Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 21  |  Issue : 1  |  Page : 37-41

Attitude, perception, acceptance, and life after amputation as seen in Lagos University Teaching Hospital


1 Department of Surgery, College of Medicine University of Lagos; Department of Orthopaedic/Trauma, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Orthopaedic/Trauma, Lagos University Teaching Hospital, Lagos, Nigeria

Date of Web Publication31-Jul-2019

Correspondence Address:
Dr. George O Enweluzo
Department of Surgery, College of Medicine, University of Lagos/Department of Orthopaedic/Trauma, Lagos University Teaching Hospital, Lagos
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jomt.jomt_5_19

Rights and Permissions
  Abstract 


Background: Amputation is a surgical ablation of a limb as a form of treatment. A survey of the attitude, perception, and acceptance of amputation was carried out to determine the level of knowledge and understanding of the indications and benefits, among adult patients and relatives at the Orthopaedic and Trauma Clinic of the Lagos University Teaching Hospital. This study also involved survey among amputees to determine prospects of life after amputation. Methods: This is a cross-sectional study in which structured questionnaires were administered to adult patients and relatives at the Orthopaedic and Trauma Clinic of the Lagos University Teaching Hospital from May 2017 to November 2018. A second questionnaire was administered to few amputees and the data obtained from the study was analyzed using SPSS. Results: A total of 332 respondents were interviewed. The mean age was 43 ± 19.4 years. There were 194 (58.4%) males and 138 (41.6%) females. Two hundred ninety-nine respondents (90%) had knowledge of amputation as a treatment method whereas 21 (6.3%) had no knowledge. Two hundred twenty-six respondents (68%) were aware of the importance of prosthesis. Seven (17.9%) were able to return to their initial work whereas eight (20.5%) were able to secure work other than their initial work. Conclusion: Majority of the respondents had good knowledge of amputation as well as the indications for amputation. Few of the amputees interviewed were able to return to their preamputation work; therefore, there is the need for improved social support, better rehabilitation, and occupational therapy in developing countries.

Keywords: Amputation, attitude, life after amputation, social support


How to cite this article:
Enweluzo GO, Ogbeide OA, Akinbode OO. Attitude, perception, acceptance, and life after amputation as seen in Lagos University Teaching Hospital. J Med Trop 2019;21:37-41

How to cite this URL:
Enweluzo GO, Ogbeide OA, Akinbode OO. Attitude, perception, acceptance, and life after amputation as seen in Lagos University Teaching Hospital. J Med Trop [serial online] 2019 [cited 2019 Aug 20];21:37-41. Available from: http://www.jmedtropics.org/text.asp?2019/21/1/37/263749




  Introduction Top


Amputation is the surgical ablation of a limb or a part thereof, as a form of treatment.[1] It is the most ancient of all surgical procedures. The aim of amputation is to save the patient’s life and reduce debility. It may be required when a limb has skeletal deficiencies, those surviving loss of limb from trauma, or severely crushed or dead limb due to impaired blood circulation in diabetic disease. Part of a limb may also die because of infection (gangrene), burns, frostbite, or disease of blood vessels.[1],[2],[3]

In recent times in the developed world, amputation is no longer a dreaded procedure because artificial devices (prosthesis) have been adapted to reproduce the functions of the amputated parts. In the developing world, it is, however, not readily practiced because of ignorance, stigmatization, and poverty that constitute reasons for resistance.

In most cases, lack of adequate rehabilitations prevent return of the patient to a functional, independent life. Therefore, it is very difficult to obtain consent until the condition becomes life threatening. Amputation is a radical form of treatment in which alternatives are usually less effective.

Because of the tremendous effect an amputation can have, it is important to consider several clinical tactics that will help the wound heal properly and efficiently, and ultimately allow the patient to readjust to daily life seamlessly. To achieve this, it is important to have an understanding of the attitudes of patients regarding amputation. The way the patient perceives amputation can to a large extent affect their acceptance of the procedure as a treatment modality, and can greatly impact postamputation rehabilitation.

We therefore set out to study the attitudes and perception of patients, relatives, and amputees concerning amputation as well as quality of life following amputation.


  Patients and methods Top


This was a cross-sectional study; structured questionnaires were administered to all adult patients and relatives who attended the outpatient clinic at the general Orthopaedics and Trauma Department of the Lagos University Teaching Hospital from December 2017 to November 2018.

The respondents were attendees to our general orthopedic and trauma clinic that consented to be part of the study and answer all the questions provided in the questionnaires. The respondents were adequately briefed on the aims and objectives of the study. All patients and their relatives with amputation were excluded from this study.

Among other things, the questionnaire focused on the knowledge and attitude toward amputation, the influence of cultural and religious beliefs on amputation, and the use of prosthesis, respect for amputees, and the surgeons. Another questionnaire was administered to amputees who were seen in our follow-up amputation clinic who consented to be part of the study requesting to know about life after amputations, their ability to return to preamputation work, and where this was not possible in the present occupation.


  Results Top


The total number of respondents was 332. The mean age of respondents was 43.0 ± 19.4 years. Age range was 18 to 75 years. There was a male preponderance with 194 (58.4%) males and 138 (41.6%) females [Table 1], [Figure 1][Figure 2].
Table 1: Demographic variables of respondents

Click here to view
Figure 1: Receptivity of amputation. 1, Wiliness to accept; 2, Refused; 3, Chose death over amputation; 4, Preferred traditional treatment; 5, Did not accept; 6, No response

Click here to view
Figure 2: Knowledge of amputation as a surgical treatment.

Click here to view


Two hundred ninety-nine respondents (90%) had knowledge of amputation as a treatment method whereas 21 (6.3%) had no knowledge and 12 (3.7%) were indifferent; 259 (78%) knew that amputation is beneficial, 43 (13%) did not respond, whereas 30 (9%) believed that it is not beneficial. Two hundred sixty-nine (81%) respondents knew the reasons for amputation, which included to save a life 179 (54%), to remove a dead limb 139 (42%), whereas 17 (5%) had no knowledge and described it as doctor’s treatment method. Twenty-three (7%) patients did not respond, 100 (30%) indicated their willingness to accept amputation when it is indicated, whereas 23 (7%) of those who refused believed prayer was an alternative; 33 (10%) chose death over amputation, 10 (3%) opted for traditional treatment, whereas 53 (16%) did not accept amputation and did not know what they will do, and 113 (34%) did not give a response.

Three hundred one (90.7%) regarded amputees as normal humans whereas 20 (6%) saw them as dependents and 11 (3.3%) were indifferent. None of the respondents saw it as a stigma or punishment for evil act.

Regarding the importance of prosthesis, 226 (68%) were aware of the importance of prosthesis, eight (24%) had no knowledge, and nonresponders were 27 (8%). Over 282 (85%) of respondents regarded doctors who perform amputation as life savers, seven (2%) saw doctors as sadists who enjoy performing amputation, whereas 33 (10%) regarded them as people who are indifferent to patient’s plight, and 10 (3%) did not respond.

Regarding life after amputation, a total of 39 amputees were interviewed. Twenty-seven were male whereas 12 were female with a ratio of 2.25:1. Seven (17.9%) were able to return to their initial work whereas eight (20.5%) were able to secure work other than their initial work and 24 (61.5%) were jobless. Of the 24 who were jobless, 18 (75%) were happy begging on the street.

Only nine (23%) amputees were using prosthesis frequently (51%) could not afford prosthesis whereas 10 (26%) deliberately did not want prosthesis to enable them beg.

Finally, two hundred nine (75%) of the respondents said that they would advise patients and their relatives to accept amputation when it is indicated, 17 (5%) said they would not advise anybody to accept, whereas 66 (20%) did not make any comment.


  Discussion Top


Amputation of an irreversibly damaged or diseased limb is truly the first step in restoring a patient to a normal productive life. However, it is a dreaded word in our society and in very rare circumstances would patients and their relatives accept this therapeutic procedure easily.

Most of the times, the patient uses denial statements such as “that is not my portion,” God forbid,” and “I would rather die than lose my limb.”[4],[5],[6],[7],[8],[9]

Amputation sometimes was practiced for punitive, ritual purposes rather than therapeutic reasons in some societies and as such carries a stigma. It is also believed to recur during incarnation.[1],[2] Most of these beliefs are based on ignorance, denial mechanism, superstition, and of no scientific basis.[1],[2],[4]

In this study, a total of 332 respondents were interviewed and a clear majority of about 90% of the population had knowledge of amputation as a surgical mode of treatment, its indication, and importance; however, only 30% indicated wiliness to accept it if indicated. This poor receptiveness may not be unconnected to the general perception of amputation in the society and the stigma associated with it.[1],[8]

Studies in Nigeria show that ignorance, fear, and stigma associated with amputation are the leading causes of discharge against medical advice and mortality among these group of patients.[4],[5],[6]

The fear of amputation is palpable such that most patients go through stages of denial, anger, and depression before acceptance, a situation akin to what is applicable to patients with conditions with high mortality like cancer or significant stigma like HIV/AIDS.The outcome most of the times depends on the delay in the decision-making process; consent for amputation is also commonly withheld until very late, thus contributing significantly to mortality.[7],[8],[9]

Amputation is the most ancient of all surgical procedures; it is the last option in the surgeon’s methods of disease treatment. It can only be carried out when there are absolute indications; however, our study found that some respondents rejected amputation for religious and/or cultural reasons. Some respondents also had the wrong impression that it is the doctor who is either sadist or indifferent to the procedure, and as such the impression that the only method of treatment of limb pathologies in hospital is amputation.[4],[10],[11]

From those we interviewed, some amputees had the general impression that life after amputation is not as bad as feared.

However, very few were able to return to their preamputation work. The reason being due to poor adaptation from wounds not healing properly and efficiently and to ultimately allow for readjustment to daily life seamlessly over time.

An amputation can severely affect a patient’s balance because their center of gravity shifts toward the remaining leg; unfortunately, our patients suffer this due to their inability to obtain limb prosthesis.


  Conclusion Top


Amputation is still not yet a receptive procedure in our society even when majority of our respondents had a fair knowledge of amputation, and may even accept or advice others to accept.

This is most likely due to ignorance and poor social support for amputees. There is therefore the need for improved social support, better rehabilitation, and occupational therapy in developing countries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Enweluzo GO, Giwa SO, Adekoya-cole TO, Mofikoya BO. Profile of amputations in Lagos University Teaching Hospital,Lagos, Nigeria. Nig Qt J Hosp Med 2010;20:205-8.  Back to cited text no. 1
    
2.
Magee RA. Amputation through the ages the oldest surgical; operation. Hust N Z Surg 1998;68:675-8.  Back to cited text no. 2
    
3.
Udosen AM, Ikpeme IA, Etiuma AU, Egor S. Major amputations at the University of Calabar Teaching Hospital,Calabar, Nigeria. Nig J Surg Sci 2004;2:60-3.  Back to cited text no. 3
    
4.
Olaolrun DA. Amputation in general practice. Nig Postgrad J 2001;8:133-5.  Back to cited text no. 4
    
5.
Yinusa W, Ugbeye ME. Problems of amputation surgery in developing country. Int Orthop 2003;27:121-4.  Back to cited text no. 5
[PUBMED]    
6.
Udosen AM, Glen E, Ogbudu S, Nkosong E. Incidence of leaving against medical (LAMA) among patients admitted at the Accident and Emergency unit of the University of Calabar Teaching Hospital,Calabar, Nigeria. Nig J Clin Prac 2006;9:122-5.  Back to cited text no. 6
    
7.
Musa AA. Pattern of requests for limb amputations as seen in a Nigerian Teaching Hospital. Nig J Orthop Trauma 2007;6:8-10.  Back to cited text no. 7
    
8.
Udosen AM, Ngim EN, Etokidem A, Ikpeme A, Urom S, Marwa A. Attitude and perception of patients towards amputation as a form of surgical treatment in the University of Calabar Teaching Hospital,Nigeria. Agr Health Sci 2009;9:254-7.  Back to cited text no. 8
    
9.
Ikpeme IA, Udosen AM, Okereke-okpa I. Patients’ perception of traditional bone setting in Calabar. Port Harcourt Med J 2007;1:104-8.  Back to cited text no. 9
    
10.
Solagberu BA. The scope of amputation in a Nigerian Teaching Hospital. Afr J Med Sci 2001;30:225-7.  Back to cited text no. 10
    
11.
Opadele TO, Salawu SAI, Apollo KD, Olaomi OO. Emerging indications for lower limb amputation in Abuja, Nigeria. Nig J Orthop Trauma 2007;6:6-7.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Patients and methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed30    
    Printed2    
    Emailed0    
    PDF Downloaded8    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]