Barth CA1,2, Blake C2, Wladis A3,4, O'Sullivan C2
1International Committee of the Red Cross, Health Unit (Physical Rehabilitation Programme), Geneva, Switzerland, 2University College Dublin, School of Public Health, Physiotherapy and Sports Science, Dublin, Ireland, 3International Committee of the Red Cross (ICRC), Health Unit (Hospital Programme), Geneva, Switzerland, 4Linköping University, Department of Clinical and Experimental Medicine (IKE), Linköping, Sweden

Background: The highest prevalence of amputation worldwide is seen in conflict settings. Modern conflict patterns dictate that civilians are as much at risk of conflict related injury as combatants. The gender dimension of service users attending physical rehabilitation services are under researched. Exploration of gender dimensions in rehabilitation is important as gender discrimination renders women particularly vulnerable to exclusion from services, reducing their rehabilitation potential, with significant social and economic impact.

Purpose: The purpose of this study is to describe gender differences in injury characteristics of patients with amputation attending the International Committee of the Red Cross (ICRC) Physical Rehabilitation Centre in Erbil, Iraq.

Methods: A retrospective analysis of de-identified service user files of those attending ICRC Physical Rehabilitation Services in Iraq over a 10 year (2008-2017) period was undertaken. Descriptive analysis was conducted using IBM SPSS Statistics for Windows, (Version 24.0). Chi square analysis were conducted where appropriate to test for statistically significant differences between gender.

Results: 9´050 service user files were reviewed, 4´349 (48.1%) of whom had amputation as a primary diagnosis. Only 28.5% of women had a diagnosis of amputation compared to 54.7% of men, (p 0.001). The main cause of amputation was traumatic (67.1 %), followed by vascular (20 %), and infection, (9%). Proportionally, twice as many men had a traumatic cause of amputation compared to women, (72.4% and 37.4 % respectively, p 0.001). Cause of amputation among women was evenly spread across traumatic, (37.4%) and vascular (35.3%) causes while men demonstrated significantly higher trauma (72.4%) compared to vascular (17.3%) causes, (p 0.001). Despite this, significantly more men presented with amputation with vascular disease as the underlying cause compared to women, (638 and 230 respectively). When trauma is explored further, conflict related injury is most prevalent, (53%) followed by road traffic accident (9.1%), with significant gender differences noted. Conflict related injury was mostly caused by landmines, (22.7%), shelling (11.4%) and bombs (11%).

Conclusion(s): This preliminary study provides an insight into gender differences in injury characteristics among people with amputation in one centre in Iraq. As may be expected, more men presented with amputation and had significantly higher trauma than women. However this trend was also evident for vascular disease as a cause of amputation. It may be assumed that both men and women have similar risk factors for vascular disease, therefore these findings suggest that women with amputation as a result of vascular disease may not access or seek out physical rehabilitation services.

Implications: Further investigation is warranted to understand barriers to physical rehabilitation for women in context specific conflict settings to maximise rehabilitation potential. Future research will investigate gender differences in health outcomes following physical rehabilitation for amputation.

Keywords: Gender, Amputation, Conflict

Funding acknowledgements: n/a

Topic: Disaster management; Disability & rehabilitation; Disaster management

Ethics approval required: No
Institution: International Committee of the Red Cross
Ethics committee: Commission Cantonal d’Ethique et Recherche” (CCER) of Geneva
Reason not required: Analysis of anonymised secondary data that were routinely collected for institutional purposes

All authors, affiliations and abstracts have been published as submitted.

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