Intranational variation in prosthetic user populations: A comparative analysis of prosthetic and orthotic centers in central and northern Sri Lanka

Background Population-level data on people with limb loss (PwLL) are needed for effective prosthetic provision and rehabilitation. These data are rare in low- and middle-income countries, and low- and middle-income countries are routinely dealt with as homogenous entities. Objectives Here, we investigate intranational variation in PwLL populations in Sri Lanka using long-term routinely collected data from prosthetic and orthotic (P&O) clinics. Study Design Retrospective study. Methods Until 2009, Sri Lanka experienced a 26-year civil war affecting primarily northern/eastern districts. Published data from 2 P&O centers in northern (Jaffna Jaipur Centre for Disability Rehabilitation, JJCDR; 1987–2018) and central (Centre for Handicapped, CFH; 1987–2024) districts were compared to investigate intranational variation in PwLL demographics and temporal trends. Summative statistics, χ 2 , and Mann-Whitney U tests (α < 0.05) were used to quantify differences. Results Major differences included a larger population of males at the CFH (88.8%) compared with the JJCDR (77.4%) and—although war-related amputations were most common at both clinics—there were relatively more war-related amputees at the JJCDR (CFH: 44.8%; JJCDR: 62.7%). In addition, the JJCDR had a higher proportion of patients registered and injured in the same district (CFH: 62.22%; JJCDR: 66.11%). Conclusions Intranational variation in PwLL populations exists in Sri Lanka as evidenced by differences in populations between northern and central P&O clinics. This points toward differences in provisional needs and temporal health/societal trends underlying limb loss, which must be considered when provisioning health services.