Managing Low-Back Pain in Rural Uganda: The Perspectives and Practices of Frontline Health Workers in Primary Care.

Paul Harscouët, Gloria Ndekezi Chimpaye, Herman Kazibwe, Jerome Kabakyenga, Denise O'Callaghan, Catherine Blake, Brian Caulfield, Cliona O'Sullivan
Purpose:

This study aims to understand the perspectives and practices of these health workers.


Methods:

A qualitative design using semi-structured focus-group discussions was employed. Purposive sampling allowed us to identify relevant participants based on their roles as healthcare professionals working in primary care context in rural South-West Uganda. Data was analysed using thematic analysis.


Results:

Participants reported that LBP is a common and persistent complaint among patients presenting to rural health centres in Uganda. Manual labour and female specific health conditions were deemed to be common causes. There was a strong reliance on medication prescription, coupled with X-ray diagnosis, with little emphasis on education or exercise. Finally, findings highlighted major barriers for patients, such as low availability of rehabilitation, out of pocket healthcare expenses and transport barriers, within the referral system to hospital care or rehabilitation.


Conclusion(s):

Low-Back Pain is a significant problem in rural Uganda, with significant barriers to provision of care. The current care system in primary care is over-reliant on medications and imaging prescriptions. Comprehensive care is unavailable due to a lack of rehabilitation workforce and an absence of available and affordable referral services pathways.

Implications:

Education and training of frontline clinicians in terms of appropriate prescribing and rehabilitation for LBP is crucial. Evidence-based rehabilitation interventions need to be developed and adapted so that they can be delivered within the time and resource constraints of the health workforce, ensuring that they are acceptable and effective to patients in the context of rural Uganda. 

Funding acknowledgements:
This project was funded by Science Foundation Ireland and Irish Aid (Grant 21/FIP/SDG/9960).
Keywords:
Low back pain
Rehabilitation
Low income countries
Primary topic:
Globalisation: health systems, policies and strategies
Second topic:
Musculoskeletal: spine
Third topic:
Primary health care
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Mbarara University of Science and Technology Research Ethics Committee, Uganda and the Human Research Ethics Committee at University College Dublin
Provide the ethics approval number:
MUST-2022-540; LS-LR-22-227-OSullivan
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

Back to the listing