Prevalence of Major Limb Loss (MLL) in Post conflict Acholi sub-region of Northern Uganda: Cross sectional study

BACKGROUNDThere 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. AIMThe first prevalence study of disability and major limb loss in the region, and evaluated spatial patterns of cases of MLL. DESIGNCross-sectional survey. SETTINGThis research was undertaken in a community setting (at subjects homes). POPULATION7,864 randomly selected households throughout the Acholi Sub-Region of Northern Uganda. METHODSThis 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 Morans I statistic. The {chi}2 goodness of fit statistic was used to profile those with major limb loss in comparison with the underlying population. RESULTSWe 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. CONCLUSIONThis 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 IMPACTThe 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 ChecklistWe confirm that this manuscript conforms to the STROBE Checklist for Cross-Sectional Studies