost of successfully treating a person with diabetic foot ulcers are about 20 times higher than the average monthly wage. This severely affects those least able to withstand the burden of the disease. Currently, only diabetes screening programs exist in the state and with limited impact. Foot care guidelines and training manuals are non-existent.The aim is to improve management and prevention of diabetes foot complications and raise awareness of proper foot care in Lagos, Nigeria.
Rainbow Specialist Medical Centre (RSMC) will help to bridge this gap by providing training in prevention and management of foot complications conducted by members of the American Podiatry Institute (API). Doctors from all regions in the country will be encouraged to participate in the annual 5-days diabetic foot workshops.At the end of the training, trainees will receive a kit, which will be used to examine and screen at least 10 patients per week from their respective clinics. A foot inspection checklist form will be included in the kit and the findings will be filed for improving follow up of patients. The patients found to be at high risk will be referred to RSMC or to other relevant institutions for free foot care.The clinics will be monitored by RSMC coordinators to ensure that the guidelines for treatment are followed and foot care toolkits are available. The clinics that meet the expectations will be rewarded with glucometer test strips and the ones that need improvement will receive guidance from a counsellor.People living with diabetes will be invited to become peer educators. They will receive foot care training and will transfer their knowledge to an estimated 20-30 other peers on a monthly basis. By the end of the training, the foot care coordinators’ contact information will be provided to the peer educators so they can have answers to future questions regarding foot care.On-going camps and training sessions will be organised for patients with a high risk foot. A minimum of 200 patients will receive training on proper foot care and educational material will be produced in order to reach a minimum of one thousand people living with diabetes.Shoe services and insoles will be available at the shoe section, which will be in partnership with a local foot care cobbler. In addition, hospitals will be provided with socks and other foot care products. This will help to prevent ulcers and promote improved healing in present ulcers.After completion of the pilot training sessions, the foot care training certified programme will be institutionalised and foot care guidelines will be produced to target primary and secondary health care centres.Finally, a sensitization workshop will be held every year to sensitize policy makers about the economic, psychological, and social burden of the diabetic foot. The national data of the diabetic foot screenings and a documentary - about people living with diabetes - will be presented to them. At the end of the workshop, an informational package will be distributed to policy makers, containing the documentary video and a diabetic foot informational brochure.The documentary will be aired on television stations and publications about the diabetic foot will be published quarterly on the newspapers.
• 1052 HCPs trained in foot care• 12 clinics strengthened and diabetic foot care integrated• 3,200 diabetes patients screened for foot complications• 544 diabetes foot ulcers detected• 201 patients with high risk foot participated in diabetes boot camp• Diabetic foot documentary produced • Contributed to the development of a new National Guideline for Prevention, Control and Management of Diabetes in Nigeria (under the Federal Ministry of Health)