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Impact of Diabetic Foot Screening on Early Detection of Foot Complications among Adults with Diabetes in Nigeria

Abstract

Diabetes mellitus is a major public health concern and may lead to several complications, including peripheral neuropathy, peripheral arterial disease, skin damage, foot ulcers, infection, and lower-limb amputation. Diabetic foot complications may develop gradually and may remain unnoticed, particularly when individuals have reduced sensation or limited awareness of early warning signs. Early identification of foot abnormalities through regular diabetic foot screening provides an opportunity for timely intervention, patient education, appropriate treatment, and prevention of complications. However, inadequate access to routine foot screening, limited availability of trained healthcare professionals, insufficient screening equipment, low patient awareness, financial barriers, and weak referral systems may contribute to delayed detection and management of diabetic foot problems in Nigeria. Against this background, this study investigates the impact of diabetic foot screening on early detection of foot complications among adults with diabetes in Nigeria. The study will be anchored on the Health Belief Model, Chronic Care Model, and Health Systems Framework. The Health Belief Model explains how adults with diabetes' perceptions of their susceptibility to diabetic foot complications, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in foot screening. The Chronic Care Model emphasizes proactive healthcare, self-management support, clinical decision-making, delivery-system design, and follow-up in the prevention and management of chronic disease complications. The Health Systems Framework emphasizes service delivery, healthcare workforce, health information, medical equipment and technologies, financing, accessibility, and referral systems as essential components of effective diabetic foot screening and care. Collectively, these theoretical perspectives provide a suitable framework for explaining how diabetic foot screening may influence early detection of foot complications among adults with diabetes in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise adults aged 18 years and above diagnosed with diabetes and receiving care in selected hospitals and primary healthcare facilities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, healthcare facilities, diabetes clinics, and eligible adults with diabetes. Diabetic foot screening will be assessed using indicators such as availability and frequency of screening, trained healthcare personnel, foot inspection, assessment of skin integrity, evaluation of peripheral sensation, assessment of peripheral pulses and circulation where appropriate, identification of deformities, footwear assessment, risk classification, patient education, documentation of findings, referral arrangements, and follow-up procedures. Early detection of foot complications will be assessed using indicators such as identification of peripheral neuropathy, skin abnormalities, calluses, foot deformities, reduced sensation, circulation abnormalities, pre-ulcerative lesions, existing ulcers, signs of infection, and other clinically relevant abnormalities detected during screening. Appropriate validated clinical foot-screening tools may be used to improve consistency and reliability of assessment. Data will be collected using structured questionnaires, standardized diabetic foot screening forms, clinical examination records, diabetes clinic registers, referral records, and relevant healthcare facility documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, and foot examination findings. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of diabetic foot screening on early detection of foot complications. Where a quasi-experimental design is adopted, detection rates before and after implementation of systematic diabetic foot screening 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 diabetic foot screening has a significant positive impact on the early detection of foot complications among adults with diabetes in Nigeria. Adults who receive regular diabetic foot screening are expected to have a higher likelihood of previously unrecognized foot abnormalities being identified than adults without routine screening. Systematic screening may facilitate early identification of neuropathy, skin abnormalities, circulation problems, deformities, and pre-ulcerative conditions before they progress to severe complications. Early detection may allow healthcare providers to provide appropriate treatment, foot-care education, footwear recommendations, closer monitoring, and timely referral to relevant specialists. Regular screening may also increase patients' awareness of diabetic foot risks and encourage appropriate self-care practices. However, inadequate equipment, shortage of trained healthcare personnel, financial constraints, low patient awareness, inconsistent clinic attendance, limited access to specialist services, and weak referral and follow-up systems may reduce the effectiveness of diabetic foot screening programmes. The study therefore expects accessible, standardized, and regularly implemented diabetic foot screening to contribute significantly to improved early detection and prevention of serious foot complications among adults with diabetes in Nigeria. The study is expected to contribute to the literature on diabetic foot screening, early detection of foot complications, diabetic foot prevention, diabetes management, peripheral neuropathy, foot ulcer prevention, chronic disease care, 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, hospitals, primary healthcare centres, diabetes clinics, physicians, nurses, podiatrists, physiotherapists, community health workers, diabetes educators, development partners, and policymakers regarding strategies for reducing diabetes-related foot complications. The study will also provide evidence-based recommendations for integrating routine diabetic foot screening into diabetes care, improving access to appropriate screening equipment and trained healthcare personnel, strengthening foot-risk documentation and referral systems, improving patient foot-care education, and establishing effective follow-up mechanisms for adults with diabetes across Nigeria.

Keywords: Diabetic foot screening, early detection, foot complications, diabetes mellitus, diabetic foot, peripheral neuropathy, foot ulcer prevention, diabetes management, chronic disease care, adults, Nigeria, public health.