400 Section - Mapping Barriers and Opportunities in the Rehabilitation Care Pathway for Leprosy-Related Amputations in Ghana: A Qualitative Study

Objectives : Leprosy is a chronic, progressive disease that can cause nerve damage and deformities that impair mobility, function, livelihood, and community participation. Individuals with leprosy who undergo lower limb amputation require counseling, dermatologic education, rehabilitation, and prosthetic support, yet little is known about how these needs are addressed within Ghana’s rehabilitation system. This study aimed to (1) map the care pathway from diagnosis through rehabilitation, (2) identify barriers and facilitators to accessing post-amputation services, and (3) develop recommendations to improve pathway consistency and accessibility.

Design: A qualitative design was used. Guided interviews were conducted with 13 Ghanaian healthcare workers involved in longitudinal leprosy care: nurses, prosthetists/orthotists, rehabilitation center managers, caregivers, and leprosarium founders. Participants represented districts where individuals with leprosy had undergone amputation within the past seven years or were treated for complications likely to lead to amputation. Five open-ended questions explored experiences with the pathway, challenges, and recommended improvements. Transcripts were analyzed thematically.

Results: Reports on rehabilitation availability ranged from some service provision (n=5) to limited (n=2), uncertain (n=4), or no services (n=4). Major challenges included financial burden (n=9), stigma (n=4), limited leprosy-specific knowledge (n=1), distance to services (n=1), and family separation (n=2). Barriers to prosthetic access included financial hardship (n=5), stigma (n=2), limited prosthetic knowledge (n=2), distance (n=5), and inadequate disability-friendly infrastructure (n=1). Suggested solutions included securing funding (n=6), increasing personnel (n=2), expanding community or provider education (n=4), strengthening family involvement (n=1), and upgrading infrastructure (n=1). Recommendations focused on increasing materials (n=6), funding (n=5), personnel (n=5), facilities (n=2), transportation (n=1), and inter-facility collaboration (n=1).

Conclusion: Findings highlight substantial gaps in the rehabilitation pathway, particularly for individuals in rural or low-resource settings. Future work will expand interviews across additional regions and incorporate patient perspectives to inform development of a standardized, patient-centered care pathway.