Diabetes related amputations in Pacific Islands countries: a root cause analysis of precipitating events

To identify precipitating events and factors preceding diabetes related amputations in Pacific Islands countries (PICs).

Using a root cause analysis approach, a questionnaire seeking information on events leading up to amputation was administered to a convenience sample of 85 people with diabetes in three PICs (Solomon Islands, Nauru and Vanuatu) who had a lower limb amputation in the previous five years.

There were 85 participants (36% females) with a mean age of 54.1 years and a mean diabetes duration of 10.5 years prior to amputation. The first event was trauma and an infected wound in 55% and a blister in another 41%. Half (51%) did take any action soon after the initial trigger event. The major reasons leading to the amputation included delaying treatment (42%), use of traditional treatments (18%) and insufficient knowledge about foot care (11%). 36% of participants had not received foot care information prior to the amputation and 19% did not attend anywhere for regular treatment.

This study identified key precipitating events and underlying factors which contribute to diabetes related amputations and which, if addressed successfully, have the potential to reduce amputations rates.