Diabetes-related amputations in the public healthcare sector in KwaZulu-Natal: a five-year perspective. Are we winning?

Background: Diabetes-related complications in the form of lower limb amputations (LLA) remain a major concern globally in the form of both human suffering and increased fiscal burden. Studies conducted in developed countries have demonstrated that the burden of diabetes-related amputations is on the decrease. These decreasing trends in developed countries provide an insight (a surrogate marker) into overall diabetes control achieved in these countries. Similar data from studies conducted in South Africa and Africa itself are scarce. Methods: The data collected by Department of Health Information Systems (DHIS) for all patients with diabetes seen at public healthcare facilities within KwaZulu-Natal from 2013 to 2017 inclusive were assessed. The DHIS data element used for this study was ‘diabetes-related amputations’. The location of the hospital was used to classify them as urban or rural. Data relating to type of housing, access to piped water, electricity and sanitation were obtained from the South African mid-year population estimates from 2016. Results: This study demonstrated that a strong positive correlation existed between amputation rate and the increasing years of the study (r？=？0.70). The trend in diabetes-related LLA in 5 of the 11 districts (45.45%) had an upward slope. The incidence of LLA was on an upward trend in urban compared with rural areas (slope 71.90？±？26.75 vs 5.20？±？10.04, respectively). Positive slopes for LLA were noted in both regional and tertiary KwaZulu-Natal hospitals (48.00？±？44.67 and 19.80？±？36.38 respectively). The prevalence of diabetes-related LLA was associated with poor accessibility to adequate housing, piped water, electricity and sanitation. Each of these four variables independently had a significant effect on the prevalence of LLA within all districts in KwaZulu-Natal. Conclusion: Diabetes-related LLA serves as a surrogate marker for overall diabetes control within a country. This study has shown that there was a strong positive correlation between amputation rates and time within KwaZulu-Natal. This finding serves as an indicator that only sub-optimal diabetes control is still being achieved