A Cross-Sectional Study of Prevalence and Spatial Patterns of Major Limb Loss in the Acholi Sub-Region of Uganda

BACKGROUND There is a widely reported preponderance of major limb loss in Northern Uganda, which is believed to have been caused in large part by prolonged civil war. Access to rehabilitation facilities is extremely limited, and there has never been a study to understand how many people have major limb loss, nor how many of them have had access to medical or rehabilitative services. AIM The first prevalence study of disability and major limb loss in the region, and evaluated spatial patterns of cases of MLL. DESIGN Cross-sectional survey. SETTING This research was undertaken in a community setting (at subjects’ homes). POPULATION 7,864 randomly selected households throughout the Acholi Sub-Region of Northern Uganda. METHODS This study comprised two questionnaires, the first to be completed by the head of every sampled household ( n =7,864), and the second by any member of the household with major limb loss ( n =181). Household locations were examined for spatial autocorrelation using Moran’s I statistic. The χ 2 goodness of fit statistic was used to profile those with major limb loss in comparison with the underlying population. RESULTS We conservatively estimate that there are c.10,117 people with major limb loss in the region who require long-term rehabilitation services (c.0.5% of the population), and c.150,512 people with disabilities other than MLL (c.8.2% of the population). People with major limb loss are spread throughout the region (as opposed to clustered in specific locations) and are disproportionately male, older and less well educated than the general population. CONCLUSION This research demonstrates, for the first time, the extent of the inadequacy of long-term rehabilitation services for those with major limb-loss in the study area. We provide new insight into the reasons that people are not accessing medical and rehabilitative services, and propose a way forward through the successful demonstration of an ‘outreach clinic’ model. CLINICAL REHABILITATION IMPACT The discovery of the spatial pattern of those with major limb loss, alongside the demonstration of the clinical outreach model, provides a compelling argument for the need of more such services and associated policy frameworks in remote and rural regions in the Global South. TIDIER Checklist We confirm that this manuscript conforms to the STROBE Checklist for Cross-Sectional Studies