• kausal sharma

Abstract Introduction: Diabetes is a major public health concern globally and, in the Pacific, including Fiji. According to global statistics on diabetes by the International Diabetes Federation (2017), there are more than 1 million annual lower limb amputations globally, one every 30 seconds. In the Pacific, the Solomon Islands, Nauru, and Vanuatu have an estimated prevalence of 13.5%, 22.7%, and 11.8% diabetic foot amputation, respectively. Fiji in 2018 reported 188 DFAs in every 100,000 population, with an estimated three amputations in 24 hours. Furthermore, 40% of the surgeries done were due to diabetic amputation, with an estimated 60,000 people having diabetes. Thus, this study aimed to find the five-year (from 2017 to 2021) prevalence, demographics, and clinical characteristics of diabetic foot amputation at CWM Hospital and to understand the coping mechanisms and medication adherence experiences of diabetic foot amputees. Method: A sequential mixed-method study was conducted at the Post Anesthesia Recovery Unit (PARU) at CWM Hospital, Suva, Fiji. In the quantitative phase, a retrospective descriptive study was conducted to determine the five-year (from 2017 to 2021) prevalence of diabetic foot amputation. For the qualitative phase of the study, an in-depth semi-structured interview guide was used to obtain information on the 20 amputees of the four types of amputation (toe, forefoot, below-knee, and above-knee) groups. Results: The overall 5-year prevalence of diabetic foot amputation (2017-2021) is 10662 per 100,000 population. The total population at risk at CWM hospital in the 5-year period was 15146. This study had 56% males and 74% iTaukei amputees, with 99% having type-2 diabetes. Most amputations occurred in individuals aged 45-50 years. The amputation increased relatively with the age of 51-60 and further increased at the age of 60 and above. Moreover, a chi-square test was used to find the significance. Gender, ethnicity, and HbA1c are strongly associated (p<0.05) with the type of diabetes (diabetic type 1 or type 2 diabetes). Of the 20 amputees, the themes identified are coping mechanisms, adherence to diabetic medication, and challenges. The sub-themes of coping mechanisms are social, behavioral, and physical support, whereas the sub-themes for adherence to diabetic medication are knowledge, financial support, and supportive health workers. Some of the challenges to medication adherence were physical support, non-compliance with medication, and traditional beliefs. The triangulation method used in this study confirms that continuous efforts and monitoring of DFA trends are necessary to ensure supportive progress in bringing Fiji's amputation rates below the global average. Family support plays a crucial role in aiding and motivating to maintenance of health. Psychological support is also needed post-amputation, and individuals use different modes of mobility assistance. Medication adherence is poor, with more than half of the participants being non-adherent, and this may have been the reason for the high DFA prevalence rate in Fiji. The majority of respondents reported not attending diabetic foot clinics or special outpatient clinics before undergoing diabetic foot amputation (DFA), and this may have been another reason for DFA. Conclusion: Diabetic foot amputation remains a major health concern in the central division of Fiji. Chances are, the whole of Fiji would present a similar trend and pattern. Early quality-coordinated diabetes screening for diabetic foot care assessment, monitoring, and treatment for diabetic patients in Fiji is urgently needed. Understanding coping mechanisms in informing family members, caregivers, or healthcare professionals about how empathic understanding of the amputee’s experience can facilitate appropriate responses, in turn providing a more adequate environment for the gradual restoration of self-agency and self-worth, while diminishing the risk of negative reactions. Significant awareness of non-adherence to diabetic medication is necessary for the target group, which is 18-50 years and above. The incidence of amputation increased among individuals aged 51-60 and rose further for those aged 60 and older. Such behavior can also have detrimental effects on managing diabetes and preventing complications, such as diabetic foot amputations.

DM- Diabetes mellitus DFA-Diabetic foot amputation FFA – Forefoot amputation BKA- Below-knee amputation AKA- Above knee amputation TA-Toe amputation NCD-Non-communicable disease LEA-Lower Extremity Amputation CWMH-Colonial War Memorial Hospital PARU-Post Anesthesia Recovery Unit WHO-World Health Organization

"Diabetic Foot Amputation at Colonial War Memorial Hospital from 2017- 2021, Suva, Fiji: A Mixed Method Study ", International Journal of Emerging Technologies and Innovative Research (www.jetir.org), ISSN:2349-5162, Vol.12, Issue 8, page no.c646-c655, August-2025, Available :http://www.jetir.org/papers/JETIR2508288.pdf

"Diabetic Foot Amputation at Colonial War Memorial Hospital from 2017- 2021, Suva, Fiji: A Mixed Method Study ", International Journal of Emerging Technologies and Innovative Research (www.jetir.org | UGC and issn Approved), ISSN:2349-5162, Vol.12, Issue 8, page no. ppc646-c655, August-2025, Available at : http://www.jetir.org/papers/JETIR2508288.pdf