Estimating the Health Care Burden of Osteomyelitis in Uganda

Christine Stanley in her 4th year of Medical School at UCSF travelled to Kampala, Uganda, October 2007-March 2008 on behalf of IGOT and the UCSF Department of Global Health Sciences to research osteomyelitis, bone infection, and the burden this condition presents on already resource constrained health care facilities. This research project was in collaboration with Dr. Titus Beyeza the Chief of Orthopaedic Surgery at the Makerere University Medical School at the Mulago Hospital in Kampala, Uganda. This research is continuous as osteomyelitis, especially chronic osteomyelitis is a significant burden on already resource constrained health care facilities and its findings hope to identify sustainable clinical interventions to treat this condition.

Christine M. Stanley, BS¹ George W. Rutherford, MD² Saam Morshed, MD, MPH³ R. Richard Coughlin, MD, MSc³ and Titus Beyeza, MD⁴

1 School of Medicine, University of California, San Francisco, USA

2 Global Health Sciences, University of California, San Francisco, USA

3 Department of Orthopaedic Surgery, University of California, San Francisco, USA

4 Department of Orthopaedics, Makerere University Medical School, Kampala, Uganda

Abstract

Chronic osteomyelitis is an uncommon condition in developed nations but is a considerable burden on the health care system in many developing countries. To estimate the burden of this disease and its impact in a developing country, we conducted a systematic sample of medical records at the orthopaedic clinics of five hospitals in Uganda. Of 2 056 outpatients sampled over 1 year, 10% of those with a documented diagnosis had osteomyelitis. Only 20% of those with osteomyelitis were older than 20 years, where as this age group accounted for 52% of the patients with other or no diagnosis (P <0.001). To estimate the surgical burden of osteomyelitis, we also reviewed the diagnoses in 9 354 operations conducted during a 1-year period at the same five hospitals. Osteomyelitis was the diagnosis in 325 (3.5%) of the surgical operations. Of the patients that underwent surgery for osteomyelitis, 32% were children between 10 to 14 years old. The tibia was the most frequent bone involved (31%), and squestrectomy was the surgery most often done (60%). These findings suggest that osteomyelitis disproportionately affects the young and is a burden on medical and surgical services in Uganda. To decrease this burden in populations with limited access to medical and surgical services, improved diagnosis and more timely treatment of acute osteomyelitis is needed.