Background: Although the awareness, diagnosis, management of the complications associated with diabetes have improved in African countries over the past decade, surveillance activities in Tanzania and anecdotal reports from other African countries have suggested an increased prevalence of Charcot Neuroarthropathy (CN) over the past few years. Aim: To characterize the epidemiology and the clinical burden of CN in a large diabetes population in Tanzania, and to evaluate outcomes of persons with the condition. Methods: This was a prospective analytic cohort study conducted between January 2013 through December 2015. Following informed consent, patients were followed at the outpatient clinic. Detailed clinical assessments and documented presence of diabetic peripheral neuropathy (DPN), macrovascular disease and microvascular disease were recorded. Education and counseling were part of the follow-up program. Results: 3271 ulcerations were presented at the clinic during the 3-year study period. 571 (18%) met the case definition for CN; all patients had Type 2 diabetes. The prevalence for each of the years 2013, 2014, and 2015 was 19/1192 (1.6%), 209/1044 (20%), and 343/1035 (34%), respectively; the increases in the slope of the trendline was statistically significant (P < .001). Conclusion: The prevalence of CN is increasing in the Tanzanian diabetes patient population, and is strongly associated with neuropathy. CN can lead to severe deformity, disability, and amputation. Due to the risk of limb amputation, patients with diabetes must seek immediate care if signs or symptoms appear and avoid delay in seeking medical attention. Early diagnosis of CN by caregivers is extremely important for successful outcomes.
AbbasZG. The diabetic foot worldwide: sub-saharan Africa. In: BoultonAJMRaymanGWukichD, eds. The Foot in Diabetes. 5th ed.John Wiley & Sons Ltd;2020:379‐385.
3.
ShiferawWSAkaluTYWorkY, et al. Prevalence of diabetic peripheral neuropathy in Africa: a systematic review and meta-analysis. BMC Endocr Disord. 2020;20:49. https://doi.org/10.1186/s12902-020-0534-5
4.
AbbasZGLutaleJKArchibaldLK. Diabetic foot ulcers and ethnicity in Tanzania: a contrast between african and asian populations. Int Wound J. 2009;6(2):124‐131.
5.
MorbachSLutaleJKViswanathanV, et al.Regional differences in risk factors and clinical presentation of diabetic foot lesions. Diabet Med. 2004;21(1):91‐95.
6.
AbbasZGLutaleJKBakkerKBakerNArchibaldLK. The ‘step by step’ diabetic foot project in Tanzania: a model for improving patient outcomes in less-developed countries. Int Wound J. 2011;8(2):169‐175.
7.
RogersLCFrykbergRGArmstrongDG, et al.The charcot foot in diabetes. Diabetes Care. 2011;34(9):2123‐2129.
8.
International Working group on the Diabetic Foot (IWGDF). The development of global consensus guidelines on the management and prevention of the diabetic foot 2019, www.iwgdf.org. https://iwgdfguidelines.org/guidelines/guidelines/Accessed 24th June 2020
9.
AbbasZGLutaleJKGameFLJeffcoateWJ. Comparison of four systems of classification of diabetic foot ulcers in Tanzania. Diabet Med. 2008;25(2):134‐137.
10.
CamilleriAGattAFormosaC. Inter-rater reliability of four validated diabetic foot ulcer classification systems. J Tissue Viability. 2020;29(4):284‐290. doi: 10.1016/j.jtv.2020.09.002.
11.
AbbasZGLutaleJKArchibaldLKJeffcoateWJ. Rat bite as a cause of diabetic foot ulcer in sub-Saharan Africa. Int Wound J. 2020;17(4):897‐899.
12.
WanzouJPVSekimpiPKomagumJONakwagalaFMwakaES. Charcot arthropathy of the diabetic foot in a sub-saharan tertiary hospital: a cross-sectional study. J Foot Ankle Res. 2019;12:33. doi: 10.1186/s13047-019-0343-0.
13.
FauziAAChungTYLatifLA. Risk factors of diabetic foot charcot arthropathy: a case control study at a Malaysian tertiary care centre. Singapore Med J. 2016. 57(4):198‐203.
14.
CavanaghPAttingerCAbbasZBalARojasNXuZR. Cost of treating diabetic foot ulcers in five different countries. Diabetes Metab Res Rev. 2012;28(Suppl 1):107‐111.
