{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:18Z","timestamp":1787016978650,"version":"build-2736575974"},"reference-count":28,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T00:00:00Z","timestamp":1660089600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["(098610\/Z\/12\/Z and 098610\/B\/12\/A)"],"award-info":[{"award-number":["(098610\/Z\/12\/Z and 098610\/B\/12\/A)"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"King's Health Partners Research and Development Challenge Fund","award":["MC_PC_16048"],"award-info":[{"award-number":["MC_PC_16048"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,6,8]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Low\/middle-income countries face a disproportionate burden of cardiovascular diseases. However, among cardiovascular diseases, burden of and associations with lower extremity disease (LED) (peripheral arterial disease and\/or neuropathy) is neglected. We investigated the prevalence and factors associated with LED among individuals known to have cardiovascular disease risk factors (CVDRFs) in Malawi, a low-income country with a significant prevalence of CVDRFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This was a stratified cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study was conducted in urban Lilongwe Area 25, and the rural Karonga Health and Demographic Surveillance Site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Participants were at least 18 years old and had been identified to have two or more known CVDRFs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>LED\u2014determined by the presence of one of the following: neuropathy (as assessed by a 10 g monofilament), arterial disease (absent peripheral pulses, claudication as assessed by the Edinburgh claudication questionnaire or Ankle Brachial Pulse Index (ABPI) &lt;0.9), previous amputation or ulceration of the lower limbs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 806 individuals enrolled into the study. Mean age was 52.5 years; 53.5% of participants were men (n=431) and 56.7% (n=457) were from the rural site. Nearly a quarter (24.1%; 95% CI: 21.2 to 27.2) of the participants had at least one symptom or sign of LED. 12.8% had neuropathy, 6.7% had absent pulses, 10.0% had claudication, 1.9% had ABPI &lt;0.9, 0.9% had an amputation and 1.1% had lower limb ulcers. LED had statistically significant association with increasing age, urban residence and use of indoor fires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrated that a quarter of individuals with two or more CVDRFs have evidence of LED and 2.4% have an amputation or signs of limb threatening ulceration or amputation. Further epidemiological and health systems research is warranted to prevent LED and limb loss.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-055501","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T11:23:35Z","timestamp":1660130615000},"page":"e055501","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Prevalence and risk factors of lower extremity disease in high risk groups in Malawi: a stratified cross-sectional study"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9208-4122","authenticated-orcid":false,"given":"Stephen","family":"Kasenda","sequence":"first","affiliation":[{"name":"Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Crampin","sequence":"additional","affiliation":[{"name":"Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi"},{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine","family":"Davies","sequence":"additional","affiliation":[{"name":"Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa"},{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"},{"name":"Medical Research Council\/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jullita Kenala","family":"Malava","sequence":"additional","affiliation":[{"name":"Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Manganizithe","sequence":"additional","affiliation":[{"name":"Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Kumambala","sequence":"additional","affiliation":[{"name":"Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Becky","family":"Sandford","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,8,10]]},"reference":[{"key":"2025101812401310000_12.8.e055501.1","doi-asserted-by":"publisher","DOI":"10.5830\/CVJA-2015-017"},{"key":"2025101812401310000_12.8.e055501.2","doi-asserted-by":"crossref","first-page":"2900","DOI":"10.1080\/09638288.2018.1480668","article-title":"Age and health-related quality of life, general self-efficacy, and functional level 12 months following dysvascular major lower limb amputation: a prospective longitudinal study","volume":"41","author":"Madsen","year":"2019","journal-title":"Disabil Rehabil"},{"key":"2025101812401310000_12.8.e055501.3","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0b013e3181a10241"},{"key":"2025101812401310000_12.8.e055501.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamasurg.2016.0446","article-title":"Peripheral arterial disease in sub-Saharan Africa: a review","volume":"151","author":"Johnston","year":"2016","journal-title":"JAMA Surg"},{"key":"2025101812401310000_12.8.e055501.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61249-0"},{"key":"2025101812401310000_12.8.e055501.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.08.049"},{"key":"2025101812401310000_12.8.e055501.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2012.05.019"},{"key":"2025101812401310000_12.8.e055501.8","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-016-0210-x"},{"key":"2025101812401310000_12.8.e055501.9","unstructured":"Chisala P , Sandford B . 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