Abstract:
BACKGROUND: Diabetes mellitus (DM) is a global health concern that has greatly affected South Africa. The gap in the current management of DM has resulted in complications such as lower extremity amputations (LEAs) and death. Eastern Cape province reflects this struggle, with disparities in access to healthcare and poor health outcomes. Understanding survival rates and associated factors between the urban Livingstone Hospital and the rural Nelson Mandela Academic Hospital can improve health interventions and outcomes.
OBJECTIVES: This study compared the survival rate of patients in urban areas and those in rural areas.
METHOD: This retrospective cohort study was conducted in an urban and a rural hospital by reviewing existing medical records of diabetic patients who underwent an LEA between 2016 and 2019.
RESULTS: The retrospective cohort study examined 439 diabetic-related LEA cases. This study found that residing in rural areas significantly decreased the risk of mortality by 62% compared with living in the urban areas. Factors such as haemoglobin A1c (HbA1c) levels, nephropathy, cardiovascular disease, human immunodeficiency virus (HIV), other comorbidities and level of amputation significantly influenced survival probabilities.
CONCLUSION: Survival analysis indicated a significant difference in the 3-year survival probabilities of the two groups, favouring rural residency (p = 0.001). The biggest cause for concern between the two regions was uncontrolled blood glucose levels as this resulted in high mortality rates.
CONTRIBUTION: Insights from this study have shown that introducing podiatry and orthotics at primary healthcare (PHC) could improve foot care and reduce diabetic-related LEAs and mortality.
