Epidemiology and Outcome of Diabetic Foot Ulcers in Nigeria: A Systematic Review and meta-analysis of 2 Decades: 2005 - 2024.

introductionDiabetic foot ulcers (DFUs) are a main factor leading to morbidity, hospitalizations, amputations, disability, and death of people with diabetes. However, the epidemiology and outcomes of DFUs in Nigeria are not well documented. This study (systematic review and meta-analysis) aimed to evaluate the prevalence, amputation rates, and clinical outcomes of DFU patients across various regions in Nigeria.

methodsThe search was comprehensively conducted through electronic databases: African Journal Online (AJOL), PubMed, SCOPUS, and Google Scholar, for studies published in English between 2005 and July 15, 2024. Eligible studies reporting on the prevalence and outcomes of DFUs in Nigerian populations were included. Some of the search terms used are (“diabetes” OR “diabetic”) AND (“foot” OR “lower extremity” OR “limb” or “leg”) AND (“amputation” OR “amputations” OR “infection” OR “gangrene” OR “necrosis” OR “ulcer” OR “ulcers” OR “wound” OR “wounds”). Two investigators independently assessed the methodological quality using the Newcastle–Ottawa Scale, and key data were extracted using Microsoft Excel. Meta-regression and meta-analysis were performed using Stata version 16, employing a random effects model to estimate pooled prevalence and outcomes. Heterogeneity among studies was assessed using the I² statistic.

resultEighteen full studies were included, encompassing 2,616 patients with DFU across the studies. The mean age was 56.43 years, with average diabetes duration of 10.62 years and ulcer duration of 46.65 days. The pooled prevalence of DFUs was 16.69% (95% CI 9.74–25.06), with the highest prevalence in the Southwest (20.38%, 95% CI 7.13–38.11) and the lowest in the Northeast (5.98%, 95% CI 4.86–7.20). DFUs predominantly affected the left foot (55.09%). The overall amputation prevalence was 33.27% (95% CI 23.09–44.29), with below-knee amputations being the most common (39.81%). The pooled mortality rate was 17.75% (95% CI 10.94–25.74), and 11.52% of patients left the hospital against medical advice. The average length of stay (on hospital admission) of the entire study population was 39.97 days.

conclusionDFUs are a high health burden in Nigeria, with high rates of amputation and mortality that vary by region. These regional differences indicate an urgent need for targeted interventions. A multidisciplinary approach to DFU management is essential to reduce amputation rates and improve health outcomes. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero , identifier CRD42024573581.