{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:32:54Z","timestamp":1785411174474,"version":"3.56.0"},"reference-count":46,"publisher":"AOSIS","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Prosthetic and orthotic devices play a significant role in enhancing the quality of life for individuals with disabilities by improving mobility, health, psychological well-being, and socio-economic opportunities. However, access to these assistive devices remains a considerable challenge, particularly in resource-limited settings.\n\nObjectives:\u00a0The aim of this systematic review was to explore and categorise the existing barriers and challenges that affect access to limb orthoses and prostheses in sub-Saharan African countries.\n\nMethod:\u00a0A systematic search of seven databases was conducted to identify relevant studies using the search terms: \u2018prosthesis\u2019 or \u2018orthosis\u2019 and sub-Saharan African countries and variations of each term. Quality assessment of each study was completed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale and the Oxford Levels of Evidence.\n\nResults:\u00a0Twenty-two journal articles were included for review following database search and screening, evaluating a total of 3726 participants. Results were organised into four generalised themes, and each theme was categorised into sub-themes.\n\nConclusion:\u00a0The review identifies multifaceted barriers to accessing and utilising limb prostheses and orthoses in sub-Saharan Africa, primarily driven by economic constraints and cultural barriers. The lack of multidisciplinary rehabilitation teams further contributes to fragmented and inefficient service delivery. Orthotic and prosthetic training centers and colleges are underdeveloped, facing problems such as ineffective teaching methods, outdated curricula, inadequate research facilities, and a shortage of experienced professionals.\n\nContribution:\u00a0This review synthesises evidence on barriers to prosthetic and orthotic access in sub-Saharan Africa, categorising challenges into thematic domains and highlighting gaps in service delivery, education, and workforce capacity to inform policy, practice, and future research directions.<\/jats:p>","DOI":"10.4102\/ajod.v15i0.1852","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T09:03:25Z","timestamp":1774602205000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring barriers to access and use of limb prostheses and orthoses in sub-Saharan Africa: A systematic review"],"prefix":"10.4102","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7818-4303","authenticated-orcid":false,"given":"Birhanu M.","family":"Addis","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02y72wh86","id-type":"ROR","asserted-by":"publisher"}],"name":"Queen's University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8900-4336","authenticated-orcid":false,"given":"Demewoz W.","family":"Menna","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02y72wh86","id-type":"ROR","asserted-by":"publisher"}],"name":"Queen's University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4880-2654","authenticated-orcid":false,"given":"Claire T.","family":"Davies","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02y72wh86","id-type":"ROR","asserted-by":"publisher"}],"name":"Queen's University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Abbady, H.E., Klinkenberg, E.T., De Moel, L., Nicolai, N., Van der Stelt, M., Verhulst, A.C. et al., 2022, \u20183D-printed prostheses in developing countries: A systematic review\u2019, Prosthetics and Orthotics International 46(1), 19\u201330. https:\/\/doi.org\/10.1097\/PXR.0000000000000057","DOI":"10.1097\/PXR.0000000000000057"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Aduayom-Ahego, A., 2020, \u2018Prosthetic rehabilitation of multiple-digit amputations using silicone material in sub-Saharan African country Ghana\u2019, Pan African Medical Journal 36, 1\u20136. https:\/\/doi.org\/10.11604\/pamj.2020.36.357.25361","DOI":"10.11604\/pamj.2020.36.357.25361"},{"key":"ref2","unstructured":"Aduayom-Ahego, A., Ehara, Y. & Kpandressi, A., 2017, \u2018Challenges in prosthetics and orthotics education in sub-Saharan Africa Francophone Country Togo\u2019, EC Orthopaedics 6, 230\u2013237."},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Allen, A.P., Bolton, W.S., Jalloh, M.B., Halpin, S.J., Jayne, D.G. & Scott, J.D., 2022, \u2018Barriers to accessing and providing rehabilitation after a lower limb amputation in Sierra Leone \u2013 A multidisciplinary patient and service provider perspective\u2019, Disability and Rehabilitation 44, 2392\u20132399. https:\/\/doi.org\/10.1080\/09638288.2020.1836043","DOI":"10.1080\/09638288.2020.1836043"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Andregard, E. & Magnusson, L., 2017, \u2018Experiences of attitudes in Sierra Leone from the perspective of people with poliomyelitis and amputations using orthotics and prosthetics\u2019, Disability and Rehabilitation 39(26), 2619\u20132625. https:\/\/doi.org\/10.1080\/09638288.2016.1236409","DOI":"10.1080\/09638288.2016.1236409"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Aoun, N., Matsuda, H. & Sekiyama, M., 2015, \u2018Geographical accessibility to healthcare and malnutrition in Rwanda\u2019, Social Science & Medicine 130, 135\u2013145. https:\/\/doi.org\/10.1016\/j.socscimed.2015.02.004","DOI":"10.1016\/j.socscimed.2015.02.004"},{"key":"ref6","unstructured":"Centre for Evidence-Based Medicine (CEBM), 2011, OCEBM levels of evidence, OCEBM, viewed n.d., from https:\/\/www.cebm.ox.ac.uk\/resources\/levels-of-evidence\/ocebm-levels-of-evidence."},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Dordunu, R., Adjei, C.A., Kyei, J.M. & Ani-Amponsah, M., 2024, \u2018Experiences of persons with lower limb amputation after prosthetic rehabilitation in Ghana: A qualitative inquiry\u2019, Prosthetics and Orthotics International 48(3), 329\u2013336. 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setting in the Mpumalanga Province, South Africa\u2019, Prosthetics and Orthotics International 43(2), 170\u2013179. https:\/\/doi.org\/10.1177\/0309364618792730","DOI":"10.1177\/0309364618792730"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Ennion, L. & Rhoda, A., 2016, \u2018Roles and challenges of the multidisciplinary team involved in prosthetic rehabilitation, in a rural district in South Africa\u2019, Journal of Multidisciplinary Healthcare 9, 565\u2013573. https:\/\/doi.org\/10.2147\/JMDH.S116340","DOI":"10.2147\/JMDH.S116340"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Esquenazi, A., 2004, \u2018Amputation rehabilitation and prosthetic restoration. From surgery to community reintegration\u2019, Disability and Rehabilitation 26(14\u201315), 831\u2013836. https:\/\/doi.org\/10.1080\/09638280410001708850","DOI":"10.1080\/09638280410001708850"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Guyatt, G.H., Oxman, A.D., Vist, G.E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P. et al., 2008, \u2018GRADE: An emerging consensus on rating quality of evidence and strength of recommendations\u2019, BMJ 336(7650), 924\u2013926. https:\/\/doi.org\/10.1136\/bmj.39489.470347.AD","DOI":"10.1136\/bmj.39489.470347.AD"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Horgan, O. & MacLachlan, M., 2004, \u2018Psychosocial adjustment to lower-limb amputation: A review\u2019, Disability and Rehabilitation 26(14\u201315), 837\u2013850. https:\/\/doi.org\/10.1080\/09638280410001708869","DOI":"10.1080\/09638280410001708869"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Hussaini, A., Kyberd, P., Mulindwa, B., Ssekitoleko, R., Keeble, W., Kenney, L. et al., 2023, \u20183D printing in LMICs: Functional design for upper limb prosthetics in Uganda\u2019, Prosthesis 5(1), 130\u2013147. https:\/\/doi.org\/10.3390\/prosthesis5010011","DOI":"10.3390\/prosthesis5010011"},{"key":"ref16","unstructured":"International Committee of the Red Cross (ICRC), 2013, Physical Rehabilitation Programme Annual Report [Online], viewed n.d., from https:\/\/www.icrc.org\/sites\/default\/files\/external\/doc\/en\/assets\/files\/publications\/icrc-002-4209.pdf"},{"key":"ref17","unstructured":"International Organization for Standardization (ISO), 2020, Prosthetics and orthotics \u2013 Vocabulary, ISO, viewed n.d., from https:\/\/www.iso.org\/standard\/79495.html."},{"key":"ref18","unstructured":"International Society for Prosthetics and Orthotics, 2024, ISPO accredited training programmes, viewed n.d., from https:\/\/www.ispoint.org\/training-programme\/."},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Jarl, G. & Ramstrand, N., 2018, \u2018A model to facilitate implementation of the International Classification of Functioning, Disability and Health into prosthetics and orthotics\u2019, Prosthetics and Orthotics International 42(5), 468\u2013475. https:\/\/doi.org\/10.1177\/0309364617729925","DOI":"10.1177\/0309364617729925"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Kelemework, A., Tora, A., Amberbir, T., Agedew, G., Asmamaw, A., Deribe, K. et al., 2016, \u2018\u201cWhy should I worry, since I have healthy feet?\u201d A qualitative study exploring barriers to use of footwear among rural community members in northern Ethiopia\u2019, BMJ Open 6, e010354. https:\/\/doi.org\/10.1136\/bmjopen-2015-010354","DOI":"10.1136\/bmjopen-2015-010354"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Lewin, S., Booth, A., Glenton, C., Munthe-Kaas, H., 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Ahlstr\u00f6m, G., 2017, \u2018Patients\u2019 satisfaction with lower-limb prosthetic and orthotic devices and service delivery in Sierra Leone and Malawi\u2019, BMC Health Services Research 17(1), 102. https:\/\/doi.org\/10.1186\/s12913-017-2044-3","DOI":"10.1186\/s12913-017-2044-3"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Magnusson, L. & Bickenbach, J., 2020, \u2018Access to human rights for persons using prosthetic and orthotic assistive devices in Sierra Leone\u2019, Disability and Rehabilitation 42(8), 1093\u20131100. https:\/\/doi.org\/10.1080\/09638288.2018.1515267","DOI":"10.1080\/09638288.2018.1515267"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Magnusson, L., Ramstrand, N., Fransson, E.I. & Ahlstrom, G., 2014, \u2018Mobility and satisfaction with lower-limb prostheses and orthoses among users in Sierra Leone: A cross-sectional study\u2019, Journal of Rehabilitation Medicine 46(5), 438\u2013446. https:\/\/doi.org\/10.2340\/16501977-1780","DOI":"10.2340\/16501977-1780"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Magnusson, L., Shangali, H.G. & Ahlstrom, G., 2016, \u2018Graduates\u2019 perceptions of prosthetic and orthotic education and clinical practice in Tanzania and Malawi\u2019, African Journal of Disability 5(1), 142. https:\/\/doi.org\/10.4102\/ajod.v5i1.142","DOI":"10.4102\/ajod.v5i1.142"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Manxusa, Y. & Botha, M., 2025, \u2018Disability inclusion and participation in Mount Frere, Eastern Cape: Barriers and facilitators\u2019, African Journal of Disability 14, 1735. https:\/\/doi.org\/10.4102\/AJOD.v14i0.1735","DOI":"10.4102\/AJOD.v14i0.1735"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Marino, M., Pattni, S., Greenberg, M., Miller, A., Hocker, E., Ritter, S. et al., 2015, \u2018Access to prosthetic devices in developing countries: Pathways and challenges\u2019, in 2015 IEEE Global Humanitarian Technology Conference (GHTC), IEEE, Seattle, Washington, October 8\u201311, 2015, pp. 45\u201351.","DOI":"10.1109\/GHTC.2015.7343953"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Mattick, K., Ben, O., Donovan-Hall, M., Magomere, G., Gakunga, J. & Holloway, C., 2023, \u2018Experiences of lower limb prosthesis users in Kenya: A qualitative study to understand motivation to use and satisfaction with prosthetic outcomes\u2019, Disability and Rehabilitation 45(26), 4478\u20134488. https:\/\/doi.org\/10.1080\/09638288.2022.2152875","DOI":"10.1080\/09638288.2022.2152875"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"McDonald, C.L., Westcott-Mccoy, S., Weaver, M.R., Haagsma, J. & Kartin, D., 2021, \u2018Global prevalence of traumatic non-fatal limb amputation\u2019, Prosthetics and Orthotics International 45(2), 105\u2013114. https:\/\/doi.org\/10.1177\/0309364620972258","DOI":"10.1177\/0309364620972258"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Mduzana, L., Tiwari, R., Lieketseng, N. & Chikte, U., 2020, \u2018Exploring national human resource profile and trends of Prosthetists\/Orthotists in South Africa from 2002 to 2018\u2019, Global Health Action 13, 1792192. https:\/\/doi.org\/10.1080\/16549716.2020.1792192","DOI":"10.1080\/16549716.2020.1792192"},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G. & Group, P., 2010, \u2018Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement\u2019, International Journal of Surgery 8(5), 336\u2013341. https:\/\/doi.org\/10.1016\/j.ijsu.2010.02.007","DOI":"10.1016\/j.ijsu.2010.02.007"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Morgado, D.Z., Nakandi, B., Ssekitoleko, R., Ackers, L., Mwaka, E., Kenney, L. et al., 2022, \u2018The lived experience of people with upper limb absence living in Uganda: A qualitative study\u2019, African Journal of Disability, 11, 890. https:\/\/doi.org\/10.4102\/ajod.v11i0.890","DOI":"10.4102\/ajod.v11i0.890"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Ngarambe, R., Sagahutu, J.B., Nuhu, A. & Tumusiime, D.K., 2022, \u2018The status and use of prosthetic devices by persons with lower limb amputation in Rwanda\u2019, African Journal of Disability 11, 1081. https:\/\/doi.org\/10.4102\/ajod.v11i0.1081","DOI":"10.4102\/ajod.v11i0.1081"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Rios, F., Boachie-Adjei, O., Yankey, K.P., Akbarnia, B.A. & Mundis, G.M., Jr., 2022, \u2018Early-onset scoliosis treatment in an outreach setting\u2019, in B.A. Akbarnia, M. Yazici & G.H. Thompson (eds.), The growing spine: Management of spinal disorders in young children, pp. 835\u2013847, Springer, New York, NY.","DOI":"10.1007\/978-3-030-84393-9_58"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Sahu, A., Sagar, R., Sarkar, S. & Sagar, S., 2016, \u2018Psychological effects of amputation: A review of studies from India\u2019, Industrial Psychiatry Journal 25(1), 4. https:\/\/doi.org\/10.4103\/0972-6748.196041","DOI":"10.4103\/0972-6748.196041"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Sterkenburg, A.J., Van der Stelt, M., Koroma, A.R., Van Gaalen, M.D., Van der Pols, M.J., Grobusch, M.P. et al., 2021, \u2018Quality of life of patients with 3D-printed arm prostheses in a rural area of Sierra Leone\u2019, Heliyon 7, e07447. https:\/\/doi.org\/10.1016\/j.heliyon.2021.e07447","DOI":"10.1016\/j.heliyon.2021.e07447"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Tsoulou, V., Karamolegou, E., Kourakos, M., Vasilopoulos, G. & Polikandrioti, M., 2019, \u2018Association of state and trait anxiety between patients who had undergone traumatic amputation and their family caregivers\u2019, The International Journal of Lower Extremity Wounds 18(2), 176\u2013185. https:\/\/doi.org\/10.1177\/1534734619848580","DOI":"10.1177\/1534734619848580"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Urva, M., Donnelley, C.A., Challa, S.T., Haonga, B.T., Morshed, S., Shearer, D.W. et al., 2023, \u2018Transfemoral amputation and prosthesis provision in Tanzania: Patient and provider perspectives\u2019, African Journal of Disability 12, 1084. https:\/\/doi.org\/10.4102\/ajod.v12i0.1084","DOI":"10.4102\/ajod.v12i0.1084"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Van der Stelt, M., Grobusch, M.P., Koroma, A.R., Papenburg, M., Kebbie, I., Slump, C.H. et al., 2021, \u2018Pioneering low-cost 3D-printed transtibial prosthetics to serve a rural population in Sierra Leone \u2013 An observational cohort study\u2019, EClinicalMedicine 35, 100874. https:\/\/doi.org\/10.1016\/j.eclinm.2021.100874","DOI":"10.1016\/j.eclinm.2021.100874"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Visagie, S., Hunt, P. & Deist, M., 2026, \u2018Burden experienced by family caregivers of children with lower limb impairments with and without ankle foot orthoses in South Africa\u2019, Prosthetics and Orthotics International 50(1), 68\u201374. https:\/\/doi.org\/10.1097\/pxr.0000000000000443","DOI":"10.1097\/PXR.0000000000000443"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Visagie, S.J., Kentane, N., Sirhayi, A., Sineke, P.N. & Mduzana, L.L., 2025, \u2018Health systems solutions to prosthetic service delivery obstacles in a low-resource setting\u2019, African Journal of Disability 14, 1837. https:\/\/doi.org\/10.4102\/AJOD.v14i0.1837","DOI":"10.4102\/AJOD.v14i0.1837"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Von Kaeppler, E.P., Hetherington, A., Donnelley, C.A., Ali, S.H., Shirley, C., Challa, S.T. et al., 2021, \u2018Impact of prostheses on quality of life and functional status of transfemoral amputees in Tanzania\u2019, African Journal of Disability 10, 839. https:\/\/doi.org\/10.4102\/ajod.v10i0.839","DOI":"10.4102\/ajod.v10i0.839"},{"key":"ref45","unstructured":"World Health Organization (WHO), 2017, WHO standards for prosthetics and orthotics, WHO, Geneva."}],"container-title":["African Journal of Disability"],"original-title":[],"link":[{"URL":"https:\/\/ajod.org\/index.php\/ajod\/article\/view\/1852\/4134","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T09:03:41Z","timestamp":1774602221000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajod.org\/index.php\/ajod\/article\/view\/1852"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,28]]},"references-count":46,"URL":"https:\/\/doi.org\/10.4102\/ajod.v15i0.1852","relation":{},"ISSN":["2223-9170","2226-7220"],"issn-type":[{"value":"2223-9170","type":"print"},{"value":"2226-7220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,28]]},"article-number":"a1852"}}