Determinants of utilization of prostheses and orthoses following lower limb amputation in Sub-Saharan Africa: A systematic review

Increasing amputee prevalence in resource-limited settings necessitates improved access to prosthetic and orthotic devices to overcome physical, psychosocial, environmental, and economic challenges. To evaluate the determinants of the utilization of prostheses and orthoses among individuals following lower limb amputation. A systematic literature search was performed across multiple databases including Scopus, Embase, PubMed, Cochrane library, Web of Science, Wiley Online Library, and Google. The three groups of keywords used were “population”, “interest” and “context”. All publications were compiled and underwent rigorous screening. The studies were carefully examined, eligible studies were critically appraised and data such as design, population, setting, and main findings were extracted from the studies. Out of 1183 identified studies, 9 met the inclusion criteria after excluding 77 duplicates and non-eligible papers. Prosthetic and orthotic cost-effectiveness varied across countries. Notably, effective referral systems and positive specialist encounters facilitated utilization, while hinderances included equipment shortages, staff deficiencies, and access limitations. Furthermore, cultural barriers like racial prejudice and traditional beliefs surfaced as significant influencing factors. Prosthetic and orthotic utilization in Sub-Saharan Africa is impacted by diverse facilitating and constraining factors. Addressing these impediments could bolster usage of these vital rehabilitation services.