A. Benyaich1, S. Aebischer Perone2, L. Angama Mueller3, L. Fakih4, Y. Sidler3, A. Bourgeois5, B. Matagne6, C.A. Barth3, E. Bernabeu Mira7
1International Committee of the Red Cross, Physical Rehabilitation Program, Beirut, Lebanon, 2International Committee of the Red Cross, Geneva Health Unit, Geneva, Switzerland, 3International Committee of the Red Cross, Physical Rehabilitation Program, Geneva, Switzerland, 4American University of Beirut, Public Health, Beirut, Lebanon, 5International Committee of the Red Cross, Physical Rehabilitation Program, Quito, Ecuador, 6International Committe of the Red Cross, Physical Rehabilitation Program, Lomé, Togo, 7International Committee of the Red Cross, Physical Rehabilitation Program, Niamey, Niger

Background: Number of people in the world with diabetes has doubled since 1980 with 422 million people estimated to be living with diabetes in 2020 (WHO). The prevalence of diabetes is growing rapidly in low and middle-income countries (LMIC).  Up to 85% of lower limb amputations in people with diabetes follow a Diabetic Foot Ulcer. In many conflict and post conflict settings, number of persons with lower limb amputations with Non-Communicable-Disease (NCD) seen at the International Committee of Red Cross (ICRC) supported Physical Rehabilitation Centers (PRC) is high, 19% in Lebanon (2018), 50% in Gaza (2016), 17% Erbil (2017).  A lack of health prevention, education, access to comprehensive diabetes management including appropriate referral lead to the development of diabetic foot ulcer with high risk of subsequent amputation. Strengthening patients’ referral between ICRC supported PRC and Primary Health Care Centers (PHC) enables to ensure the continuum of care for patients at risk.

Purpose: Identify training needs on diabetic foot care among ICRC health staff and implication to better address services in conflicts contexts through interprofessional consultations based on informed-evidence and self- perceptions.

Methods: An anonymous training needs questionnaire on diabetic foot management was sent on 15 March 2020 to about 50 health professionals working in ICRC projects in 40 countries. The questionnaire was divided into four themes and 5 questions: (1) Participants and countries determinants; (2) Contexts’ needs and gaps; (3) 9 questions on knowledge, skills competencies with a Likert scale; (4) Key strategies explored with open questions.  The data collection was finalized on 30 April 2020 and analyzed using the Kobo toolbox to understand barriers and develop best practices for diabetic foot care.

Results: 29 participants from 18 countries (45% from Africa) with a high prevalence of diabetes returned the questionnaire (only 2 sites had a prevalence of less than 5%). Participants were physiotherapists (n=11), medical doctors (n=7), nurses (n=5), ortho-prosthetists (n=4) and others (n=2).  More than three quarters of participants mentioned the lack of health prevention (n=26), referral systems (n=23) and of trained professional (n=23) as main barrier. About 50% of participants reported lack of knowledge in pain management, wound care and offloading techniques. Development of clinical training, raising awareness and referral pathways, are the main enabling actions recommended by participants.

Conclusion(s): Our findings contributed to identify baseline information about needs and gaps in the field of diabetic foot care in conflict and post conflicts contexts, feeding the development of a comprehensive training that includes a broad spectrum of inter-professional stakeholders (physiotherapists, ortho-prosthetists, nurses, and medical doctors).

Implications: To improve the management of diabetic foot care and quality of life of diabetic persons in health centers supported by ICRC through a comprehensive training including interprofessional clinical management and referral pathways. 

Funding, acknowledgements: International Committee of The Red Cross (ICRC)

Keywords: Diabetic foot care management, Conflicts-post conflicts contexts, Multidisciplinary clinical training

Topic: Non-communicable diseases (NCDs) & risk factors

Did this work require ethics approval? No
Institution: Commission Cantonale d'Ethique de la Recherche (CCER)
Committee: Commission Cantonale d'Ethique de la Recherche (CCER) in Geneva
Reason: Questionnaire is anonymous focus on knowledge, skills of ICRC personnal, self perceptions and gaps

All authors, affiliations and abstracts have been published as submitted.

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