Step by Step Project
For Prevention of Amputation in Egypt

Prof. Hanan Gawish

Diabetic Foot is one of the most common and feared complications of diabetes that might lead to limb amputation especially in developing countries.

The prevalence of diabetic foot ulcers in Egyptian population has been found to be 6.9% among outpatient people with diabetes. Surprisingly, the commonest reasons for that were found to be inappropriate footwear in 61.6% and the lack of knowledge regarding diabetic foot problems in 93.8%. Previous studies have shown that with proper provision including regular follow-up and education of the patient, the rate of diabetic foot problems resulting in amputation may be reduced.

The necessity to have a‘Step by Step project for prevention of Amputation in Egypt was clear, especially after its success in other countries as Tanzania and Pakistan. The project was funded by the World Diabetes Foundation to increase awareness and improve care for diabetic foot patients.

Mansoura University -that hasleaded the implementation of the project- lies in north Egypt, Delta region. It was the first clinic in the country that provides integrated, multidisciplinary foot care services to people with diabetes. The project aimed at establishment of a network of 30 basic diabetic foot clinic. This was done through training of 30 medical teams consisting of a doctor and a nurse over 2 courses; a basic and an advanced. During the basic course, participants were taught to perform physical examinations, screen for neuropathy and ischemia, classify and stage the foot, and organize appropriate foot care and education. Emphasis was also put on acquiring teaching skills to enable the participants to educate their patients and passing on the gained knowledge to their colleagues in their home region and thereby creating a spin-off effect. After one year, the trained teams were called for an advanced course with emphasis on advanced foot pathology cases through interactive sessions focusing on sharing of experience among the trained teams. The teams presented and discussed cases experienced in their respective clinics over the previous year.

Appropriate education materials were created by Mansoura foot team: an Atlas booklet for nurses, an educational DVD in Arabic for patients, and another one for physicians in English to be used in the education of their colleagues. Each team was supplied with basic instrumentation to start diabetic foot clinics.

Consequently, the Egyptian Society of Diabetic Foot was founded. It is a nongovernmental organization that aims to enhance foot care in Egypt through spreading the knowledge and enhancing active collaboration between all specialties interested in saving limbs and lives of people with diabetes.

References:El-Nahas et al, The prevalence of risk factors for foot ulceration in Egyptian diabetic patients. Practical Diabetes International, Volume 25, Issue 9, pages 362–366, November/December 2008