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Sume BW, Geneti SA. Determinant Causes of Limb Amputation in Ethiopia: A Systematic Review and Meta-Analysis. Ethiop J Health Sci 2023; 33:891-902. [PMID: 38784515 PMCID: PMC11111207 DOI: 10.4314/ejhs.v33i5.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 05/25/2024] Open
Abstract
Background Most amputees suffered from lack of rehabilitation services and went on streets as glorified beggars. However, there is a paucity of information about determinant causes of amputation in Ethiopia. Therefore, this systematic review and meta-analysis was conducted to estimate pooled prevalence of limb amputation and its determinant causes in Ethiopian population. Methods Worldwide databases such as PubMed/MedLine, Web of Science, CINAHL, Embase, Scopus, and Science Direct were searched to retrieve pertinent articles. Grey literatures were also looked in local and national repositories. Microsoft excel was used to extract data which were exported to stata version 14.0 for analysis. Cochrane Q and I2 tests were used to assess heterogeneity. Egger's and Begg's tests were employed to assess reporting biases. Random effect meta-analysis model was applied to estimate pooled prevalence. Results Twenty-one qualified studies with 18,900 study participants were reviewed. Pooled prevalence of limb amputation was 31.69%. Lower extremity amputation (LEA) accounted for 14.41%, and upper extremity amputation (UEA) took 10.53% (6.50, 14.53). Above knee amputations (2.50 %) were common orthopedic operations whereas ray amputations (0.03%) were the least orthopedic procedures of LEA. Above elbow amputations (2.46%) were common from UEA while shoulder disarticulations (0.02%) were the least orthopedic surgical procedures. The major causes of limb amputations were trauma (11.05%), diabetic foot ulcer (9.93 %), traditional bone setters (24.10%) and burn (10.63%). Conclusions Lower extremity amputations were common orthopedic surgical procedures. Major determinant causes were trauma, diabetic foot ulcer, traditional bone setters and burn.
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Affiliation(s)
- Bickes Wube Sume
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Soressa Abebe Geneti
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Tamfu NS, Gustave TJ, Ngeh EN, Kwijirba NB, Christopher PT. Indications and complications of lower extremity amputations in two tertiary hospitals in the North West Region of Cameroon. Pan Afr Med J 2023; 44:196. [PMID: 37484574 PMCID: PMC10362659 DOI: 10.11604/pamj.2023.44.196.34969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/02/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction the study aimed to outline the common indications and complications of lower extremity amputations among amputated patients in two tertiary hospitals in the North West Region of Cameroon. Methods this hospital based retrospective study was conducted in the Bamenda Regional Hospital and Mbingo Baptist Hospital over a 5-year period from 2015-2019. We identified and reviewed amputee´s medical records over the 5-year period. A well designed extraction form was used for data collection and the data obtained was analysed using Epi-info version 7.2.4. Results a total of 148 patients underwent 159 amputations in Bamenda Regional Hospital and Mbingo Baptist Hospital with a mean age of 54.28 years (SD ±19.28). Males out-numbered females with a ratio of 2: 1. The most common indication for lower extremity amputation was Diabetic foot gangrene (42.14%) followed by trauma (22.01%). The most frequently performed procedure was Below Knee Amputation (48.42%). Post-amputation complication rate was recorded at 40.25% with surgical site infection being the most common (25.8%). Mortality rate was recorded at 6.28%. Conclusion diabetic foot gangrene is the leading indication of lower limb amputation in our setting and the most frequently performed procedure is Below Knee Amputation with surgical site infection being the most common complication.
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Affiliation(s)
- Ntuntu Sweni Tamfu
- Department of Clinical Sciences, Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | | | - Etienne Ngeh Ngeh
- Regional Hospital Bamenda, Bamenda, Cameroon
- Research Organisation for Health Education and Rehabilitation, Yaoundé, Cameroon
- Department of Physiotherapy St. Louis University Douala, Douala, Cameroon
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Urva M, Donnelley CA, Challa ST, Haonga BT, Morshed S, Shearer DW, Razani N. Transfemoral amputation and prosthesis provision in Tanzania: Patient and provider perspectives. Afr J Disabil 2023; 12:1084. [PMID: 36876024 PMCID: PMC9982473 DOI: 10.4102/ajod.v12i0.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/10/2022] [Indexed: 02/15/2023] Open
Abstract
Background The burden of disability because of traumatic limb amputation, particularly transfemoral amputation (TFA) is disproportionately carried by low- and middle-income countries. The need for improved access to prosthesis services in these settings is well-documented, but perspectives on the burden imposed by TFA and the challenges associated with subsequent prosthesis provision vary among patients, caregivers and healthcare providers. Objectives To examine the burden of TFA and barriers to prosthesis provision as perceived by patient, caregiver and healthcare professional, at a single tertiary referral hospital in Tanzania. Method Data were collected from five patients with TFA and four caregivers recruited via convenience sampling, in addition to 11 purposively sampled healthcare providers. All participants participated in in-depth interviews regarding their perceptions of amputation, prostheses and underlying barriers to improving care for persons with TFA in Tanzania. A coding schema and thematic framework were established from interviews using inductive thematic analysis. Results All participants noted financial and psychosocial burdens of amputation, and perceived prostheses as an opportunity for return to normality and independence. Patients worried about prosthesis longevity. Healthcare providers noted significant obstacles to prosthesis provision, including infrastructural and environmental barriers, limited access to prosthetic services, mismatched patient expectations and inadequate coordination of care. Conclusion This qualitative analysis identifies factors influencing prosthesis-related care for patients with TFA in Tanzania which are lacking in the literature. Persons with TFA and their caregivers experience numerous hardships exacerbated by limited financial, social and institutional support. Contribution This qualitative analysis informs future directions for research into improving prosthesis-related care for patients with TFA in Tanzania.
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Affiliation(s)
- Mayur Urva
- Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - Claire A Donnelley
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, United States
| | - Sravya T Challa
- Department of Orthopaedic Surgery, Harvard University, Boston, United States
| | - Billy T Haonga
- Department of Orthopaedic Surgery, Muhimbili Orthopaedic Institute, Dar es Salaam, United Republic of Tanzania
| | - Saam Morshed
- Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - David W Shearer
- Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States
| | - Nooshin Razani
- Department of Epidemiology and Biostatistics, University of California, San Francisco, United States
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Boateng D, Ayellah BB, Adjei DN, Agyemang C. Contribution of diabetes to amputations in sub-Sahara Africa: A systematic review and meta-analysis. Prim Care Diabetes 2022; 16:341-349. [PMID: 35305899 DOI: 10.1016/j.pcd.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022]
Abstract
Diabetes related amputations remain a major global problem, with devastating complications. We critically appraised relevant literature to quantify the prevalence of diabetes related amputations in sub-Saharan Africa (SSA). An electronic search was performed using the EMBASE and PubMed databases until 2020. Twenty-four out of 834 studies retrieved were included. The pooled prevalence of diabetic-related amputations was 36.9% (95%CI: 32.9%-40.8%). Complications of diabetes related amputations included infection, anaemia, foot deformity and mortality. The study revealed a substantial contribution of diabetes to the burden of amputations in SSA and suggests the need for further studies to assess how to reduce the incidence of diabetes, reduce the incidence of and or delay the progression of macro and microvascular complications of diabetes in SSA.
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Affiliation(s)
- Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | | | - David Nana Adjei
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Korle-Bu, Accra, Ghana
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Abbas ZG, Boulton AJM. Diabetic foot ulcer disease in African continent: 'From clinical care to implementation' - Review of diabetic foot in last 60 years - 1960 to 2020. Diabetes Res Clin Pract 2022; 183:109155. [PMID: 34838640 DOI: 10.1016/j.diabres.2021.109155] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 12/22/2022]
Abstract
The prevalence of diabetes mellitus is increasing globally and the greatest potential increases in diabetes will occur in Africa. Data suggest that these increases is associated with rapid demographic, sociocultural and economic transitions. There will be a parallel increase in the complications of diabetes and among the various complications those related to diabetic foot disease are associated with the highest morbidity and mortality. Diabetic Peripheral neuropathy (DPN) is the most common cause of diabetic foot complications in African countries; however, peripheral arterial disease (PAD) appears to increase, possibly a result of rising urbanization. Search done for the past six decades (1960 to 2020) on all foot complications. Rates of complications of diabetic foot in last six decades varied by country as follow: DPN: 4-90%; PAD: 0-77%; foot ulcers: 4-61%; amputation rates: 3-61% and high mortality rates reaching to 55%, patients who presented late with infection and gangrene. Educational and prevention programmes are required to curb the growing complications of diabetic foot ulcers in Africa among patients and health care workers. Secondly, it is imperative that governments across the African continent recognise the clinical and public health implications of diabetic foot disease in persons with diabetes.
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Affiliation(s)
- Zulfiqarali G Abbas
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Abbas Medical Centre, Dar es Salaam, Tanzania.
| | - Andrew J M Boulton
- Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, Faculty of Biology(,) Medicine and Health, University of Manchester, Manchester, UK; Miller School of Medicine, University of Miami, FL, USA
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von Kaeppler EP, Hetherington A, Donnelley CA, Ali SH, Shirley C, Challa ST, Lutyens E, Haonga BT, Morshed S, Andrysek J, Shearer DW. Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania. Afr J Disabil 2021; 10:839. [PMID: 34692432 PMCID: PMC8517763 DOI: 10.4102/ajod.v10i0.839] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background The rise of diabetes and traumatic injury has increased limb loss-related morbidity in low- and middle-income countries (LMICs). Despite this, the majority of amputees in LMICs have no access to prosthetic devices, and the magnitude of prosthesis impact on quality of life (QOL ) and function has not been quantified. Objectives Quantify the impact of prostheses on QOL and function in Tanzanian transfemoral amputees. Method A prospective cohort study was conducted. Transfemoral amputees at Muhimbili Orthopaedic Institute were assessed twice before and three times after prosthetic fitting using EuroQol-5D-3L (EQ-5D-3L), Prosthetic Limb Users Survey of Mobility (PLUS-M), 2-minute walk test (2MWT) and Physiologic Cost Index (PCI). Data were analysed for change over time. Subgroup analysis was performed for amputation aetiology (vascular or non-vascular) and prosthesis use. Results Amongst 30 patients, EQ-5D, PLUS-M and 2MWT improved after prosthesis provision (p < 0.001). EuroQol-5D increased from 0.48 to 0.85 at 1 year (p < 0.001). EuroQol-5D and 2MWT were higher in non-vascular subgroup (p < 0.030). At 1-year, 84% of non-vascular and 44% of vascular subgroups reported using their prosthesis (p = 0.068). Conclusion Prosthesis provision to transfemoral amputees in an LMIC improved QOL and function. This benefit was greater for non-vascular amputation aetiologies. Quality of life and function returned to pre-prosthesis levels with discontinued use of prosthesis.
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Affiliation(s)
- Ericka P von Kaeppler
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Alexander Hetherington
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Claire A Donnelley
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Syed H Ali
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Corin Shirley
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Sravya T Challa
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | | | - Billy T Haonga
- Department of Orthopaedic Surgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Saam Morshed
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
| | - Jan Andrysek
- LegWorks, Inc., Buffalo, United States of America.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - David W Shearer
- Institute of Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, United States of America
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Gaba EW, Asimeng BO, Kaufmann EE, Foster EJ, Tiburu EK. The Influence of Pineapple Leaf Fiber Orientation and Volume Fraction on Methyl Methacrylate-Based Polymer Matrix for Prosthetic Socket Application. Polymers (Basel) 2021; 13:polym13193381. [PMID: 34641196 PMCID: PMC8513026 DOI: 10.3390/polym13193381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 02/02/2023] Open
Abstract
This work reports on the use of low-cost pineapple leaf fiber (PALF) as an alternative reinforcing material to the established, commonly used material for prosthetic socket fabrication which is carbon-fiber-reinforced composite (CFRC) due to the high strength and stiffness of carbon fiber. However, the low range of loads exerted on a typical prosthetic socket (PS) in practice suggests that the use of CFRC may not be appropriate because of the high material stiffness which can be detrimental to socket-limb load transfer. Additionally, the high cost of carbon fiber avails opportunities to look for an alternative material as a reinforcement for composite PS development. PALF/Methyl Methacrylate-based (MMA) composites with 0°, 45° and 90° fiber orientations were made with 5-50 v/v fiber volume fractions. The PALF/MMA composites were subjected to a three-point flexural test to determine the effect of fiber volume fraction and fiber orientation on the flexural properties of the composite. The results showed that 40% v/v PALF/MMA composite with 0° fiber orientation recorded the highest flexural strength (50 MPa) and stiffness (1692 MPa). Considering the average load range exerted on PS, the flexural performance of the novel composite characterized in this work could be suitable for socket-limb load transfer for PS fabrication.
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Affiliation(s)
- Eric Worlawoe Gaba
- Department of Biomedical Engineering, School of Engineering Sciences, University of Ghana, Accra P.O. Box LG 74, Ghana; (E.W.G.); (B.O.A.); (E.E.K.)
| | - Bernard O. Asimeng
- Department of Biomedical Engineering, School of Engineering Sciences, University of Ghana, Accra P.O. Box LG 74, Ghana; (E.W.G.); (B.O.A.); (E.E.K.)
| | - Elsie Effah Kaufmann
- Department of Biomedical Engineering, School of Engineering Sciences, University of Ghana, Accra P.O. Box LG 74, Ghana; (E.W.G.); (B.O.A.); (E.E.K.)
- Department of Orthotics and Prosthetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho PMB 31, Ghana
| | - E. Johan Foster
- Department of Chemical and Biological Engineering, University of British Columbia, 2360 East Mall, Vancouver, BC V6T 1Z3, Canada;
| | - Elvis K. Tiburu
- Department of Biomedical Engineering, School of Engineering Sciences, University of Ghana, Accra P.O. Box LG 74, Ghana; (E.W.G.); (B.O.A.); (E.E.K.)
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence:
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Traumatic Injuries are the Main Indication for Limb Amputations During and After Humanitarian Crises. World J Surg 2021; 45:1021-1025. [PMID: 33452564 DOI: 10.1007/s00268-020-05905-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Populations at risk during humanitarian crises can suffer traumatic injuries or have medical conditions that result in the need for limb amputation (LA). The objectives of this study were to describe the indications for and associations with LA during and after humanitarian crises in surgical projects supported by Médecins Sans Frontières (MSF). METHODS MSF-Operational Center Brussels data from January 1, 2008, to December 31, 2017, were analyzed. Surgical projects were classified into (annual) periods of crises and post-crises. Indications were classified into trauma (intentional and unintentional) and non-trauma (medical). Associations with LA were also reported. RESULTS MSF-OCB performed 936 amputations in 17 countries over the 10-year study period. 706 (75%) patients were male and the median age was 27 years (interquartile range 17-41 years). Six hundred and twenty-one (66%) LA were performed during crisis periods, 501 (53%) during conflict and 119 (13%) post-natural disaster. There were 316 (34%) LA in post-crisis periods. Overall, trauma was the predominant indication (n = 756, 81%) and accounted for significantly more LA (n = 577, 94%) in crisis compared to post-crisis periods (n = 179, 57%) (p < 0.001). DISCUSSION Our study suggests that populations at risk for humanitarian crises are still vulnerable to traumatic LA. Appropriate operative and post-operative LA management in the humanitarian setting must be provided, including rehabilitation and options for prosthetic devices.
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Muhoma T, Waruiru MW, Sanni O, Knecht LD, McFarland M. A quality improvement project to improve diabetes self-management and patient satisfaction in a low-resourced central Kenyan hospital. Afr Health Sci 2020; 20:1322-1328. [PMID: 33402981 PMCID: PMC7751541 DOI: 10.4314/ahs.v20i3.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background There is limited evidence about effective strategies for promoting culturally congruent diabetes education in low-resourced primary-care settings. Objectives This project, conducted in Central Kenya, examined the effect of an intervention on provider practices and patients' knowledge of diabetes self-care management. Methods The intervention consisted of short (30-minute) sessions that offered providers evidenced-based, culturally congruent diabetes education and teaching materials to use with patients. A checklist was used to assess providers' diabetes care practices at baseline and post intervention. Data from semi-structured patient interviews assessed patients' diabetes knowledge at baseline and post intervention. Providers and patients also completed post-intervention satisfaction surveys. Results Six providers and 74 patients participated in the project. Statistical analysis was completed using SPSS. Significant increases were noted in patients' post-intervention overall diabetes knowledge score (p=.05) and the foot care knowledge subscale (p=.02). No significant differences were noted between patients' baseline and post-intervention scores in the general diabetes (p=.86) or nutrition knowledge (p=.32) subscales. Conclusion These findings suggest supporting providers with culturally congruent tools and resources about diabetes care guidelines can improve knowledge of self-care practices in patients with diabetes.
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Grudziak J, Mukuzunga C, Melhado C, Young S, Banza L, Cairns B, Charles A. Etiology of major limb amputations at a tertiary care centre in Malawi. Malawi Med J 2020; 31:244-248. [PMID: 32128034 PMCID: PMC7036427 DOI: 10.4314/mmj.v31i4.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Amputations in low- and middle-income countries (LMICs) represent an important cause of disability and economic hardship. LMIC patients are young and suffer from preventable causes, such as trauma and trauma-related infections. We herein studied the etiology in amputations in a Malawian tertiary care hospital over a 9-year period. Methods Operative and anaesthesia logs at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi, were reviewed for 2008–2016. Baseline demographic and clinical variables and type of amputation performed were collected. Only major limb amputations, defined as above or below the knee, above or below the elbow, and above the wrist, were included in this study. Results A total of 610 patients underwent 630 major amputations during the study period. Of these, 170 (27%) patients were female, and the median age of the cohort was 39 (interquartile range [IQR] 25–55). Of these patients, 345 (54.8%) had infection or gangrene recorded among the indications for amputation, 203 (32.2%) had trauma, 94 (14.9%) had cancer and 67 (10.6%) had documented diabetes. Women underwent diabetes-related amputations more often than men (37 out of 67, or 56.1%), and were significantly younger when their amputations were due to diabetes (median age 48 vs 53 years old, P=0.004) or trauma (median age 21 vs 30 years old, P=0.02). The commonest operative procedures were below the knee amputations, at 271 (43%), and above the knee amputations, at 213 (33.8%). Conclusion Amputations in Malawi affect primarily the young, in the most economically productive time of their lives, in contrast to amputees in high-income countries. Preventable causes, such as infection and trauma, lead to the majority of amputations. These etiologies represent an important primary prevention target for public health efforts in LMICs.
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Affiliation(s)
- Joanna Grudziak
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | | | | | - Sven Young
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,University of Malawi College of Medicine, Lilongwe, Malawi
| | - Leonard Banza
- UNC Project, Malawi.,University of Malawi College of Medicine, Lilongwe, Malawi.,Institute of Clinical studies (K1) and Centre for International Health, University of Bergen, Norway
| | - Bruce Cairns
- Department of Surgery, University of North Carolina at Chapel Hill, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, USA.,Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,UNC Project, Malawi
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Yongu W, Kortor J, Mue D, Anhange S, Musa T. Patients' perception and attitude to surgical amputation in Makurdi, North Central Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_122_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gebreslassie B, Gebreselassie K, Esayas R. Patterns and Causes of Amputation in Ayder Referral Hospital, Mekelle, Ethiopia: A Three-Year Experience. Ethiop J Health Sci 2018; 28:31-36. [PMID: 29622905 PMCID: PMC5866287 DOI: 10.4314/ejhs.v28i1.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Amputation is a surgical procedure for the removal of a limb which is indicated when limb recovery is impossible. There are different types of amputation, and their causes can vary from one area to the other. Therefor, the aim of this study is to find out the patterns and causes of amputations in patients presented to Ayder Referral Hospital, Mekelle, Ethiopia. Methods the record of 87 patients who had amputation at different sites after admission to Ayder referral hospital, Mekelle, Ethiopia in three years period were reviewed retrospectively. Result A total of 87 patients had amputation of which 78.2% were males. The age range was from 3 to 95 years, and the mean age was 40.6 in years. The most common indications were trauma (37.7%), tumor (24.1%), and peripheral arterial disease (PAD) (20.7%). The commonest type of amputation was major lower limb amputation (58.6%) which includes above knee amputation (35.6%)and below knee amputation (23%) followed by digital amputation (17.2%). There was 11.4% major upper limb amputation of which there was one patient who had re-amputation. Conclusion Most of the indications for amputations in our setup are potentially preventable by increasing awareness in the society on safety measures both at home and at work and early presentation to health facilities.
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Affiliation(s)
| | | | - Reiye Esayas
- Department of Surgery, College of Health Sciences, Mekelle University
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Hagan R, Kadzi J, Rahman G, Morna M. PATTERNS AND INDICATIONS OF AMPUTATION IN CAPE COAST TEACHING HOSPITAL: A FOUR YEAR RETROSPECTIVE REVIEW. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2018; 8:45-58. [PMID: 32754456 PMCID: PMC7368576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Limb amputation is reported to be a major but preventable public health problem that is associated with profound economic, social and psychological effects on the patient and family especially in developing countries where prosthetic services are unavailable, inaccessible or unaffordable. AIM The purpose of this study was to determine the patterns of and indications for limb amputations. METHODOLOGY A retrospective study, covering a 4-year period, involving 126 patients who underwent amputation at a teaching hospital was carried out. Data on patients including indication for amputation were obtained from theatre record books and folders and analyzed using SPSS and MS Excel. Data was presented in frequencies and percentages. Chi square tests were used to compare categorical variables and differences were considered significant if p<0.05. RESULTS The mean age of the 126 patients was 60.92(SD19.03) years with a median of 67years. There were 68 females and 58 males giving a female to male ratio of 1.2:1. Lower limb amputations were performed in 114(90.48%) and upper limb amputations in 12(9.52%) patients. The commonest indication for amputation was diabetic foot gangrene accounting for 54(42.86%) patients, followed by peripheral vascular disease 43(34.13%) and trauma 12(9.52%). Twenty-one of the patients who had amputations for indications other than diabetic foot gangrene also had diabetes mellitus. Below knee amputation was the commonest procedure performed (43.65%). One hundred and twenty (95.2%) were unilateral and 116 (92.1% ) were performed in a single-stage procedure. CONCLUSION Most of the amputations in the Cape Coast Teaching Hospital were performed in elderly patients, with a slight preponderance of women over men. Lower limb amputations were far more common than upper limb ones. The commonest indication for amputations was diabetic foot gangrene, with below knee amputation being the commonest type. There is an urgent need for public education on diabetes and its complications and on diabetic foot care. The establishment of a multidisciplinary diabetic foot care clinic is advocated if the incidence of limb amputations is to be reduced in the Cape Coast Teaching Hospital.
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Affiliation(s)
- R Hagan
- Department of Surgery, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - J Kadzi
- Department of Surgery, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - G Rahman
- Department of Surgery, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Surgery, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - M Morna
- Department of Surgery, Cape Coast Teaching Hospital, Cape Coast, Ghana
- Department of Surgery, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
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14
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Nwosu C, Babalola MO, Ibrahim MH, Suleiman SI. Major limb amputations in a tertiary hospital in North Western Nigeria. Afr Health Sci 2017; 17:508-512. [PMID: 29062347 DOI: 10.4314/ahs.v17i2.26] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Amputation is the removal of whole or part of a limb, often as a life saving measure. It is a mutilating surgical procedure altering the body image and producing severe functional deficit. It is a common orthopedic surgical procedure performed worldwide. AIMS AND OBJECTIVES The aim of this study was to determine the pattern and indications for amputation in Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria; between January 2008 and December 2014, in a bid to proffer preventive measures. PATIENTS AND METHODS This was a retrospective study of consecutive patients who had major limb amputations at the Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria; between January 2008 and December 2014. Case notes of patients were retrieved with relevant information extracted and analyzed. RESULTS A total of 112 amputations were studied. The age range of patients was between 3-89 years. Amputation in 23.5% of patients was due to trauma, followed by diabetic foot gangrene in 21% of cases. About 42.9% of the amputations were above knee, followed by below knee amputations in 37% of cases. The lower limbs were involved in 84.8% of cases and upper limbs in 15.2% of cases. CONCLUSION Trauma was the most predominant indication for amputation in this study. This was followed by diabetic foot gangrene. This is usually due to the high rate of road traffic accidents and consequent mismanagement by traditional bone setters.
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Affiliation(s)
- Chikwendu Nwosu
- Departments of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State
| | - Misbau O Babalola
- Departments of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Muhammad H Ibrahim
- Departments of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State
| | - Siyaka I Suleiman
- Departments of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State
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15
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Consensus recommendations for essential vascular care in low- and middle-income countries. J Vasc Surg 2016; 64:1770-1779.e1. [PMID: 27432199 DOI: 10.1016/j.jvs.2016.05.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/13/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Many low- and middle-income countries (LMICs) are ill equipped to care for the large and growing burden of vascular conditions. We aimed to develop essential vascular care recommendations that would be feasible for implementation at nearly every setting worldwide, regardless of national income. METHODS The normative Delphi method was used to achieve consensus on essential vascular care resources among 27 experts in multiple areas of vascular care and public health as well as with experience in LMIC health care. Five anonymous, iterative rounds of survey with controlled feedback and a statistical response were used to reach consensus on essential vascular care resources. RESULTS The matrices provide recommendations for 92 vascular care resources at each of the four levels of care in most LMICs, comprising primary health centers and first-level, referral, and tertiary hospitals. The recommendations include essential and desirable resources and encompass the following categories: screening, counseling, and evaluation; diagnostics; medical care; surgical care; equipment and supplies; and medications. CONCLUSIONS The resources recommended have the potential to improve the ability of LMIC health care systems to respond to the large and growing burden of vascular conditions. Many of these resources can be provided with thoughtful planning and organization, without significant increases in cost. However, the resources must be incorporated into a framework that includes surveillance of vascular conditions, monitoring and evaluation of vascular capacity and care, a well functioning prehospital and interhospital transport system, and vascular training for existing and future health care providers.
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16
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Santos ICRV, Sobreira CMM, Nunes ENDS, Morais MCDA. [The prevalence and factors associated with diabetic foot amputations]. CIENCIA & SAUDE COLETIVA 2014; 18:3007-14. [PMID: 24061027 DOI: 10.1590/s1413-81232013001000025] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/27/2012] [Indexed: 11/21/2022] Open
Abstract
The scope of this investigation was to establish the prevalence of diabetic foot amputations and analyze associations with factors related to the individual and to primary health care. It is a cross-sectional epidemiological study and the sample included 214 inpatients with diabetic feet in one of the four hospitals specialized in vascular surgery in the state of Pernambuco. Data were collected using semi-structured questionnaires. In the data analysis, chi-square association, Poisson regression (p < 0.05) and descriptive statistics procedures were applied. The prevalence of amputation ascertained was 50%. The following factors related to the individual were associated with its occurrence: low education (p = 0.027); two or more people living in the household (p = 0.046); and patient income below the minimum wage (p = 0.004). The following factors related to primary health care were associated with amputation: not having feet examined (PR = 1.17); not receiving guidance on foot care (PR = 2.24) in consultations in the past year; not using the drug for DM control as prescribed (PR = 1.60); and inadequate glycemic control (PR = 1.83). Understanding these factors helps to identify aspects of preventive care that require improvement.
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17
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Lazzarini PA, O'Rourke SR, Russell AW, Clark D, Kuys SS. What are the key conditions associated with lower limb amputations in a major Australian teaching hospital? J Foot Ankle Res 2012; 5:12. [PMID: 22647678 PMCID: PMC3464163 DOI: 10.1186/1757-1146-5-12] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 04/02/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower extremity amputation results in significant global morbidity and mortality. Australia appears to have a paucity of studies investigating lower extremity amputation. The primary aim of this retrospective study was to investigate key conditions associated with lower extremity amputations in an Australian population. Secondary objectives were to determine the influence of age and sex on lower extremity amputations, and the reliability of hospital coded amputations. METHODS Lower extremity amputation cases performed at the Princess Alexandra Hospital (Brisbane, Australia) between July 2006 and June 2007 were identified through the relevant hospital discharge dataset (n = 197). All eligible clinical records were interrogated for age, sex, key condition associated with amputation, amputation site, first ever amputation status and the accuracy of the original hospital coding. Exclusion criteria included records unavailable for audit and cases where the key condition was unable to be determined. Chi-squared, t-tests, ANOVA and post hoc tests were used to determine differences between groups. Kappa statistics were used to measure reliability between coded and audited amputations. A minimum significance level of p < 0.05 was used throughout. RESULTS One hundred and eighty-six cases were eligible and audited. Overall 69% were male, 56% were first amputations, 54% were major amputations, and mean age was 62 ± 16 years. Key conditions associated included type 2 diabetes (53%), peripheral arterial disease (non-diabetes) (18%), trauma (8%), type 1 diabetes (7%) and malignant tumours (5%). Differences in ages at amputation were associated with trauma 36 ± 10 years, type 1 diabetes 52 ± 12 years and type 2 diabetes 67 ± 10 years (p < 0.01). Reliability of original hospital coding was high with Kappa values over 0.8 for all variables. CONCLUSIONS This study, the first in over 20 years to report on all levels of lower extremity amputations in Australia, found that people undergoing amputation are more likely to be older, male and have diabetes. It is recommended that large prospective studies are implemented and national lower extremity amputation rates are established to address the large preventable burden of lower extremity amputation in Australia.
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Affiliation(s)
- Peter A Lazzarini
- Allied Health Research Collaborative, Metro North Health Service District & Queensland University of Technology, The Prince Charles Hospital, Rode Road, Chermside QLD, 4032 Brisbane, Australia.
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Odatuwa-Omagbemi DO, Adiki O. Extremity amputations in warri, South-South Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2012; 2:14-24. [PMID: 25452975 PMCID: PMC4170288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Amputation is one of the most common procedures in the practice of Orthopaedics and Traumatology in Nigeria. Many previous studies and reports from different centres show variations in the indications for this surgical procedure. AIMS & OBJECTIVES The aim of this study is to find the most important indications for amputation in our immediate environment and make possible suggestions towards reducing the incidence. PATIENTS AND METHOD This is a retrospective study of consecutive patients who had limb amputations at the Central Hospital, Warri between January, 2009 and December, 2011. Case notes of patients were retrieved, relevant information extracted and analysed. RESULTS A total of 44 patients had 46 amputations within the study period. The age range of patients was between 8-88 years. Amputation in 63.6% of the patients was due to diabetic foot disease, followed by trauma in 20.5% of cases. About (62.5%) of the amputations were below knee amputations while toe amputations made up 17.4% of cases. The lower limb was involved in 91% of cases and upper limbs in 9% of cases. Complication rate was about 39.1% which was mostly as a result of wound infections. CONCLUSION Diabetic foot disease was the most important indication for amputation in this study. Rigorous public enlightenment on the prevention and effective treatment of diabetes will reduce the incidence of lower limb amputations in this environment.
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Affiliation(s)
| | - Ot Adiki
- Department Of Surgery, Central Hospital, Warri. Delta State. Nigeria
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