Understanding the need for hand and upper extremity surgery in sub-Saharan Africa: A survey of providers

Abstract

Background: Injuries, disorders, and deformities of the hands and upper extremities cause significant morbidity worldwide, but in sub-Saharan Africa, the burden of disease and the availability of appropriate care remain unknown. We sought to characterize disease burden and barriers to care for hand and upper extremity conditions across sub-Saharan Africa, examining differences in burden and access by geographic region and national income level.

Methods: From 6 June 2020 through 17 March 2021, we surveyed providers of musculoskeletal care in sub-Saharan Africa regarding the provision of care and the most common acute and chronic hand or upper extremity conditions encountered by respondents. Surveys were distributed through professional networks across sub-Saharan Africa. We categorized responses by each respondent’s national income level and geographic region. Then, we examined how frequently various challenges to accessing healthcare, as well as how frequently acute or chronic conditions, were reported. Additionally, we analyzed how these data varied by income level and geographic region.

Results: We received 193 responses from 39 countries in sub-Saharan Africa. Eighty-eight per cent of respondents reported that general orthopaedic surgeons and orthopaedic traumatologists primarily manage upper extremity conditions. A lack of adequate and timely diagnosis was reported by 142 respondents (74%); late referral for treatment was reported by 149 (77%); and inadequate physical therapy, occupational therapy, and rehabilitation was reported by 149 respondents (77%). The most commonly reported acute conditions were adult and paediatric radius/ulna fractures/dislocations, adult metacarpal/phalangeal fractures/dislocations, soft-tissue injuries (including burns), and paediatric elbow fractures/dislocations. The most commonly reported chronic conditions were tendinitis/tenosynovitis, chronic infections/osteomyelitis, neuropathies, posttraumatic stiff hand, and radius/ulna malunion/nonunion. Neglected trauma (including chronic elbow injuries and burn contractures) was frequently reported, especially in low-income countries.

Conclusions: Trauma care should be strengthened through training of general orthopaedic surgeons in hand and upper extremity surgery throughout sub-Saharan Africa. Especially in low-income countries, particular training emphasis should be placed on the management of malunion/nonunion, osteomyelitis, acute and chronic elbow injuries, and burn contractures. These findings should inform the development of core competencies in hand surgery for providers managing musculoskeletal conditions in sub-Saharan Africa, as well as guide capacity-building activities on the continent.