Evaluation of the current status of prosthetic rehabilitation services for major limb loss: a descriptive study in Ugandan Referral hospitals

Abstract

Purpose

Low-and-middle-income countries (LMICs) have a large burden of major limb loss. No recent study has reported on Uganda’s state of public sector prosthetics services. This study aimed to document the landscape of major limb loss, and the structure of available prosthetics services in Uganda.

Methods

This study involved a retrospective review of medical records at Mulago National Referral Hospital, Fort Portal Regional Referral Hospital, and Mbale Regional Referral Hospital, and a cross-sectional survey of personnel involved in the fabrication and fitting of prosthetic devices across orthopaedic workshops in the country.

Results

Upper limb amputations accounted for 14.2%, and lower limb accounted for 81.2%. Gangrene (30.3%) was the leading cause of amputation, followed by road traffic accidents and diabetes mellitus. Orthopaedic workshops offered decentralised services, and most materials used were imported. Essential equipment was largely lacking. Orthopaedic technologists had diverse experience and skill sets, but many other factors limited their service provision.

Conclusion

The Ugandan public healthcare system lacks adequate prosthetic services both in terms of personnel and supporting resources, including equipment, materials, and components. The provision of prosthetics rehabilitation services is limited, especially in rural regions. Decentralising services could improve patients’ access to prosthetic services.

Implications for Rehabilitation

• Availability and accessibility of prosthetic services are essential to the rehabilitation and reintegration of amputees into communities in Low-and-Middle-Income countries (LMICs).

• For stakeholders to formulate effective plans to address issues within prosthetics service provision, quality data on the current state of services is necessary.

• Service providers should prioritise the decentralisation of prosthetic rehabilitation services, especially for patients in rural areas, to improve access and reach of these services.

• To achieve optimal limb functionality after amputation for both lower and upper limb amputees, rehabilitation professionals working in LMICs should focus on delivering comprehensive multidisciplinary rehabilitation services.

• Orthopaedic personnel should ensure complete and accurate documentation of patient information following amputation to enable effective tracking and monitoring of patient care to improve outcomes of rehabilitation.

Keywords:

• Major limb loss
• low-and-middle-income countries
• prosthetics services
• decentralisation
• Ugandan referral hospitals
• orthopaedic technologists

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 A recognised professional association for orthopaedic technologists and technicians in Uganda.

2 A regulatory body that was established to regulate, supervise, and control the training and practice of Allied Health Professionals in Uganda.

3 Clinical personnel, whose training involved completion of an approved 3- or 4-years course of education and who are authorised by the AHPC to evaluate, design, fabricate and fit orthopaedic appliances to restore the quality of life (QoL) for clients.

4 Technical personnel that have either completed at least a 4-year apprenticeship or two years of formal training with a focus on P&O device fabrication.

Additional information

Funding

This work was supported by the UK Government Global Challenges Research Fund through the Engineering and Physical Sciences Research Council and the National Institute for Health Research under Grant (EP/R013985/1).