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Effect of Community-Based Peripheral Neuropathy Screening on Peripheral Neuropathy Detection among Adults with Diabetes in Nigeria

Abstract

Peripheral neuropathy is a common complication of diabetes and an important public health concern among adults living with diabetes in Nigeria. Persistent abnormalities in blood glucose levels may contribute to nerve damage, particularly in the lower limbs, resulting in symptoms such as numbness, tingling, burning sensations, reduced sensation, pain, and weakness. Peripheral neuropathy may develop gradually and remain undetected when symptoms are mild or absent, increasing the risk of foot injuries, ulcers, infections, impaired mobility, and other diabetes-related complications. Limited access to routine diabetes complication screening, inadequate awareness, financial constraints, geographical barriers, and shortages of trained healthcare professionals may contribute to delayed detection among adults with diabetes. Community-based peripheral neuropathy screening provides an opportunity to identify neurological abnormalities among people living with diabetes through community outreach programmes, primary healthcare centres, diabetes support programmes, mobile health services, and other accessible community platforms. Early detection may facilitate appropriate foot-care education, glycaemic management, clinical evaluation, preventive interventions, and referral for specialized care where necessary. Against this background, this study investigates the effect of community-based peripheral neuropathy screening on peripheral neuropathy detection among adults with diabetes in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how adults with diabetes' perceptions of susceptibility to peripheral neuropathy, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in community-based peripheral neuropathy screening. The Social Ecological Model emphasizes the influence of individual, household, community, socioeconomic, behavioural, and healthcare factors on diabetes self-management, foot-care practices, healthcare-seeking behaviour, and access to complication screening. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective community-based diabetes complication screening and management programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based peripheral neuropathy screening may influence peripheral neuropathy detection among adults with diabetes in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 18 years and above with diagnosed diabetes mellitus residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, diabetes clinics, and eligible adults with diabetes. Community-based peripheral neuropathy screening will be measured using indicators such as availability of screening services, screening coverage, frequency of screening activities, assessment of neuropathic symptoms, foot examination, sensory testing, monofilament testing where appropriate, vibration or other neurological assessments where available, availability of trained healthcare personnel, diabetes and foot-care education, screening equipment, and referral arrangements. Peripheral neuropathy detection will be assessed using indicators such as abnormal sensory findings, reduced protective sensation, neuropathic symptoms, abnormal monofilament or other appropriate neurological test results, newly detected peripheral neuropathy, severity of neuropathic impairment, identification of individuals at increased risk of diabetic foot complications, referrals for further clinical evaluation, and linkage to appropriate diabetes and foot-care services. Data will be collected using structured questionnaires, community screening registers, neurological assessment forms, diabetes clinic records, foot examination records, referral registers, and relevant community health programme documents. Descriptive statistics will be used to summarize participants' characteristics, diabetes-related factors, screening coverage, neurological findings, and patterns of peripheral neuropathy detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of community-based peripheral neuropathy screening on peripheral neuropathy detection. Where appropriate, peripheral neuropathy detection rates before and after implementation of community-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based peripheral neuropathy screening has a significant positive effect on peripheral neuropathy detection among adults with diabetes in Nigeria. Adults with diabetes who participate in community-based peripheral neuropathy screening are expected to have a higher likelihood of having previously undetected neurological abnormalities identified than those without access to such services. Community-based screening may facilitate early recognition of sensory loss and other neuropathic symptoms and provide opportunities for appropriate clinical evaluation and preventive foot-care interventions. Early detection may support improved diabetes self-management, foot-care education, appropriate glycaemic management, injury prevention, and timely referral for specialized assessment where necessary. Bringing screening services closer to adults with diabetes may reduce geographical, financial, and time-related barriers and encourage participation in routine diabetes complication assessments. Community-based health education may also improve awareness of peripheral neuropathy symptoms, foot-care practices, appropriate footwear, injury prevention, and the importance of seeking medical attention for foot abnormalities. Conversely, inadequate screening coverage, limited diagnostic equipment, shortage of trained healthcare personnel, low participation, financial constraints, and weak referral and follow-up systems may reduce the effectiveness of community-based peripheral neuropathy screening. The study therefore expects accessible and well-organized community-based peripheral neuropathy screening to contribute significantly to improved detection and early management of peripheral neuropathy among adults with diabetes in Nigeria. The study is expected to contribute to the literature on community-based peripheral neuropathy screening, peripheral neuropathy detection, diabetes complications, diabetic foot health, diabetes self-management, community health services, preventive healthcare, chronic disease management, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, diabetes clinics, endocrinologists, neurologists, podiatrists and foot-care professionals, community health workers, diabetes educators, development partners, and policymakers regarding strategies for preventing diabetes-related neurological complications. The study will also provide evidence-based recommendations for expanding community-based peripheral neuropathy screening programmes, improving access to appropriate neurological and foot assessments, strengthening training of healthcare workers in peripheral neuropathy screening, increasing diabetes and foot-care education, improving availability of screening equipment, strengthening referral and follow-up systems, promoting early management of detected neuropathy, and integrating peripheral neuropathy assessment into comprehensive community-based diabetes care programmes across Nigeria.

Keywords: Community-based peripheral neuropathy screening, peripheral neuropathy detection, adults with diabetes, diabetic neuropathy, diabetes complications, diabetic foot health, neurological screening, diabetes management, preventive healthcare, community health services, Nigeria, public health.