Transfemoral amputation and prosthesis provision in Tanzania: Patient and provider perspectives

Mayur Urva; Claire A Donnelley; Sravya T Challa; Billy T Haonga; Saam Morshed; David W Shearer; Nooshin Razani

doi:10.4102/ajod.v12i0.1084

Transfemoral amputation and prosthesis provision in Tanzania: Patient and provider perspectives

Afr J Disabil. 2023 Feb 14:12:1084. doi: 10.4102/ajod.v12i0.1084. eCollection 2023.

Authors

Mayur Urva¹, Claire A Donnelley², Sravya T Challa³, Billy T Haonga⁴, Saam Morshed⁵, David W Shearer⁵, Nooshin Razani⁶

Affiliations

¹ Department of Orthopedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States.
² Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, United States.
³ Department of Orthopaedic Surgery, Harvard University, Boston, United States.
⁴ Department of Orthopaedic Surgery, Muhimbili Orthopaedic Institute, Dar es Salaam, United Republic of Tanzania.
⁵ Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California, San Francisco, United States.
⁶ Department of Epidemiology and Biostatistics, University of California, San Francisco, United States.

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.

Keywords: Tanzania; barriers; caregiver; low-resource setting; prosthetic rehabilitation; qualitative; thematic analysis; transfemoral amputation.