CAUSES OF LOCOMOTOR DISABILITY AND NEED FOR ORTHOPEDIC DEVICES IN A HEAVILY MINED TALIBAN-CONTROLLED PROVINCE OF AFGHANISTAN - ISSUES AND CHALLENGES FOR PUBLIC-HEALTH MANAGERS

We conducted a locomotor disability survey on a heavily mined Taliban- controlled province of Afghanistan to document the problem of locomoto r disability and to assess the need for orthopaedic rehabilitation dev ices in a study population of 12065. Global prevalence of locomotor di sability was 23/1000 (95% CI: 20-26). War-related injuries were the le ading cause of disability, affecting almost exclusively adult males. L eading causes of disability among women and children were medical and poliomyelitis. Devices most needed were lower limb ortheses (8.2 devic es/1000 people; 95% CI: 5.9-10.4) and orthopaedic shoes (6.0/1000; 95% CI:4.3-8.0). The need for lower limb prostheses was less frequent (2. 0/1000; 95% CI: 1.1-2.8). Most lower limb amputees (mainly victims of landmine injuries) were fitted with an artificial leg, while rehabilit ation needs for other types of disability remained largely unmet. We e stimated that it would take at least 3 years to provide enough orthopa edic shoes and 10 years for ortheses, whereas the need for lower limb prostheses could be met in less than 4 months. None of the 27 women wi th lower limb disability were equipped with an orthopaedic device, alt hough this was the case for 31 of 89 men (35%). The problem of landmin es should not divert attention from other causes of disability such as poliomyelitis or from other rehabilitation requirements. Immunization programmes and restoration of the public health infrastructure should be given high priority; rehabilitation services are largely insuffici ent and should be developed. Extreme gender difference in needs covera ge is a matter of concern. Researching culturally sensitive strategies to tackle this problem should be a priority for donors and implementi ng agencies.