METHODS: A comprehensive literature review was conducted, focusing on studies conducted in Low and Middle Income Countries to facilitate a qualitative analysis. The review examined the aetiology and risk factors to developing DFUs, clinical presentation, multidisciplinary management and evidence based interventions, challenges to the provision of care and future directions, all pertaining to DFUs in low and middle income countries.
RESULTS: The aetiology and risk factors contributing to the development of DFUs are complex and multifaceted. Factors such as limited access to health care, inadequate diabetes management, and socioeconomic disparities significantly influence the incidence of DFUs. Clinical presentation varies, with patients often presenting at advanced stages of the disease due to delayed or missed diagnoses. Multidisciplinary management, incorporating podiatry, endocrinology, and wound care services, has exhibited substantial promise in enhancing patient outcomes. Evidence-based interventions, including offloading techniques, wound debridement, and the use of advanced wound dressings, have proven effective in promoting ulcer healing.
CONCLUSION: The burden of DFUs in LMICs requires comprehensive strategies. Integrating podiatry, endocrinology, and wound care services, along with patient education and self-care practices, is essential for reducing amputations and improving patients' quality of life. Regular follow-up and early detection are vital for effective DFU management, emphasizing the need for ongoing research and investment in LMIC health care infrastructure. Embracing these multidisciplinary, patient-centered approaches can effectively address the challenge of DFUs in LMICs, leading to better patient outcomes and improved quality of life.
OBJECTIVES: This review focuses on colorectal cancer (CRC) and hepatocellular carcinoma (HCC) as exemplar conditions, synthesising current evidence on disparities across the care continuum and exploring strategies to mitigate them.
METHODS: Current national data and published evidence were reviewed to assess inequities in disease prevalence, access to care, and outcomes across socioeconomic strata, regions, and ethnic groups. The analysis also examined workforce distribution, policy frameworks, and emerging interventions aimed at addressing these disparities.
RESULTS: Disease prevalence and outcomes are markedly worse in socioeconomically deprived regions; liver disease mortality is more than twice as high in the poorest deciles, and CRC survival is significantly lower among disadvantaged populations. Access to care remains uneven-deprived groups exhibit lower CRC screening uptake, delayed diagnoses, and higher emergency presentation rates. Routine HCC surveillance in at-risk patients is inconsistently delivered. Workforce shortages and maldistribution exacerbate these inequities, with under-resourced regions facing longer waiting times and limited specialist access. Systemic challenges, including social determinants, data deficits, and policy underprioritisation, further hinder progress.
EMERGING DEVELOPMENTS: Promising advances include the NHS's expansion of community diagnostic centres, targeted workforce investment, national hepatitis C virus (HCV) elimination programmes, and structural interventions such as minimum unit pricing for alcohol. Technological innovations-including non-invasive diagnostics and digital tools-offer additional opportunities to bridge care gaps.
CONCLUSIONS: Targeted actions, such as implementing primary care FibroScan services, CRC outreach initiatives with GP endorsement, and patient navigation for HCC surveillance, are critical to reducing inequalities and improving outcomes. By addressing upstream determinants and ensuring that innovations reach under-served populations, the UK can progress toward reducing GI health inequalities, improving outcomes, and achieving more uniform digestive health across all communities.