MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES
SCHOOL OF NURSING

ASSESSMENT OF KNOWLEDGE ABOUT DIABETIC FOOT CARE AMONG MUHAS UNDERGRADUATE NURSING STUDENTS.NAME: SUZANA NYANZILA
REG NO: 2015-04-08876
BACHELOR OF SCIENCE IN NURSING
SUPERVISOR: MR.MENT NDILE
COORDINATOR: DR. LILLIAN T. MSELLE
18 JUNE 2018
ABBREVIATION
MUHAS – Muhimbili University of health and Allied Sciences
INTRODUCTION AND BACKGROUND
INTRODUCTION
Diabetes mellitus is the one among non-communicable diseases, it affects body ability to use the energy found in food. There are three types of diabetes mellitus: type 1 diabetes, type 2 diabetes and gestational diabetes. The risk factors for the type two diabetes are cultural changes, aging, dietary change, decreased physical activities and unhealthy lifestyles ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.9734/JALSI/2015/20174″,”ISSN”:”23941103″,”author”:{“dropping-particle”:””,”family”:”Masaki”,”given”:”Stanley”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Ngoye”,”given”:”Abu”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Petrucka”,”given”:”Pammla”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Buza”,”given”:”Joram”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”Journal of Applied Life Sciences International”,”id”:”ITEM-1″,”issue”:”4″,”issued”:{“date-parts”:”2015″},”page”:”157-168″,”title”:”Type 2 Diabetes Prevalence and Risk Factors of Urban Maasai in Arusha Municipality and Rural Maasai in Ngorongoro Crater”,”type”:”article-journal”,”volume”:”3″},”uris”:”http://www.mendeley.com/documents/?uuid=30b0538a-cc47-4ab7-8793-7dda0450d43a”},”mendeley”:{“formattedCitation”:”(Masaki, Ngoye, Petrucka, & Buza, 2015)”,”plainTextFormattedCitation”:”(Masaki, Ngoye, Petrucka, & Buza, 2015)”,”previouslyFormattedCitation”:”(Masaki, Ngoye, Petrucka, & Buza, 2015)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Masaki, Ngoye, Petrucka, & Buza, 2015). Normally the body use sugars and carbohydrate eaten to make energy, but insulin is needed so that the sugar and carbohydrate in form of glucose can be taken into the cell to produce energy. In diabetes mellitus the body fails to produce or the insulin is produced in small amount. So the cells fail to take the glucose this lead to the high increase of blood glucose. The high blood glucose level can lead to the damage of small blood vessels kidney, heart, eyes and nervous system.

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To the person with diabetes mellitus the damage of nervous system lead to not able to feel his or her feet properly. The production of sweat and oil is impaired, this lead to the pressure on skin, bones and joints during walking and can lead to break down of the foot. Sores may develop
“The international Diabetes Federation has estimated that the world diabetes incidence will be approximately 522 million people by the year of 2030. This incidence has indirectly increased the prevalence of diabetic foot ulcers, which occur in 1 to 4% of patients with diabetes mellitus and will further contribute to minor and major amputations of the lower limbs, for which foot ulcer patients have a 25 times higher risks than the rest of the population” ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1155/2013/608313″,”ISBN”:”2090-4630 2090-4649″,”ISSN”:”2090-4649″,”PMID”:”23476800″,”abstract”:”The escalating incidence of diabetic mellitus has given rise to the increasing problems of chronic diabetic ulcers that confront the practice of medicine. Peripheral vascular disease, neuropathy, and infection contribute to the multifactorial pathogenesis of diabetic ulcers. Approaches to the management of diabetic ulcers should start with an assessment and optimization of the patient’s general conditions, followed by considerations of the local and regional factors. This paper aims to address the management strategies for wound bed preparation in chronic diabetic foot ulcers and also emphasizes the importance of preventive measures and future directions. The “TIME” framework in wound bed preparation encompasses tissue management, inflammation and infection control, moisture balance, and epithelial (edge) advancement. Tissue management aims to remove the necrotic tissue burden via various methods of debridement. Infection and inflammation control restores bacterial balance with the reduction of bacterial biofilms. Achieving a moist wound healing environment without excessive wound moisture or dryness will result in moisture balance. Epithelial advancement is promoted via removing the physical and biochemical barriers for migration of epithelium from wound edges. These systematic and holistic approaches will potentiate the healing abilities of the chronic diabetic ulcers, including those that are recalcitrant.”,”author”:{“dropping-particle”:””,”family”:”Mat Saad”,”given”:”Arman Zaharil”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Khoo”,”given”:”Teng Lye”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Halim”,”given”:”Ahmad Sukari”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”ISRN Endocrinology”,”id”:”ITEM-1″,”issued”:{“date-parts”:”2013″},”page”:”1-9″,”title”:”Wound Bed Preparation for Chronic Diabetic Foot Ulcers”,”type”:”article-journal”,”volume”:”2013″},”uris”:”http://www.mendeley.com/documents/?uuid=3fca8ad6-8903-4114-af1c-2d9c73fe3723″},”mendeley”:{“formattedCitation”:”(Mat Saad, Khoo, ; Halim, 2013)”,”plainTextFormattedCitation”:”(Mat Saad, Khoo, ; Halim, 2013)”,”previouslyFormattedCitation”:”(Mat Saad, Khoo, ; Halim, 2013)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Mat Saad, Khoo, & Halim, 2013).

The knowledge and skills of nurses in caring the patient with diabetic foot ulcer is important because it contribute much to the healing and prevention of complication like infection which will reduce the rate amputations. There studies that about the self-care to the patients with diabetes mellitus. Nurses are the one who are provide the education and awareness to the diabetes patients so it is important to assess their knowledge.

PROBLEM STATEMENT
There is an increase in the number of diabetic patients in developing and developed countries. One common complication is diabetic foot ulcer which may lead to amputation.Despite the medical advancement there is range of 1.0-4.0% and 5.3-10.5% of prevalence of diabetic foot ulceration respectively and about 5-10% of these patient need elective amputation which contributes to more than 50% 0f non traumatic amputation ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“author”:{“dropping-particle”:””,”family”:”El-rahman”,”given”:”Mona Abed”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”El-ezaby”,”given”:”Hassan”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:”Al”,”family”:”Kalaldeh”,”given”:”Taher”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2016″},”page”:”8-13″,”title”:”Review ; research Self-reported knowledge and self-care practices of diabetic foot patients”,”type”:”article-journal”,”volume”:”3″},”uris”:”http://www.mendeley.com/documents/?uuid=84fe1dfb-9ca6-4e9f-9b51-c9676ccd9a26″},”mendeley”:{“formattedCitation”:”(El-rahman, El-ezaby, ; Kalaldeh, 2016)”,”plainTextFormattedCitation”:”(El-rahman, El-ezaby, ; Kalaldeh, 2016)”,”previouslyFormattedCitation”:”(El-rahman, El-ezaby, ; Kalaldeh, 2016)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(El-rahman, El-ezaby, & Kalaldeh, 2016).

So the diabetic foot contributes much to the disability due amputation. This leads to the increase of dependence. There are many studies about self-care to the patients with diabetes mellitus; most of them show that patients are not aware enough to avoid complication. One study about the knowledge of diabetic foot care to the patients show that 82.5% receive the information from nurses, 16.6% receive information from doctors and 6.2% were educated by other sources such as media ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1186/s13047-015-0080-y”,”ISSN”:”1757-1146″,”author”:{“dropping-particle”:””,”family”:”Chiwanga”,”given”:”Faraja S”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Njelekela”,”given”:”Marina A”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”Journal of Foot and Ankle Research”,”id”:”ITEM-1″,”issued”:{“date-parts”:”2015″},”page”:”1-7″,”publisher”:”Journal of Foot and Ankle Research”,”title”:”Diabetic foot : prevalence , knowledge , and foot self-care practices among diabetic patients in Dar es Salaam , Tanzania – a cross-sectional study”,”type”:”article-journal”},”uris”:”http://www.mendeley.com/documents/?uuid=e63c2db9-7c11-462c-b63c-240c4e4f6e1c”},”mendeley”:{“formattedCitation”:”(Chiwanga ; Njelekela, 2015)”,”plainTextFormattedCitation”:”(Chiwanga ; Njelekela, 2015)”,”previouslyFormattedCitation”:”(Chiwanga ; Njelekela, 2015)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Chiwanga & Njelekela, 2015). The study conducted at Jordan University of Science and Technology show that Nursing students was having poor knowledge on diabetes ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“author”:{“dropping-particle”:””,”family”:”Tawalbeh L; Gharaibeh B”,”given”:””,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issued”:{“date-parts”:”2014″},”title”:”DIABETES KNOWLEDGE AMONG NURSING STUDENTS GHARAIDEH.pdf”,”type”:”article”},”uris”:”http://www.mendeley.com/documents/?uuid=3199b59b-e436-4fc2-9f14-efa4cfe7ecf9″},”mendeley”:{“formattedCitation”:”(Tawalbeh L; Gharaibeh B, 2014)”,”plainTextFormattedCitation”:”(Tawalbeh L; Gharaibeh B, 2014)”,”previouslyFormattedCitation”:”(Tawalbeh L; Gharaibeh B, 2014)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Tawalbeh L; Gharaibeh B, 2014)
The study need to be done on assessment of the knowledge about diabetic foot care to nurses because they are the one who play the large part in provision of care and education to the clients about diabetes. Most of current studies based on patient’s knowledge on self-care but there is the need also to assess the source of information which they use. The undergraduate nursing students are involved in different activities in clinical areas including caring of diabetic patient with foot ulcers. So the study is focus to them to assess their level of knowledge so that more education can be provided orother specific measures can be taken to reduce and prevent complication of diabetic foot.

BROAD OBJECTIVE
To assess and describe the knowledge and skills of diabetic foot care among undergraduate nursing students at MUHAS from December 2018 to March 2019.
SPECIFIC OBJECTIVES
To assess the level of knowledge on diabetic foot care among undergraduate nursing students at MUHAS.

To assess the level of knowledge on complication of diabetic foot among nursing students at MUHAS.

RESEARCH QUESTIONS
What is the level of knowledge about diabetic foot care among MUHAS nursing students?
What is the level of knowledge on complication of diabetic foot among nursing students at MUHAS?
HYPOTHESIS
Nursing students with knowledge about diabetic foot care are more likely to prevent complications of diabetic foot compared to students with no knowledge about diabetic foot care.

Independent variable Dependent variable
Knowledge on diabetic foot care Prevention of complication
CONCEPTUAL FRAMEWORK
This conceptual framework shows the impact of the education to the knowledge and attitude and how the education, knowledge and attitude influence the practice to get the outcome. In this study, the framework will be used to assess the level knowledge of MUHAS undergraduate Nursing students that they acquire through education and the impact of it on the complication of diabetic foot ulcer.
Knowledge on diabetic foot care

Education

Outcome
Practice on diabetic foot care

Attitude towards diabetic foot care

LITERATURE REVIEW
In Africa countries with burden of diabetes are Nigeria followed by South Africa with 2.6 million cases, Ethiopia 1.9 million, and Tanzania 1.7million, the global prevalence of diabetes by 2013 estimate is 382 million cases, a large population of it (175 million) undiagnosed, and the global prevalence about 8.3% ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“abstract”:”Background: Diabetes self-management programs have advocated the need to improve knowledge, attitude, and practice of self-care. However, many studies fail to explain how health education works for lack of causal specifications. Purpose of the Study: This study formulates an appropriate framework, specifies the relationships among knowledge, attitude, practice and outcomes (KAP-O), and examines the factors influencing variations in the glycated hemoglobin (A1C), low-density lipoprotein cholesterol (LDLC), functional capacity (FC), and poor perceived health (PPH). Review of Conceptual and Theoretical Perspectives: Health behavioral theories were reviewed. Relevant studies on the knowledge, attitude, practice, and health care outcomes were reviewed to support a theoretical framework and to deduce testable hypotheses. Causal Specifications of the KAP-O Studies: General findings suggest the support of a positive effect of health educational interventions on improved Diabetics’ knowledge, attitude, and preventive practice, and health care outcomes. Initially, four causally specified hypotheses were deduced: 1) Health educational intervention directly improves knowledge; 2) health educational intervention directly improves attitude; 3) health educational intervention directly improves preventive practice; and 4) health educational intervention directly lowers A1C and LDLC, improves FC), and decreases PPH. Furthermore, the causal mechanisms of improved outcomes from a behavioral perspective also suggest two additional research hypotheses for further evaluation. They include: 1) health educational intervention may indirectly improve preventive practice via knowledge and attitude improvements; and 2) health educational intervention also indirectly improves outcomes via changing knowledge, attitude, and self-care practice. Future Research on KAP-O Model: The causal mechanisms in improved diabetes outcomes should be empirically validated in clinical trial studies, using structural equation modeling with multi-centers, multiple providers and a diverse population of Type 2 patients. Baseline knowledge and attitude should be continuously improved during the study period of one to two years. The study should assess outcomes more than four times over the study period. The study will enable discovery of whether knowledge or attitude has a more dominant influence on preventive practice and thus on diabetes care outcomes.”,”author”:{“dropping-particle”:””,”family”:”Marathe”,”given”:”K.R”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Wan”,”given”:”T.T.H”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Marathe”,”given”:”S.”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”Medical Research Archives”,”id”:”ITEM-1″,”issue”:”1″,”issued”:{“date-parts”:”2016″},”title”:”A SYSTEMATIC REVIEW ON THE KAP-O FRAMEWORK FOR DIABETES EDUCATION AND RESEARCH”,”type”:”article-journal”,”volume”:”4″},”uris”:”http://www.mendeley.com/documents/?uuid=29a4fcc3-bae3-44ec-a4ed-98cfaa482b89″},”mendeley”:{“formattedCitation”:”(Marathe, Wan, & Marathe, 2016)”,”plainTextFormattedCitation”:”(Marathe, Wan, & Marathe, 2016)”,”previouslyFormattedCitation”:”(Marathe, Wan, & Marathe, 2016)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Marathe, Wan, & Marathe, 2016).

“The large study done in European specialized foot centers, 23% of patients with diabetic foot ulcer lost at least part of their foot, despite intensive treatment. The results reflects the fact that diabetic foot disease is both an acute and recurrent affliction that mainly affect older patients with several co morbidities” ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1016/S2213-8587(15)00252-1″,”author”:{“dropping-particle”:””,”family”:”Lipsky”,”given”:”Benjamin Alan”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issue”:”AUGUST”,”issued”:{“date-parts”:”2015″},”page”:”13-15″,”title”:”Diabetic foot disease : moving from roadmap to journey Diabetic foot disease : moving from roadmap to journey”,”type”:”article-journal”,”volume”:”8587″},”uris”:”http://www.mendeley.com/documents/?uuid=70422b65-179d-4c03-99e2-c209747ad32c”},”mendeley”:{“formattedCitation”:”(Lipsky, 2015)”,”plainTextFormattedCitation”:”(Lipsky, 2015)”,”previouslyFormattedCitation”:”(Lipsky, 2015)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Lipsky, 2015). In study explained that the diabetic foot disease also requires both local and systemic treatments, given by knowledgeable providers, to adherent patients. The knowledge of nurses contributes much to the progress of the patients. The reduction of diabetic foot diseases will require more clinicians who are knowledgeable about guidance (reading the road-maps) but also about implementing these practices at their clinical sites( taking the journey) ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1016/S2213-8587(15)00252-1″,”author”:{“dropping-particle”:””,”family”:”Lipsky”,”given”:”Benjamin Alan”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issue”:”AUGUST”,”issued”:{“date-parts”:”2015″},”page”:”13-15″,”title”:”Diabetic foot disease : moving from roadmap to journey Diabetic foot disease : moving from roadmap to journey”,”type”:”article-journal”,”volume”:”8587″},”uris”:”http://www.mendeley.com/documents/?uuid=70422b65-179d-4c03-99e2-c209747ad32c”},”mendeley”:{“formattedCitation”:”(Lipsky, 2015)”,”plainTextFormattedCitation”:”(Lipsky, 2015)”,”previouslyFormattedCitation”:”(Lipsky, 2015)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Lipsky, 2015).

Diabetic foot ulcer is the common, preventable complication of Diabetes mellitus; it is also contributing much to the hospitalization, infections, amputation and mortality. The study done in Sri Lanka at the open university of Sri Lanka concluded that nurses in the study demonstrated suboptimal knowledge which may be attributable to the level of exposure they get on ulcer care ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1111/jocn.13917″,”ISSN”:”0962-1067″,”PMID”:”28618043″,”author”:{“dropping-particle”:””,”family”:”Kumarasinghe”,”given”:”Sriyani A”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Hettiarachchi”,”given”:”Lecturer Priyadarshika”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”Journal of Clinical Nursing”,”id”:”ITEM-1″,”issue”:”June 2017″,”issued”:{“date-parts”:”2017″},”page”:”203-212″,”title”:”Nurses ‘ knowledge on diabetic foot ulcer disease and their attitudes towards patients affected : A cross-sectional institution-based study”,”type”:”article-journal”,”volume”:”27″},”uris”:”http://www.mendeley.com/documents/?uuid=5f2b5e1f-2a7b-4872-b98e-476139e6fa53″},”mendeley”:{“formattedCitation”:”(Kumarasinghe ; Hettiarachchi, 2017)”,”plainTextFormattedCitation”:”(Kumarasinghe ; Hettiarachchi, 2017)”,”previouslyFormattedCitation”:”(Kumarasinghe ; Hettiarachchi, 2017)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Kumarasinghe & Hettiarachchi, 2017). It is important to assess the knowledge of nurses on caring the patients with diabetic foot ulcer, so as to be sure on their ability to on caring these patients.

Nurses are highly responsible on caring patients with diabetic foot. The study at Dar es Salaam on diabetic foot knowledge and self-care show that the 83.5% of clients received the education from nurses, 16.6% receive foot care information from doctors and 6.2% were educated by other sources such as the media ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1186/s13047-015-0080-y”,”ISSN”:”1757-1146″,”author”:{“dropping-particle”:””,”family”:”Chiwanga”,”given”:”Faraja S”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Njelekela”,”given”:”Marina A”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”Journal of Foot and Ankle Research”,”id”:”ITEM-1″,”issued”:{“date-parts”:”2015″},”page”:”1-7″,”publisher”:”Journal of Foot and Ankle Research”,”title”:”Diabetic foot : prevalence , knowledge , and foot self-care practices among diabetic patients in Dar es Salaam , Tanzania – a cross-sectional study”,”type”:”article-journal”},”uris”:”http://www.mendeley.com/documents/?uuid=e63c2db9-7c11-462c-b63c-240c4e4f6e1c”},”mendeley”:{“formattedCitation”:”(Chiwanga ; Njelekela, 2015)”,”plainTextFormattedCitation”:”(Chiwanga ; Njelekela, 2015)”,”previouslyFormattedCitation”:”(Chiwanga ; Njelekela, 2015)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Chiwanga & Njelekela, 2015).

The study done at the Jordan university of Science and Technology, Irbid, Jordan show that the diabetes knowledge among the university nursing students was inadequate ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“author”:{“dropping-particle”:””,”family”:”Tawalbeh L; Gharaibeh B”,”given”:””,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issued”:{“date-parts”:”2014″},”title”:”DIABETES KNOWLEDGE AMONG NURSING STUDENTS GHARAIDEH.pdf”,”type”:”article”},”uris”:”http://www.mendeley.com/documents/?uuid=3199b59b-e436-4fc2-9f14-efa4cfe7ecf9″},”mendeley”:{“formattedCitation”:”(Tawalbeh L; Gharaibeh B, 2014)”,”plainTextFormattedCitation”:”(Tawalbeh L; Gharaibeh B, 2014)”,”previouslyFormattedCitation”:”(Tawalbeh L; Gharaibeh B, 2014)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Tawalbeh L; Gharaibeh B, 2014)
There is the need to conduct the study to assess the level of knowledge on caring patient with diabetic foot among nurses including nursing students so as to facilitate healing and prevention of complication. Tanzania is among four countries in Africa with high prevalence of diabetes mellitus, and patients are very prone to it’s complications. One among challenging complication of diabetes mellitus is diabetic foot ulcer due its delay in healing so which can lead to the further damage of tissues, infection then amputation remain the only option. This leads to the increase of dependence and burden to the country.

There are many studies about self-foot care to the patient on diabetic mellitus. The main source of information about their foot care is from nurses who are mostly caring them. So it is important to assess the level of knowledge among nurses so that to decide which action to be taken to prevent the complication of diabetic foot ulcer. This study is going to be conducted to the undergraduate nursing students at Muhimbili University of Health and Allied Sciences because they have got education on diabetes mellitus and they have been in clinical areas caring patients with diabetes foot.

References
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Chiwanga, F. S., & Njelekela, M. A. (2015). Diabetic foot?: prevalence , knowledge , and foot self-care practices among diabetic patients in Dar es Salaam , Tanzania – a cross-sectional study. Journal of Foot and Ankle Research, 1–7. https://doi.org/10.1186/s13047-015-0080-y
El-rahman, M. A., El-ezaby, H., & Kalaldeh, T. Al. (2016). Review & research Self-reported knowledge and self-care practices of diabetic foot patients, 3(1), 8–13.

Kumarasinghe, S. A., & Hettiarachchi, L. P. (2017). Nurses ‘ knowledge on diabetic foot ulcer disease and their attitudes towards patients affected?: A cross-sectional institution-based study. Journal of Clinical Nursing, 27(June 2017), 203–212. https://doi.org/10.1111/jocn.13917
Lipsky, B. A. (2015). Diabetic foot disease?: moving from roadmap to journey Diabetic foot disease?: moving from roadmap to journey, 8587(AUGUST), 13–15. https://doi.org/10.1016/S2213-8587(15)00252-1
Marathe, K. ., Wan, T. T. ., & Marathe, S. (2016). A SYSTEMATIC REVIEW ON THE KAP-O FRAMEWORK FOR DIABETES EDUCATION AND RESEARCH. Medical Research Archives, 4(1). Retrieved from http://journals.ke-i.org/images/sidebar/pdf/483-1710-1-PB.pdf
Masaki, S., Ngoye, A., Petrucka, P., & Buza, J. (2015). Type 2 Diabetes Prevalence and Risk Factors of Urban Maasai in Arusha Municipality and Rural Maasai in Ngorongoro Crater. Journal of Applied Life Sciences International, 3(4), 157–168. https://doi.org/10.9734/JALSI/2015/20174
Mat Saad, A. Z., Khoo, T. L., & Halim, A. S. (2013). Wound Bed Preparation for Chronic Diabetic Foot Ulcers. ISRN Endocrinology, 2013, 1–9. https://doi.org/10.1155/2013/608313
Tawalbeh L; Gharaibeh B. (2014). DIABETES KNOWLEDGE AMONG NURSING STUDENTS GHARAIDEH.pdf.

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