{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:31:24Z","timestamp":1786739484436,"version":"build-2736575974"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Lower extremity amputation (LEA) in individuals with diabetes is a serious health issue with a considerable physical and social burden. The aim of this study was to assess the prevalence and risk factors associated with LEA in diabetic foot ulcer (DFU) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This was a cross-sectional health facility-based study that recruited 315 diabetes individuals with foot ulcers from the diabetes center in Khartoum, Sudan. Direct interviewing of subjects was used to obtain data, using a standardized validated questionnaire. Chi-square and logistic regression analysis were used in data analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      69.5% of the diabetic participants were aged 50 years old or more, and 71.1% were males. Most of the subjects (48.2%) were diabetics for a duration of &gt;10 years, while more than one third (37.5%) of them were diabetic for 5\u201310 years. The majority (89.5%) had type 2 DM, while only 10.5% were type 1 DM. Two hundred forty-five patients had a left lower foot ulcer; 55.1% of the patients' ulcers were present in the toes, while 21.6% were in the foot sole. The overall prevalence of lower limb amputation was 17.1%. Individuals with diabetes patients with LEA had a higher incidence of hypertension (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.000), retinopathy (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.000), nephropathy (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002), ulcer size &gt;2.5 cm (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.000), and neuropathy (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.000) through Chi-square analysis. Furthermore, logistic regression analysis showed that amputation was significantly associated with retinopathy (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.000), size of ulcer (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.000), and neuropathy (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.016).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The overall prevalence of LEA was 17.1%. The primary risks factors associated with amputation were presence of neuropathy and ulcer size &gt;2.5 cm. Presence of retinopathy predispose diabetic individuals to amputation. Amputation is associated with disability and psychological problems; therefore, there is an urgent need for more improvement in preventative measures and primary health care system in low resource setting country like Sudan in order to decrease diabetes complications, especially patient's education about diabetes management by primary care physicians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfmpc.jfmpc_1881_20","type":"journal-article","created":{"date-parts":[[2021,2,26]],"date-time":"2021-02-26T15:18:45Z","timestamp":1614352725000},"page":"985-990","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Risk factors associated with lower extremity amputation in Sudanese individuals with diabetes: The need for improvement in primary health care system"],"prefix":"10.4103","volume":"10","author":[{"given":"Alaa Tag E.","family":"Elkhider","sequence":"first","affiliation":[{"name":"Public and Tropical Health Program, Graduate College, University of Medical Sciences and Technology, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed O.","family":"Almobark","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, P. 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Box 12810, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safaa","family":"Badi","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Faculty of Pharmacy, Omdurman Islamic University, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanan","family":"Tahir","sequence":"additional","affiliation":[{"name":"Public and Tropical Health Program, Graduate College, University of Medical Sciences and Technology, Khartoum, Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azza","family":"Ramadan","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Al-Ain University, Abu Dhabi, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas A.","family":"Khalil","sequence":"additional","affiliation":[{"name":"Department of Medicine, Arrowe Park Hospital, Arrowe Park Rd, Upton, Birkenhead, Wirral, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elamin","family":"Elshaikh","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed H.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eagelstone, Milton Keynes, Buckinghamshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,2]]},"reference":[{"key":"R1-20260527","first-page":"16","article-title":"Management of diabetic foot ulcers: A review","volume":"33","author":"Frykberg","year":"2016","journal-title":"Fed Pract"},{"key":"R2-20260527","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1001\/jama.293.2.217","article-title":"Preventing foot ulcers in patients with diabetes","volume":"293","author":"Singh","year":"2015","journal-title":"JAMA"},{"key":"R3-20260527","first-page":"1655","article-title":"Diabetic foot ulcers: Pathogenesis and management","volume":"66","author":"Frykberg","year":"2002","journal-title":"Am Fam Physician"},{"issue":"Suppl 1","key":"R4-20260527","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1002\/1520-7560(200009\/10)16:1+<::AID-DMRR139>3.0.CO;2-8","article-title":"What is the most effective way to reduceincidence of amputation in the diabetic foot?","volume":"16","author":"Apelqvist","year":"2000","journal-title":"Diabetes Metab Res Rev"},{"key":"R5-20260527","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1001\/archinte.1992.00400150120022","article-title":"The prevalence and incidence of lower extremity amputation in a diabetic population","volume":"152","author":"Moss","year":"2012","journal-title":"Arch Intern Med"},{"key":"R6-20260527","doi-asserted-by":"crossref","first-page":"607","DOI":"10.2337\/diacare.19.6.607","article-title":"Risk factors predicting lower extremity amputation in patients with NIDDM","volume":"19","author":"Lehto","year":"2016","journal-title":"Diabetes Care"},{"key":"R7-20260527","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1590\/S1020-49892012000900004","article-title":"Diabetes-related lower-extremity amputation incidence and risk factors: A prospective seven-year study in Costa Rica","volume":"32","author":"Lacle","year":"2012","journal-title":"Rev Panam Salud Publica"},{"key":"R8-20260527","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.foot.2011.09.003","article-title":"Incidence, risk factors for amputation among patients with diabetic foot ulcer in a North Indian tertiary care hospital","volume":"22","author":"Zubair","year":"2012","journal-title":"Foot"},{"key":"R9-20260527","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/1534734603002001004","article-title":"A case-control study of the risk factors for toe amputation in a diabetic population","volume":"2","author":"Carlson","year":"2003","journal-title":"Int J Lower Ext Wounds"},{"key":"R10-20260527","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.jdiacomp.2014.04.011","article-title":"The independent contribution of diabetic foot ulcer on lower extremity amputation and mortality risk","volume":"28","author":"Martins-Mendes","year":"2014","journal-title":"J Diabetes Complications"},{"key":"R11-20260527","doi-asserted-by":"crossref","first-page":"286","DOI":"10.14310\/horm.2002.1245","article-title":"Predictors of amputation in diabetics with foot ulcer: Single center experienced in a large Turkish cohort","volume":"8","author":"Yesil","year":"2009","journal-title":"Hormones (Athens)"},{"key":"R12-20260527","first-page":"S1","article-title":"Diabetic foot disorders: A clinical practice guideline. 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