Background and Objectives: Diabetic foot sepsis (DFS) accounts for approximately 60% of hospital admissions in patients with diabetes mellitus (DM). Individuals with DM are at risk of severe COVID-19. This study investigated factors associated with major amputation and mortality in patients admitted with DFS during the COVID-19 pandemic. Materials and Methods: Demographic information, COVID-19 and HIV status, clinical findings, laboratory results, treatment and outcome from records of patients with diabetic foot sepsis, were collected and analysed. Supervised machine learning algorithms were used to compare their ability to predict mortality due to diabetic foot sepsis. Results: Overall, 114 records were found and 57.9% (66/114) were of male patients. The mean age of the patients was 55.7 (14) years and 47.4% (54/114) and 36% (41/114) tested positive for COVID-19 and HIV, respectively. The median c-reactive protein was 168 mg/dl, urea 7.8 mmol/L and creatinine 92 µmol/L. The mean potassium level was 4.8 ± 0.9 mmol, and glycosylated haemoglobin 11.2 ± 3%. The main outcomes included major amputation in 69.3% (79/114) and mortality of 37.7% (43/114) died. AI. The levels of potassium, urea, creatinine and HbA1c were significantly higher in the deceased. Conclusions: The COVID-19 pandemic led to an increase in the rate of major amputation and mortality in patients with DFS. The in-hospital mortality was higher in patients above 60 years of age who tested positive for COVID-19. The Random Forest algorithm of ML can be highly effective in predicting major amputation and death in patients with DFS.

Background/Objective: Prevention of foot ulceration is critical to reduce the amputation rate in individuals with diabetes mellitus (DM). We investigated the knowledge of diabetic foot care management and prevention of diabetic foot ulcer (DFU) among categories of healthcare practitioners (HCPs). Methods: This descriptive cross-sectional observational study was conducted at public healthcare facilities within the Charlotte Maxeke Johannesburg Academic Hospital Cluster in Gauteng, South Africa. Participants included podiatrists, physiotherapists, occupational therapists, dieticians, medical orthotists and prosthetists, nurses, and medical doctors. Data were collected using a self-administered questionnaire that assessed knowledge of DFU risk factors, foot examination, foot care, and appropriate footwear. Knowledge level was classified as extremely poor if less than 50% of participants from a category of HCPs answered appropriately, reasonable for 50–59%, average at 60–69%, above average from 70–79%, and excellent when ≥80%. The questionnaire was completed by 449 HCPs and analyzed using STATA version 15, with statistical significance set at a p-value less than 0.05. Results: A total of 449 HCPs participated, which comprised the following: 48.1% (216) therapeutic health practitioners (THPs), 37.4% (168) nurses, and 14.5% (65) medical doctors. Only 36% (162) of participants had prior education on DFU. The overall knowledge levels among participants were risk factors of DFU (80%), foot examination (80%), identification of limb-threatening conditions (82%), foot care (77%), and footwear (65%). Medical doctors had the highest median scores for risk factors (85) and foot examination (80), followed by nurses (80 for risk factors and 78 for foot examination). THPs had the lowest median scores for risk factors (78) and foot examinations (70). Differences in knowledge levels across HCPs were statistically significant (p < 0.05). Conclusions: THPs have insufficient knowledge of diabetic foot care and prevention of DFUs. Comprehensive training and targeted educational programs are needed to fill these gaps and improve patient care.

Background: Diabetic foot sepsis (DFS) accounts for approximately 60% of hospital admissions in patients with diabetes mellitus (DM). Individuals with DM are at risk of severe COVID-19. This study investigated investigated factors associated with major amputation and mortality in patients admitted with DFS during the COVID-19 pandemic. Methods: Demographic information, COVID-19 and HIV status, clinical findings, laboratory results, treatment and outcome from records of patients with diabetic foot sepsis. The chi-square test, Fisher’s test, Student t-test or Mann-Whitney compare findings when appropriate. Multivariate logistic regression to determine factors that were associated with major amputation and mortality. Results of logistic regression were compared with outputs from analysis using machine learning algorithms. Kaplan-Meier survival curve to compare survival between COVID-19 positive and negative patients. Statistical was a p-value below 0.05. Supervised machine learning algorithms were used to compare their ability to predict major and deaths. Results: Overall, 114 records were found and 57.9% (66/114) were of male patients. The mean age of the patients was 55.7 (14) years and 47.4% (54/114) and 36% (41/114) tested positive for COVID-19 and HIV, respectively. The median c-reactive protein was 168mg/dl, urea 7.8mmol/l and creatinine 92µmol/l. The mean potassium level was 4.8±0.9mmol, and glycosylated haemoglobin 11.2±3%. The main outcomes included major amputation in 69.3% (79/114) and mortality of 37.7% (43/114) died. AI. The level of potassium, urea, creatinine and HbA1c were significantly higher in the deceased. Conclusions: The COVID-19 pandemic led to an increase in the rate of major amputation and mortality in patients with DFS. The in-hospital mortality was higher in patients above 60 years of age who tested positive for COVID-19. The Random Forest algorithm of ML can be highly effective predicting major amputation and death in patients with DFS.

Background/Objective: Prevention of foot ulceration is critical to reduce the rate of amputation in individuals with diabetes mellitus (DM). We investigated knowledge of risk factors and prevention of diabetic foot ulcer (DFU) among healthcare practitioners (HCPs). Methods: This was a prospective cross-sectional observational study using a self-administered questionnaire. Participants were HCPs involved in management of patients with DM. The questionnaire investigated professional background, prior education, knowledge of risk factors DFU, foot care and appropriate footwear. Participants were asked to indicate if they agreed or disagree with a statement. Scores were based on percentage response by each category of HCPs. Knowledge level was classified as very poor if less than 50% of participants from a category of HCPs answered appropriately, reasonable for 50%-59%, average at 60%-69%, above average from 70%-79% and excellent when ≥80%. The chi-square test to compare the knowledge levels across the categories of HCPs. Results: 449 HCPs participated and 48.1% (216/449) were therapeutic health practitioners (THPs), 37.4% (168/449) nurses and 14.5% (65/449) medical doctors. 36% (162/449) of participants had prior education on DFU. Overall knowledge level among participants of risk factors of DFU was 80%, appropriate technique of foot examination 80%, identification of limb-threatening conditions 82%, proper foot care 77% and selection of appropriate footwear 65%. Differences in knowledge levels across HPCs was statistically significant (P <0.05). Conclusion: Majority of HCPs had no prior education on prevention of DFU. The level of knowledge regarding foot care, risk factors and prevention of DFU among HCPs was mostly insufficient.

Background: Rehabilitation remains an unmet need and a neglected health service in South Africa. To address the country’s complex burden of disease, a skilled rehabilitation workforce is needed. Aim: This study aimed to identify prevalent medical conditions and disease trends among patients treated by rehabilitation therapists over a six-year period. It further examined whether these prevalent health conditions are represented in the rehabilitation health education curricula. Setting: The study was undertaken in public healthcare facilities within Gauteng province, South Africa. Methods: Secondary data on provincial rehabilitation data from April 2019 to March 2024 were analysed and categorised into non-communicable diseases (NCDs), children-specific conditions, injuries, and communicable diseases. Data were analysed descriptively. Lastly, the undergraduate rehabilitation health training curriculum (Occupational therapy, Physiotherapy, Speech therapy and Audiology) was reviewed to assess whether it covers the medical conditions treated by rehabilitation therapists. Results: The most treated conditions were NCDs (44.1%), injuries (36.4%) and children-specific conditions (15.6%). All health conditions decreased during the coronavirus disease 2019 pandemic, followed by an increase in NCDs and injuries between 2022 and 2024. The undergraduate rehabilitation health training curriculum covers the most prevalent conditions treated by public sector rehabilitation therapists. Conclusion: The burden of diseases treated in public healthcare rehabilitation departments aligns with the national burden of diseases. The impact of the COVID-19 pandemic on rehabilitation services is evident in the trend analysis over the years. Continual review of the curriculum is needed to ensure local health responsiveness. Contribution: This study highlights the burden of disease treated by the public health sector rehabilitation therapists, the trends over time and the importance of ensuring that the curriculum is locally responsive.

Background: Patients with diabetes mellitus are at increased risk of foot ulcerations. Prevention and timeous treatment of diabetic foot ulcer requires a multidisciplinary team, including patients and healthcare workers. The study investigated levels of knowledge regarding foot care and prevention of diabetic foot ulcer in patients with diabetes mellitus. Methods: We conducted a cross-sectional descriptive study using structured face-to-face interviews of patients seen at the outpatient department. Interviews covered socio-demographic and clinical characteristics, and foot care practices. Statistical analysis was performed using STATA 15. Results: The study involved 245 participants with a mean age of participants was 53.7 (SD) years, and 69% were female. The majority, 77.6%, had Type 2 diabetic mellitus (DM). Mean score of appropriate knowledge on diabetic foot ulcer (DFU) was 73.5%, lower scores were 44.9% and 45.7% for moisturizing between toes and wearing slippers outdoors, respectively. Knowledge of foot care was significantly influenced by age (p = 0.0033), duration of DM (p = 0.047), treatment type (p = 0.002), prior education on foot care (p < 0.0001), and existence of foot complications (p = 0.030). Conclusions: Younger patients and those with Type 1 diabetes mellitus had less knowledge of appropriate foot care and prevention of DFU. We recommend the implementation of structured and targeted educational interventions.