article · International Wound Journal
Diabetic foot ulcers cause substantial disability, amputation, and healthcare costs across sub-Saharan Africa, exacerbated by limited access to preventive care and multidisciplinary services. Systemic hyperbaric oxygen therapy offers a possible adjunct to standard care for non-healing ulcers. Global evidence indicates that hyperbaric oxygen can improve wound healing in select patients who do not respond to standard treatments, though results vary and evidence regarding amputation prevention remains uncertain. Direct evidence from sub-Saharan Africa is sparse. Deploying this intervention requires continuous electricity, reliable oxygen supplies, specialised personnel, robust maintenance, and sustainable funding. Consequently, the therapy is not recommended as a routine or first-line intervention. Instead, implementation should begin through monitored pilot programmes at well-equipped referral centres to evaluate clinical outcomes, feasibility, safety, and economic impact before any wider adoption is considered.
Diabetic foot ulcers present a critical health and economic burden in sub-Saharan Africa, often leading to amputations. Understanding whether advanced therapies like hyperbaric oxygen are clinically viable and feasible within constrained health systems helps policymakers and healthcare providers prioritise investments effectively without diverting resources from basic, high-impact preventive care.
This intervention represents a specialised clinical therapy for diabetic wound management, targeted at tertiary hospitals and specialist referral centres. Given significant requirements for electricity, oxygen, and trained staff, the therapy is at an early pilot-evaluation stage for regional healthcare adoption. Wider procurement or commercial deployment depends on future pilot studies confirming safety, cost-effectiveness, treatment completion rates, and equity within local health systems.
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Diabetic foot ulcers are an important cause of morbidity, amputation, disability and healthcare expenditure in sub-Saharan Africa, where limitations in preventive foot care, referral pathways, vascular services, multidisciplinary wound care and financial protection may contribute to poor outcomes. This critical narrative review evaluates the potential role of systemic hyperbaric oxygen therapy as an adjunct to standard diabetic foot ulcer care in sub-Saharan Africa by integrating evidence on clinical effectiveness and safety with health-system, economic, equity and implementation considerations. Evidence was drawn from clinical studies, systematic reviews, clinical guidelines, economic evaluations and literature relevant to diabetic foot care and health-system capacity in the region. Global evidence suggests that systemic hyperbaric oxygen therapy may improve wound healing in selected patients whose ulcers fail to heal with best standard care, but findings remain heterogeneous; evidence for reducing amputation is uncertain, and direct regional evidence is sparse. Implementation in sub-Saharan Africa would require reliable oxygen, electricity, trained staff, safe maintenance systems, multidisciplinary care, referral pathways, sustainable financing and feasible treatment completion. The therapy should therefore not be considered routine or first-line treatment. Where appropriate infrastructure exists, carefully monitored referral-centre pilots should assess clinical outcomes, safety, treatment completion, affordability, budget impact and equity before wider implementation.
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DOI: 10.1111/iwj.71027
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