Mulindwa Benedict, Nalwoga Racheal P, Nakandi Brenda T, Mwaka Erisa S, Kenney Laurence P J, Ackers Louise, Ssekitoleko Robert Tamale
Biomedical Engineering Unit, Department of Physiology, Makerere University, Kampala, Uganda.
Department of Anatomy, Makerere University, Kampala, Uganda.
Disabil Rehabil. 2023 Mar 24:1-10. doi: 10.1080/09638288.2023.2188266.
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.
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.
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.
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 RehabilitationAvailability 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.
中低收入国家（LMICs）面临着巨大的肢体严重缺失负担。近期尚无研究报道乌干达公共部门假肢服务的状况。本研究旨在记录乌干达肢体严重缺失的情况以及现有假肢服务的结构。
本研究包括对穆拉戈国家转诊医院、福特波特地区转诊医院和姆巴莱地区转诊医院的病历进行回顾性分析，以及对该国骨科车间参与假肢装置制作和装配的人员进行横断面调查。
上肢截肢占14.2%，下肢截肢占81.2%。坏疽（30.3%）是截肢的主要原因，其次是道路交通事故和糖尿病。骨科车间提供分散式服务，且使用的大多数材料是进口的。基本设备大多短缺。骨科技术人员经验和技能各异，但许多其他因素限制了他们的服务提供。
乌干达公共医疗系统在人员以及包括设备、材料和部件在内的支持资源方面都缺乏足够的假肢服务。假肢康复服务的提供有限，尤其是在农村地区。服务分散化可改善患者获得假肢服务的机会。
对康复的启示
假肢服务的可获得性和可及性对于中低收入国家（LMICs）截肢者的康复以及重新融入社区至关重要。
为使利益相关者能够制定有效的计划来解决假肢服务提供中的问题，有关服务现状的高质量数据是必要的。
服务提供者应优先考虑假肢康复服务的分散化，特别是针对农村地区的患者，以改善这些服务的可及性和覆盖范围。
为使下肢和上肢截肢者截肢后实现最佳肢体功能，在中低收入国家工作的康复专业人员应专注于提供全面的多学科康复服务。
骨科人员应确保截肢后患者信息的完整准确记录，以便有效地跟踪和监测患者护理情况，从而改善康复效果。
