Stories: Angela Onwuzoo
To reduce the complications associated with Diabetes Mellitus particularly foot ulcers and amputations among Nigerians living with the condition , stakeholders have called on the federal government to take decisive steps towards addressing the burden of the disease in Nigeria by initiating, implementing and sustaining a National Diabetes Foot Care Policy.
Having such policy in place according to them, would adequately address the healthcare needs of Nigerians living with diabetes especially now that the country has the highest population of patients with diabetes foot complications in Africa.
The stakeholders stated that diabetic foot complications, though preventable, are the leading cause of admission, amputation and mortality in diabetic patients worldwide, insisting that as far as diabetes mellitus foot syndrome is concerned, prevention is better than cure.
The healthcare professionals drawn from USA, South Africa and Nigeria gave the charge at the Third Podiatry & Diabetes Foot Care Workshop with the theme: “Initiating, Implementing and Sustaining a National Diabetes Foot Care Policy” organised in Lagos recently by Rainbow Specialist Medical Centre, in partnership with the World Diabetes Foundation and the Podiatry Institute, USA.
In her welcome address, Medical Director of Rainbow Specialist Medical Centre, Dr. Afoke Isiavwe, said the workshop was aimed at empowering health workers with much needed skills to help prevent, identify and reduce the risk of diabetes-related foot amputations in the country.
Isiavwe who is the Project Coordinator, Diabetes Podiatry Initiative Nigeria, said till date, 11 hospitals from all cadres across the country have benefited from the initiative.
The Consultant Endocrinology said the initiative was crucial because Africa and indeed Nigeria cannot afford to watch while her citizens come down with complications of diabetes mellitus especially in a situation where the continent was already burdened with infectious diseases.
“Nigeria is also expected to have the highest number of persons living diabetes on the African continent. Indeed, local data show that we are already beginning to experience increase in diabetes prevalence in Nigeria, and with this increased prevalence accompanying increase in complications like diabetes mellitus related foot ulcers and amputations”, she said.
Chief Medical Director, Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH), and the National President of the Diabetes Association of Nigeria (DAN),Dr Mohammed Alkali, in his remarks, revealed that as at the end of 2015, a total of about 5million Nigerians were living with diabetes, out of which 1.56million were new cases diagnosed last year alone.
Alkali added that there was still a lot of undiagnosed diabetes in Nigeria.
According to him: “We also have diabetes in young people, which is also a major threat called juvenile diabetes, which is an emerging disease in Nigeria now. We see people less than 17 years being diagnosed with diabetes. Another major threat is that we have had children diagnosed at infancy with diabetes and the issue of diabetes is that it is not only a disease that is composed of sugar, sugar is all over the body, but the complications of diabetes are the issues. We have issues which affect the eyes, kidneys, heart; we have issues of diabetes causing hypertension, food disease.”
Listing the way forward, the DAN President called on the government and manufacturers to subsidize diabetic drugs because they are very expensive and beyond the reach of many Nigerians living with diabetes.
Apart from subsidising the drugs, “we also have to look at an alternative source of funding the National Health Insurance Scheme (NHIS) to increase coverage”, he noted.
He pointed out that the country’s current policy is not conducive for diabetic patients, hence the need for more holistic one that would comprehensively address many of the complications associated with the disease.
“In diabetes treatment, only few drugs are covered in the NHIS. The current scheme only covers 14 days of hospital admission. So, if someone spends three months in the hospital and requires insulin, how much insulin does he get from the health insurance scheme? So, the whole issue of the health insurance policy has to change in terms of increasing the coverage. The Federal Government has to look at the issue of diabetes beyond hospitals, diabetes is all about education, we have to have a robust education for patients”, he said.
The Keynote Speaker, Dr Andrew Clarke from South Africa, in his address, said reducing foot ulcers and amputations requires a multidisciplinary foot care team.
Clarke recommended early detection of risk factors for foot ulcers and amputations such as infections while appealing to those affected to visit podiatrists for appropriate foot wear.
Clarke also suggested the creation of a database to ensure that all known diabetic patients receive annual foot examination by healthcare practitioners capable of recognizing risk factors for ulceration and amputation.
Also, Head, Department of Medicine, College of Health Sciences, University of Abuja, Prof. Felicia Anumah, stressed the need for healthcare workers to constantly educate diabetic patients on the risk factors for foot ulcers and amputations.
The Professor of Endocrinology and Diabetology , affirmed that diabetic education remains one of the most effective ways of managing diabetes while reminding medical practitioners that they owe patients the responsibility of education . “The first step to prevention is patient education. The more information you can provide your patient, the better they understand the condition and adhere to treatment”, she said.
She identified wrong foot wear, poor foot hygiene and infections as some of the risk factors for foot ulcers and amputations.