{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:40:37Z","timestamp":1789486837057,"version":"build-2803163510"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetes\u2010related lower\u2010limb amputation (LLA) is a major global health problem; although rates have declined in some high\u2010income settings, the burden in low\u2010 and middle\u2010income countries (LMICs) has not been systematically quantified. This review aimed to estimate the prevalence and incidence of diabetes\u2010related LLA in LMICs, based on available published evidence from community and facility\u2010based populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following a PROSPERO\u2010registered protocol (CRD42021238656), we searched Medline, CINAHL, AJOL, Scopus, Embase, and Google Scholar (January 1990\u2013June 2025) for quantitative studies reporting diabetes\u2010related LLA in LMICs from community and facility populations. Data were extracted using Joanna Briggs Institute tools, low\u2010quality studies were excluded from quantitative synthesis, and meta\u2010analyses used the Freeman\u2013Tukey double\u2010arcsine transformation; subgroup analyses (age, sex, WHO region, high\u2010risk groups) explored heterogeneity, and certainty of evidence (CoE) was assessed with GRADE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 201 included studies from 32 LMICs, 121 moderate\u2010to\u2010high\u2010quality studies were meta\u2010analyzed; most were facility\u2010based high\u2010risk cohorts (especially diabetic foot or advanced\u2010complication care). Pooled prevalence was 23 per 100 individuals (95% CI 0.21\u20130.24;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a089; moderate CoE), incidence 29 per 100 (95% CI 0.25\u20130.32;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a029; low CoE), re\u2010amputation 31 per 100 (95% CI 0.14\u20130.48;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a08; low CoE), and contralateral amputation 23 per 100 (95% CI 0.13\u20130.33;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a02; very low CoE).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Diabetes\u2010related LLA remains a substantial burden in LMICs, while scarce population\u2010based data highlights key surveillance gaps for prevention planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70493","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:26:06Z","timestamp":1784096766000},"page":"2750-2759","source":"Crossref","is-referenced-by-count":0,"title":["Lower Limb Amputations Among Individuals Living With Diabetes Mellitus in Low\u2010 and Middle\u2010Income Countries: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9068-6979","authenticated-orcid":false,"given":"Kriste N.","family":"Alberts","sequence":"first","affiliation":[{"name":"Department of Surgery Centre for Global Surgery Stellenbosch University  Stellenbosch Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0015-296X","authenticated-orcid":false,"given":"Mercia N.","family":"Companie","sequence":"additional","affiliation":[{"name":"Department of Surgery Centre for Global Surgery Stellenbosch University  Stellenbosch Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2801-288X","authenticated-orcid":false,"given":"Maxine P.","family":"Kerrod","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences Stellenbosch University  Stellenbosch Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4695-9028","authenticated-orcid":false,"given":"Jessica","family":"Davies","sequence":"additional","affiliation":[{"name":"International Association of Student Surgical Societies  Stellenbosch Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4735-008X","authenticated-orcid":false,"given":"Rosa D. E.","family":"Bock","sequence":"additional","affiliation":[{"name":"St John's Hospital NHS Lothian  Lothian UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7864-7467","authenticated-orcid":false,"given":"Cinae","family":"Swart","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences Stellenbosch University  Stellenbosch Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5575-7842","authenticated-orcid":false,"given":"Eyitayo O.","family":"Owolabi","sequence":"additional","affiliation":[{"name":"Department of Surgery Centre for Global Surgery Stellenbosch University  Stellenbosch Cape Town South Africa"},{"name":"Center for Health Promotion and Disease Prevention Edson College of Nursing and Health Innovation Arizona State University  Tempe Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6834-1838","authenticated-orcid":false,"given":"Justine","family":"Davies","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8923-7447","authenticated-orcid":false,"given":"Kathryn M.","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Surgery Centre for Global Surgery Stellenbosch University  Stellenbosch Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2730-6478","authenticated-orcid":false,"given":"Michael","family":"McCaul","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics Department of Global Health Stellenbosch University  Stellenbosch Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"IDF Diabetes Atlas","author":"Duke L.","year":"2019"},{"key":"e_1_2_13_3_1","unstructured":"World Health Organization (WHO). \u201cDiabetes Key Facts \u201d (2024) accessed February 17 2026 https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/diabetes."},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010009\u20101638\u20107"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010012\u20102588\u2010z"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc19\u20101614"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000967"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2011.03279.x"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0182081"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/s2666\u20107568(21)00089\u20101"},{"key":"e_1_2_13_11_1","volume-title":"Chapter 5: Systematic Reviews of Prevalence and Incidence","author":"Moola S.","year":"2020"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0266907"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.46658\/JBIMES-20-06"},{"key":"e_1_2_13_14_1","unstructured":"H. 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