Amputees in Uganda

There are 2 types of amputee, those who have had a limb removed or those people born deficient in limbs. These are defined as:

1. Amputation is the removal of all or part of a limb by a surgical process. Amputation of the leg, above are below the knee is the most common form of surgical removal. 
2. People who are born with all or part of a limb not developed are congenital amputees.

There are many reasons for limb amputation. Some of these are listed here: (see Wikipedia):

Complications of diabetes
Removal of cancerous bone or soft tissue
Severe limb injuries
Limb deformities
Infection of bones or soft tissue

Statistics for amputations vary between countries. It is also difficult to find accurate statistics for Uganda. It is generally accepted that amputation has has a base figure of 1.5 per 1,000 people worldwide (Estimates of Amputee Population). A review of worldwide literature found that congenital amputation is between 1.2 and 4.4 per 10,000 births (Epidemiology of limb loss and congenital limb deficiency: a review of the literature).

With artificial legs this man can show that disability is not inability

In the absence of statistics from Uganda these figures from Kikuyu Hospital, a rural hospital in Kenya, give some idea of the causes and numbers of amputations. Limb amputation records were examined between October 1998 and September 2008:

One hundred and forty patients underwent amputation. Diabetic vasculopathy accounted for 11.4% of the amputations and 69.6% of the dysvascular cases. More prevalent causes were trauma (35.7%), congenital defects (20%), infection (14.3%) and tumours (12.8%). Diabetic vasculopathy, congenital defects and infection are major causes of amputation. Control of blood sugar, foot care education, vigilant infection control and audit of congenital defects are recommended.

Again, in the absence of data from Uganda these figures from a city in the Democratic Republic of Congo, Kisangani Clinical University, General Hospital Makiso-Kisangani and Kabondo Reference General Hospital from 1st January 2005 to 31st December 2014 provide an interesting contrast. 62 cases of amputation were analysed:

The prevalence of 14.69% of all interventions of limbs. The age group of 57 - 75 years is the most concerned and the male/female sex ratio is 2.9/1. The unemployed are most affected 51.6%. The lower limb is concerned in 88.7%, including 30.6% in the lower leg and the right side is 56.5% of cases. Diabetic gangrene (30.1%) was followed by traumatism (27.4%). The mortality rate is 17.8%.

The report concludes

The adult male is most affected. Diabetic gangrene and open fractures are the most encountered causes. Mortality is high. The early management of diabetics and open fractures is recommended.

Road traffic accidents are a major reason for amputations, on the 6th March 2016 the following article was printed in the Daily News:

The rise in the number of accidents, owing mostly to increased use of motorcycles as a major means of transport, has led to over 150 per cent more surgeries including amputations. Some analysts say the cost of rehabilitation and prosthesis going is now at the tune of 3.5m/- per person.
Statistics from 2016 edition of the 'On the move', a local magazine on road safety in the country cited that in 2008 there were a total of 20,615 accidents that resulted in 2,905 deaths and 17,861 injuries and in 2011 this number shot to 24,665 accidents, 3,582 deaths and 20,656 injuries but saw a significant drop in 2015 where there were 8,337 accidents, 3,468 deaths and 9,383 injuries.
The World Health Organisation's (WHO) global status report on road safety 2015 cited that some 1.25 million people die each year as a result of road accidents despite improvements in road safety.
Responding to gravity of most accidents, Ms Mamseri said that some of amputations are done at the scene of the accidents even before reaching the hospital, while others develop infections due to maltreatment in the areas they first receive the initial treatment and some are severely injured resulting to an amputation.
According to the Digital Resource Foundation website, the numbers of amputees in the developing world are truly staggering. Vietnam is commonly reported to have 200,000 amputees; Cambodia, 36,000; Angola, 15,000; Uganda, 5,000; Mozambique, 8,000 and so on. The accuracy of these figures may be questioned since most field survey research is incomplete.
However, amputations performed for traumatic injury in the developing world are significantly higher than in the modern world.

In a rural setting diabetes and congenital defects are a major cause of amputation. Whilst in the city diabetes  and open fractures are a problem. Both the above reports conclude that more education about diabetes and its complications is necessary. 

There is an organization for amputees in Uganda. Rock Rehabilitation - Uganda has the stated aims

• To increase awareness of limblessness and what it means for sufferers in Uganda.
• To promote worldwide the rehabilitation of persons who have suffered the loss of limbs 
• To enable the development of services to assist in this rehabilitation by offering training and general education to professionals, orthopedic and prosthetics opportunities, general life skills services
• Set up rehabilitation centres in countries where provision is wanting, eg: Uganda

Rock Rehabilitation - Uganda describes the reality for amputees in Uganda:

They’re many who have lost limbs through car accidents, land mines, war injuries, industrial accidents. Amputation is undertaken in a general hospital or by a local herbal doctor if hospital fees can not be afforded. The Ugandan view is that if you lose a limb you have lost your life; there is no expectation of life capability.

Attitudes must change. Disability Support Uganda is working with amputees to show that disability is not inability. People with disabilities (PWDs) can make an effective contribution to the Ugandan  economy and society with the right equipment.