Prevalence of Infected Diabetic Foot Ulcers in Kisumu County, Kenya: Identifying Risk Factors

Silas O. Awuor; Eric O. Omwenga; Eliud Wafula; Ibrahim I. Daud; Richard M. Mariita

Abstract

Diabetic foot ulcers (DFUs) represent a major cause of hospitalization and amputation worldwide. The prevalence and specific risk factors for infected DFUs, however, remain inadequately characterized among people living with diabetes (PLWD) in Kisumu County, Kenya. The present study sought to determine these prevalence and to identify associated clinical determinants. A cross-sectional study employing stratified random sampling was conducted at three major referral hospitals in Kisumu. A total of 471 PLWD were recruited. Data collection comprised sociodemographic interviews, clinical record reviews, and DFU screenings, including assessments for peripheral neuropathy, ankle-brachial index, and ulceration. The relationship between variables was assessed using chi-square analysis and logistic regression modeling, with a significance threshold defined at p-values below 0.05. Among participants (51.8% male; mean age 57.5 ± 13 years), the majority had Type 2 diabetes. Clinical assessments indicated a substantial burden of foot pathology, with fungal infection markers detected in 63.1% of males and 43.2% of females. A history of foot ulceration was significantly associated with diabetes duration exceeding 11 years (p < 0.001). Distal neuropathy was identified as an independent predictor of diabetic foot ulcers, showing a statistically significant association (OR = 1.8; 95% CI: 1.1–2.6; p = 0.029). In contrast, insulin treatment demonstrated a lower prevalence association against DFU development. The findings indicate a substantial burden of DFU risk in Kisumu County, primarily attributable to neuropathy and prolonged disease duration. The observed protective association of insulin highlights potential therapeutic benefits. These results emphasize the urgent need for policies mandating routine foot screening and optimizing insulin use in primary care to prevent limb loss.

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