Footwear for every diabetic – prevent ulcers , prevent amputations, Pakistan

Objectives

A burden of diabetic foot prevails in Pakistan and other developing countries. The widespread use of inappropriate footwear is one of the major reasons for the lack of progress in reducing ulceration and amputation rates in people with diabetes.

In Pakistan, two parallel health care systems exist; the public and the private system. In the public system, in most instances no separate diabetes care institutions exist and specialised diabetes care services are not available. The treatment cost in the public sector is low or negligible but the facilities and services are scanty.

Comparatively better facilities and services are available in the private sector but the cost of treatment is very high and not affordable by the majority of the population, as the vast majority is living under the poverty line. Even in the private sector, specialised diabetes care institutions are few and located in the large cities only. These are unable to cater the huge and ever increasing burden of diabetes, diabetic foot and other complications of diabetes.

This project focuses on the prevention of foot ulcers and amputations caused by diabetes. It will create focused awareness on foot care and foot wear, identify feet at risk, build capacity in footwear manufacturing for people with diabetes and establish sustainable footwear facilities in the country.

Approach

Baqai Institute of Diabetology and Endocrinology (BIDE) is the main collaborating partner of the project. It is a tertiary care diabetes care and academic institution. Other 10 collaborating partners are the tertiary care centers located in various parts of the country.

The project activities include:

Preparation of foot care and footwear training and educational materials based on existing and recognised material, incl. learnings from previous WDF funded projects in Pakistan (e.g. WDF07-261).

Training of trainers (ToTs) of foot care assistants and cobblers from the main foot care facility at BIDE (1 week) by a team of senior experts from BIDE, including an international footwear trainer and specialist.

Training of foot care assistants and cobblers (1 week) from tertiary health care facilities in the performance of team risk assessments of patients, in prescription of footwear according to risks observed and footwear manufacturing; yearly refresher courses will be held.

Provision of advanced footwear production equipment to BIDE to strengthen the institute as a main footwear and training facility, with subsequent provision to targeted facilities of basic footwear manufacturing equipment in order to produce low-cost and standardised footwear.

Roll out of foot care education and risk assessments of foot ulcers and peripheral vascular diseases of diabetes patients attending the already established diabetes clinics at targeted facilities. Follow up of complicated cases every 1-3 months and provision of footwear to patients requiring specialised footwear.

Results at completion

11 Diabetic foot assessment clinics and footwear manufacturing facilities established
20 ToTs trained
Pre/post assessment of training skills performed
171,584 diabetes patients screened for diabetic foot complications
102,950 people identified with feet at risk, 15,743 people with foot ulcers treated and 0 amputations conducted
20,000 pairs of low cost shoes manufactured and provided to people with diabetes
Electronic records for data on indicators related to capacity building and clinical impact established at targeted clinics