Focus on delay as a strategy for care designs and evaluation of diabetic foot ulcers in developing countries: a review
Otieno, C.F.; Nyamu, P.M.; Atieno Jalang' o, G.
East African Medical Journal 82(12 Suppl): S204-S208
2005
ISSN/ISBN: 0012-835X Document Number: 263460
Objectives: To review certain aspects in the care of diabetes foot ulcers in Developing Countries, with emphasis on causes of delay in care delivery. Data Sources: Review of published literature on care of diabetic foot ulcers as well as local experiences. Main Outcome Measures: The levels of potential or actual delay in care delivery and the causes of such delay in pre-hospital phase, and access to hospital and within-hospital phase of care. Data Synthesis and Conclusions: The barriers or causes of delay are observed to occur at various levels: decision to seek care, reaching the treatment facility, and receiving the desired optimal care. The presence of peripheral neuropathy may cause delays in recognition of ulcers and in the decision to seek care; peripheral vascular insufficiency and infection are both involved in initiation of diabetic foot ulcers and are also major causes of delay in ulcer healing process. Aside from the processes unique to diabetes, the health care providers and health care facilities have major contributions in delaying the desired care for foot ulcers. This may arise from heavy workload, priority illnesses, shortage of required supply for standard care and/or just wrong attitudes. The inadequate knowledge on self-care and unique socioeconomic and sociocultural characteristics of patients also contribute to the barriers that compound suboptimal foot care. Care programme designs that lay emphasis on causes of delay are more likely to eliminate such causes.