Systematic review and meta-analysis of diabetic foot ulcers and associated factors among adults in Ethiopia.

BACKGROUND: Diabetic foot ulcers are a common and serious complication of diabetes that substantially increases morbidity, disability, and healthcare costs worldwide. In Ethiopia, the national burden of diabetic foot ulcers remains unclear due to fragmented and inconsistent evidence. This systematic review and meta-analysis aimed to estimate the pooled prevalence of diabetic foot ulcers among adults with diabetes in Ethiopia and to identify major associated factors. METHODS: A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar databases for studies published between January 1, 2015, and August 9, 2025. Observational studies reporting the prevalence of diabetic foot ulcers, defined as ulceration of the foot below the ankle in adults with diabetes mellitus, were included. Studies were considered complete if they reported sufficient data on sample size, and diabetic foot ulcer cases or prevalence. Two reviewers independently screened, extracted, and verified the data using a standardized, pilot-tested form. The pooled prevalence and associated factors were estimated using a random effects model in Stata software version 17. Statistical heterogeneity was assessed using the I² statistic, and publication bias was evaluated using funnel plots and Egger's regression test. RESULTS: Out of all identified studies, 14 met the inclusion criteria, including 4,794 adults with diabetes, approximately 686 of whom had diabetic foot ulcers. The pooled prevalence of diabetic foot ulcers was 13.92% (95% CI: 11.29-16.55). Major risk factors significantly associated with diabetic foot ulcers were poor foot care practices (AOR = 2.75, 95% CI: 1.03-4.48), physical inactivity (AOR = 2.26, 95% CI: 1.04-3.48), and peripheral neuropathy (AOR = 4.07, 95% CI: 1.85-6.28). CONCLUSION: This meta-analysis confirms that diabetic foot ulcers are a common and serious complication among Ethiopian adults with diabetes. To reduce diabetic foot ulcers, research should develop prevention strategies tailored to Ethiopia, emphasizing patient education on foot care, increased physical activity, and routine neuropathy screening.