Peripheral arterial disease among high-risk patients at a tertiary hospital in Blantyre, Malawi: A 2-phase observational study

  • Palesa Chisala
  • Becky Sandford
  • Eric Borgstein
Keywords: hypertension, diabetes, smoking, HIV, peripheral arterial disease, Malawi


Background: There is uncertainty regarding the prevalence of peripheral arterial disease (PAD) in sub-Saharan Africa, but several small studies have suggested a significant disease burden and unmet healthcare need. This study investigated the prevalence of PAD among patients with risk factors in Blantyre, Malawi.

Methods: This was a 2-phase study. Phase 1 was a retrospective study of patients admitted to a single centre between 2010 and 2015 who underwent lower limb amputation. Case files were reviewed, and data were collected regarding the indications for amputation.

Phase 2 was a prospective study of individuals with cardiovascular risk factors. Patients attending outpatient clinics from January through April 2017 for diabetes mellitus, hypertension, and HIV management were included in the study. All patients underwent a structured interview and clinical examination, including ankle–brachial pressure index measurement. Patients admitted for intervention related to lower limb ischaemia during the study period were also included.

Results: There were 135 patients who had undergone amputation during Phase 1 of the study. In Phase 2, there were 186 patients: 14 (7.5%) were found to have an ankle–brachial pressure index <0.9. A further 18 patients (10%) presented with tissue loss, and 36 (19%) gave a history convincing for claudication. Nineteen patients were admitted for intervention; 15 of these underwent major limb amputation and no attempt at revascularization was made.

Conclusions: This study revealed a previously unrecognized burden of PAD among high-risk groups in Malawi. Further research is warranted to better understand the underlying drivers of PAD in this context and the potential strategies to prevent associated death and disability.

Original Research