Amputation Prevention Strategies in Belize, Central America

Background: No data are published as to the causes of amputations or the frequency with which they occur in Belize or any of the developing nations of Central America. (1) Throughout Latin America and the Caribbean, absent or limited surveillance and reporting of all disabilities has made accurate description of the disabled population impossible. (2, 3) Policies and programs aimed at disability prevention or addressing the needs of the disabled population in general, or amputees specifically; do not exist in the region. (4) Amputation surveillance data describing the affected population, their amputation causes and frequencies are critical to increasing recognition of the public health burden of amputation, formulating health-care policy, identifying high-risk groups, developing strategies to reduce the burden of this disability, and evaluating progress of prevention. (5-8)

Aim: The aim of this research is to provide a basis for the development of amputation prevention strategies in the Central American developing nation of Belize by examining two datasets of amputees as well as the country, her healthcare system and her population.

Methods: Two datasets of amputees from Belize were examined in order to describe the causes and frequencies of both major and minor amputations as well as the affected population. This information was then taken in light of the country, the healthcare system and the general population in order to establish a basis for amputation prevention strategy development.

Figure 1: Comprehensive amputation prevention strategy framework

Results: There were 155 amputations included from both datasets including 116 major amputations and 39 minor amputations. Males constituted over 77% of the amputee population. The majority of amputations were attributable to various trauma (44%) and diabetes (43%). Nearly half (41%) of the traumatic amputations were the result of motor vehicle accidents. Other causes included congenital limb deficiencies (4.5%), cancer (1.9%), infection (1.3%), elective amputations (0.6%), peripheral vascular disease (0.6%) and causes unknown (3.9%).

Conclusions: Amputation prevention recommendations for Belize focused on four areas: surveillance and reporting, traumatic amputation reduction, diabetes management and community based rehabilitation. While these recommendations are specific to Belize, the process established to create them is applicable to other developing nations.

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8. Pan American Health Organization. Diabetes Initiative for the Americas (DIA): Action Plan for Latin America and the Caribbean 2001-2006. July 2001. Accessed online 12 Jan 2004 http://www.paho.org/English/AD/DPC/NC/dia-action-plan-2001-2006.PDF