Barriers to accessing and providing rehabilitation after a lower limb amputation in Sierra Leone – a multidisciplinary patient and service provider perspective

Abstract

Purpose

The primary aim was to explore the perceived barriers that lower limb amputees and service providers face when accessing or providing rehabilitation services. The secondary aim was to describe the lower limb amputations performed in public hospitals in the Western Area of Sierra Leone in 2018.

Materials and methods

A mixed methodology was employed, involving the collection of amputation data from surgical logbooks and interviews with amputees (n = 10) and group discussion and interviews with service providers (n = 11).

Results

Of the 37 primary lower limb amputations (49% men, 51% women; median age 56 years; 62% transtibial and 35% transfemoral amputations) 86% were for diabetic and vascular causes. Barriers to accessing services included poor transportation access, high service fees, rural living, gender and a lack of government support. Insufficient funding and supplies, skilled staff shortages and a lack of local training programmes were frequently reported barriers to providing rehabilitation services.

Conclusions

A low prioritisation means rehabilitation services are underfunded, resulting in numerous barriers to both accessing and providing amputee rehabilitation services. Subsidised services and an outreach programme may improve access for patients. Increased funding and local training programmes are needed to improve service delivery.

Implications for Rehabilitation

• Comprehensive and accessible amputee rehabilitation services can enable people with amputations to regain their independence and aid their participation in their community and workplace.

• There are numerous barriers to both accessing and providing amputee rehabilitation services in the Western Area, Sierra Leone, chiefly financial.

• We recommend a revised effort by the Sierra Leonean government to implement the progressive policies on disability they have already adopted into law, which will aid the improvement of amputee rehabilitation services.

• New education and training programmes for all levels of prosthetic and orthotic professions are needed to secure the future of prosthetics and orthotics in Sierra Leone.

Keywords:

• Lower limb amputation
• rehabilitation
• Sierra Leone
• developing country
• physiotherapy
• prosthesis

Acknowledgements

The authors gratefully acknowledge all of the staff at Connaught Hospital, 34 Military Hospital, the National Rehabilitation Centre and the National Office for the Amputee and War Wounded Association who helped with this project.

Disclosure statement

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

Additional information

Funding

This research was funded by the Royal College of Surgeons (England) Student Intercalating BSc grant scheme and National Institute for Health Research (NIHR) [16/137/44] using UK aid from the UK Government to support global health research.