Department of Surgery

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Browsing Department of Surgery by Author "Atim, Pamela"

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    Major limb loss (MLL): An overview of etiology, outcomes, experiences and challenges faced by amputees and service providers in the post-conflict period in Northern Uganda
    (Journal of Global Health Reports, 2019) Okello, Tom Richard; Magada, Samuel M; Atim, Pamela; Ezati, Daniel; Campion, Alice; Moro, Emmanuel B; Huck, Jonathon; Byrne, Ged; Redmond, Anthony; Nirmalan, Mahesh
    Background Trauma is a leading cause for major limb loss (MLL) during war. As societies transition into peace other factors become important. The voluntary sector plays a diminishing role in service delivery as countries transition towards peace. Methods We undertook a retrospective review of 141 inpatient case notes at two hospitals in Northern Uganda to study the etiology of MLL. Focus group discussions, a literature search and key informant interviews were undertaken to ascertain patients’ experience and the state of current services. Results The most common indication for amputation was malignancy (36%), followed by gangrene and complications from diabetes. Trauma was the 5th most common cause. The mean (standard deviation, SD) age of this cohort was 43 (22.2) years and the mean (SD) distance from their homes to the closest rehabilitation service unit was 91 (75) km. Less than 1% of patients were formally referred to rehabilitation services. Patients described experiences of stigma and marginalization impacting relationship and/or employability. Rehabilitation services were limited/ unaffordable and inaccessible. Unpreparedness of government agencies in taking over rehabilitation services was evident. Conclusions Non-communicable diseases account for the majority of MLL in this region now. These new cohorts of patients join an existing large pool of war-related amputees. Chronic dependence on the voluntary sector has rendered a state of unpreparedness amongst the local health providers.
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    Major Limb Loss and Prosthesis Use in the Post Conflict era in Acholi Sub-Region, Northern Uganda
    (International Journal of Science Academic Research, 2022) Okello, Tom Richard; Magada, Samuel Moses; Atim, Pamela; Campion, Alice; Moro, Emmanuel Ben; Jonathan, Hucks; Mahesan, Nirmalan
    Introduction: This study assessed amputees’ residual limb stump in the post war era of Acholi sub-region for suitability of prosthetic fit use and associated challenges with their current prosthesis and psycho-socio emotional experiences. Methods: A cross-sectional clinical assessment of amputees living within the communities in Acholi sub-region was done between September 2018 to August 2019 by a team of Surgical Consultants, orthopaedic technician and prosthetic therapist. Result: The biggest proportion of amputees living in the Acholi communities were adults of 35-65yrs (mean of 43.36yrs, SD+/- 15.694) and more male were affected than females (73.4%:26.6% respectively). The negative predictors of prosthetic fit and use were advancing age, gender, increased duration of disability, high percentage of disability, but stump length and power were positive predictor. Lower limb amputees tend to suffer more psycho-socio emotional disorder like pain sensation, stress, mood and anxiety disorders, as well as sexual discrimination. Lower limb amputee experiences more prosthesis complication like excessive sweating, extremely bothersome sound, terrible fit,and terrible appearance than upper limb. Conclusion: Residual stump length and power are the most important predictor of prosthesis fit. For proper prosthetic adherence, mental health and socio-emotional support need to be included in a comprehensive rehabilitation of amputees
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    Prevalence of Major Limb Loss (MLL) in Post conflict Acholi sub-region of Northern Uganda: Cross sectional study
    (BioRxiv, 2020) Atim, Pamela; Loum, Constantine S; Okello, Tom Richard; Magada, Samuel M; Yagos, Walter Onen; Abelle, Peter; Moro, Emmanuel B; Huck, Jonathan; Redmond, Anthony; Nirmalan, Mahesh
    Background: Awareness of residual disabilities amongst people living in countries recovering from prolonged armed conflicts and their socio-economic consequences is increasing. Robust data on the prevalence of such disabilities are important for planning cost effective health services. This study outlines the first community-based prevalence study of Major Limb Loss (MLL) in the Acholi sub region of Northern Uganda. The generic lessons learnt are relevant to many other postconflict societies in Asia and Africa. Methods: A cross sectional survey using random cluster sampling was conducted across 8,000 households in eight districts, of which 7,864 were suitable for analysis. The households were sampled randomly using a high-resolution population model generated using a combination of census data and artificial intelligence. Data were collected using semi-structured questionnaires administered by trained staff, and results were statistically analysed to identify patterns. Results: Data obtained from 7,864 households demonstrated that 47.9% (3,763) of households contained people with disabilities, and 3.0%, (237) of households contained people living with MLL. Of those exhibiting disabilities, the most common types were physical disabilities affecting mobility and other conditions limiting vision or hearing. Our analysis suggests that MLL sufferers are disproportionately male, older and less well educated than the general population. Using the identified prevalence rate of MLL (0.6%) and an estimated population value for the Acholi Sub- Region of 1.9 million, we estimate that there are approximately 11,400 MLL sufferers in the region who require long-term rehabilitation services. Conclusions: This is the first large scale study on the prevalence of MLL following the Ugandan civil war - known for extreme forms of violence, cruelty and mutilation. Our study demonstrates the magnitude of the problem still faced by the affected people, almost 15 years after the end of large scale combat, and the relative paucity of rehabilitation services to meet their needs. Suitable alternative health policy frameworks are required to address these relatively invisible needs.