Chronic osteomyelitis in a Ugandan rural setting
AbstractObjective: To determine the incidence pattern and outcome of chronic osteomyelitis in a rural setting.
Design: A prospective descriptive study where a proforma was drafted to study all consecutive patients with features of chronic osteomyelitis over a period of six years, Clinical findings on presentation, treatment, duration of symptoms, initial treatment sought, operative treatment, post operative outcome and demographic data were all documented.
Setting: Mityana hospital, a rural 120 hospital bed, located in Mubende District. It serves Mubende district and the neighbouring districts of Mpigi, Sembabule, Kyenjojo, Kibale and Kiboga. The majority of the population in these districts are mainly peasants involved in cattle keeping and agriculture.
Patients: One hundred and twenty patients with chronic osteomyelitis were treated between June 1996 - June 2001.
Results: One hundred and twenty patients with chronic osteomyelitis seen in a period of six years, involving various bones of the body. Forty five percent were females, the highest incidence occurred in the age range of 10 - 19 years. The commonest a etiological history was by pricks. The bones most frequently affected were phalanges (43.3%) followed by the tibia (21.6%). Forty four percent of these patients first used local herbs before going to hospital. Fifty five percent of the patients were found to have a big spleen of not less than 12cm below the costal margin and the best treatment option was sequestrectomy and curretage with imperical administration of antibiotics. Complications observed on follow up were: cosmetically bad fingers where curretage and sequestrectomy were done. Distortion of the foot arches where the matarsals were disarticulated and persistent discharging sinuses.
Conclusion: Chronic osteomyelitis is a debilitating dirty disease endemic in the peasantry communities. It persists because of delay in seeking medical treatment because the first line of treatment is mainly herbs where the terminal phalanges were involved. Sequestrectomy and curettage were a better option to disarticulation because the function of the finger is not interfered with. The biggest number of cases seen involved the phalanges (45.3%) followed by the tibia 21.6% because of the nature of occupation of the rural communities.
(East African Medical Journal: 2003 80(5): 242-246)