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LOWER LIMB AMPUTATIONS AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
Abstract
Background: Lower limb amputations continue to be widely performed despite attempts to manage
risk factors such as diabetes mellitus and peripheral vascular diseases. The incidence of vascular
major lower limb amputations is higher in the developed countries than that reported in the
developing ones mainly due to the ageing population. In developing countries, poor access to
basic healthcare due to poverty impacts negatively on health seeking behaviour with conditions
otherwise preventable or easily manageable complicating to warrant amputation. There has been a
rise in the number of patients with diabetes being managed at Kenyatta National Hospital (KNH).
However, the impact of this disease on the overall rates and pattern of lower limb amputations in
KNH has not been studied.
Objective: To determine the causes and pattern of lower limb amputations at the Kenyatta National
Hospital.
Design: Descriptive prospective study.
Setting: The Kenyatta National Hospital between July 2003 and June 2004.
Results: A total of 77 lower limb amputations (LLA) were performed on 74 patients. The age ranged
from seven months to 96 years (mean 44.8 ± 22.5). Forty six patients (62.1%) were males. Majority of
the patients (89.1%) had primary or no formal education, forty one (55.4%) were unemployed, with
39% self employed in the informal sector. Peripheral vascular diseases were the main indication for
LLA (55.3%), 13 patients (17.5%) due to diabetes-related gangrene. Eighteen patients (24.3%) had
tumours, mainly osteogenic sarcoma (16.2%), while trauma accounted for 18.9%. Forty two (55%)
of the amputations were above-the-knee, 24 (31%) below-the-knee, four (5%) hip disarticulations
and seven (9%) were foot amputations.
Conclusion: This study found peripheral vascular diseases unrelated to diabetes to be the main
indication for lower limb amputations at Kenyatta National Hospital contrary to previous
institutional and loco-regional studies which report trauma as the leading cause. Further
investigation into vascular causes is therefore recommended.
risk factors such as diabetes mellitus and peripheral vascular diseases. The incidence of vascular
major lower limb amputations is higher in the developed countries than that reported in the
developing ones mainly due to the ageing population. In developing countries, poor access to
basic healthcare due to poverty impacts negatively on health seeking behaviour with conditions
otherwise preventable or easily manageable complicating to warrant amputation. There has been a
rise in the number of patients with diabetes being managed at Kenyatta National Hospital (KNH).
However, the impact of this disease on the overall rates and pattern of lower limb amputations in
KNH has not been studied.
Objective: To determine the causes and pattern of lower limb amputations at the Kenyatta National
Hospital.
Design: Descriptive prospective study.
Setting: The Kenyatta National Hospital between July 2003 and June 2004.
Results: A total of 77 lower limb amputations (LLA) were performed on 74 patients. The age ranged
from seven months to 96 years (mean 44.8 ± 22.5). Forty six patients (62.1%) were males. Majority of
the patients (89.1%) had primary or no formal education, forty one (55.4%) were unemployed, with
39% self employed in the informal sector. Peripheral vascular diseases were the main indication for
LLA (55.3%), 13 patients (17.5%) due to diabetes-related gangrene. Eighteen patients (24.3%) had
tumours, mainly osteogenic sarcoma (16.2%), while trauma accounted for 18.9%. Forty two (55%)
of the amputations were above-the-knee, 24 (31%) below-the-knee, four (5%) hip disarticulations
and seven (9%) were foot amputations.
Conclusion: This study found peripheral vascular diseases unrelated to diabetes to be the main
indication for lower limb amputations at Kenyatta National Hospital contrary to previous
institutional and loco-regional studies which report trauma as the leading cause. Further
investigation into vascular causes is therefore recommended.
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