Managing Low-Back Pain in Rural Uganda

Low-back pain (LBP) is a major health issue affecting many people around the world. It has been found to be the leading cause of years lived with disabilities globally. In Uganda, it is the second most common cause of disabilities. In 2020, around 619 million people globally experienced this condition, which accounted for a significant percentage of disability-related years lived. While more people in wealthy countries have LBP, countries like Uganda are seeing an increase in cases due to aging populations and longer life expectancies.

In Uganda, the number of older individuals with back pain is high, especially among women. There is a correlation between a person's social and economic standing and the likelihood of experiencing back pain, with poorer individuals often affected more. Chronic LBP can severely impact everyday activities, work life, relationships, and overall well-being. Many studies have looked into how LBP affects people's lives but most of this research comes from richer countries. Older people generally experience more disabilities due to LBP than younger individuals.

In urban Uganda, LBP leads to loss of workdays and decreases in quality of life. Despite the growing number of people suffering from back pain, health policies in low- and middle-income countries often overlook issues related to musculoskeletal health. LBP frequently does not have a clear cause and is often termed non-specific. However, it can sometimes indicate serious health issues like spinal fractures or infections. A study in Uganda found that a noticeable percentage of patients with LBP had serious spinal problems, which is higher than reports from wealthier nations.

Patients with LBP in rural Uganda typically receive first-line care from health centers run by clinical officers or nurses. However, existing medical guidelines in Uganda do not specifically address LBP Management apart from mentioning it in palliative care contexts. Rehabilitation, which includes education, advice, and exercises, is the main approach to managing non-specific LBP. Unfortunately, Uganda faces a big shortage of rehabilitation professionals, especially in rural areas where such services are nearly non-existent. This lack of available care makes it hard for people with disabilities, including those with LBP, to get the help they need.

#The BACKTRACK Project

The BACKTRACK project aims to improve how LBP is managed in rural communities in Uganda using technology. This particular study looked at how primary care clinicians in rural areas view and handle LBP. It aligns with calls from health authorities to boost research on rehabilitation, especially regarding different service delivery models and the challenges people face when seeking care.

#Study Design and Approach

The research involved a focus group discussion to gather information about LBP management from Healthcare Providers in rural Uganda. This approach allowed participants to share their views in a group, encouraging a more extensive discussion about the topic.

#Participant Selection

Ten health centers in rural areas were randomly chosen for the study. Health officers from these areas gave permission to recruit participants, who were clinical officers and nurses. The focus was on obtaining perspectives from healthcare workers in primary care settings. Each center provided at least one nurse and one clinical officer for better representation. All contacted professionals agreed to join the research.

#Focus Group Discussions

Three separate focus group discussions were held with healthcare providers. Each session lasted about an hour to an hour and a half and was conducted in English. Participants were informed about the study's purpose and had the opportunity to read an information leaflet before agreeing to participate. The discussions were recorded and analyzed.

#Data Analysis

The researchers carefully reviewed the discussions to identify common themes in participants' perceptions and experiences regarding LBP management. This analysis focused on conveying a rich understanding of the data, looking beyond the surface to uncover deeper meanings and connections.

#Ethical Approval

The research obtained ethical approval from two relevant university ethics committees, ensuring that the study met necessary ethical standards.

#Findings

#Major Themes Identified

The results of the study revealed five main themes:

1. The burden of LBP
2. Common causes of LBP
3. Management of LBP
4. Patient expectations
5. Challenges in referral pathways

#The Burden of LBP

LBP is prevalent among patients visiting rural health centers in Uganda. Many patients do not come specifically for back pain; it often coexists with other health issues. For instance, many women with reproductive health problems also report experiencing back pain.

The issue has a gender aspect, as more women seek help for LBP compared to men, often due to additional health issues or differing health-seeking behaviors. Older people frequently come back for care due to chronic back pain, indicating that this issue is persistent and often untreated.

Healthcare workers acknowledged the seriousness of LBP, citing its high rates of occurrence and the potential for severe underlying conditions.

#Common Causes of LBP

Participants identified several factors contributing to LBP. These include age, trauma, lifestyle choices, the kinds of occupations people have, and health conditions. Many healthcare workers believe that the heavy physical labor involved in farming and household duties significantly adds to the risk of LBP, especially for women.

Other factors mentioned include inactivity, such as prolonged sitting in office jobs, which can worsen back pain. Injuries, violent incidents, and medical conditions like infections and tumors were also cited as causes of LBP.

Deficiencies in knowledge about LBP among patients were noted as a risk factor, with some people holding beliefs about back pain being linked to old age, heavy lifting, or childbirth.

#Management of LBP

Management strategies for LBP varied significantly among healthcare providers. The primary approach was pain relief, often through medications like ibuprofen and diclofenac. In some cases, patients were also given exercise and lifestyle advice, although healthcare workers expressed that they were not well-trained in this area.

Non-medical strategies involved recommending massages or warm compresses. However, these approaches were often viewed as ineffective. Very few healthcare workers mentioned exercise as a part of care, indicating a need for better training in prescribing appropriate exercises.

#Patient Expectations

Patients often had strong beliefs about the management of their LBP, mainly expecting pain relief medications. Many expressed frustration when they were not prescribed drugs during their visits. Previous experiences with painkillers influenced their expectations of treatment and their willingness to accept advice about non-pharmaceutical options.

Patients were also known to self-medicate, seeking medicines from various sources outside the healthcare system. There was a general misunderstanding about the nature of LBP, with many patients hoping for quick fixes rather than understanding the chronic nature of the condition.

#Challenges in Referral Pathways

The process of referring patients to higher-level facilities for further evaluation or treatment posed many challenges. Often, patients faced financial barriers when required to travel long distances for care, and the lengthy waiting times at referral hospitals discouraged them from pursuing necessary investigations.

Healthcare workers noted significant losses to follow-up when patients were referred, with many unable to afford the costs associated with reaching these facilities. Some patients also reported being unclear about the referral process, contributing to dissatisfaction and reluctance to seek care.

#Conclusion

This study exposes the many challenges surrounding the management of LBP in rural Uganda. It highlights that LBP is a common issue that significantly influences individuals' lives and well-being, yet health systems are not addressing it adequately.

The findings suggest that there is an urgent need for better education and training for healthcare workers on LBP management. This includes understanding how to appropriately prescribe medications, promote rehabilitation strategies, and empower patients to manage their conditions.

Furthermore, developing innovative and context-specific solutions, such as community-based rehabilitation services, is critical to improving access to care. By doing so, healthcare systems can better meet the needs of patients suffering from LBP and ultimately enhance their quality of life.

Future research should aim to develop practical interventions tailored for rural settings and explore the perspectives of various stakeholders in the healthcare system, including patients, clinicians, and policymakers.