Post-Amputation Rehabilitation in Africa: Pathways, Workforce Gaps, and the Unfinished Policy Agenda: A Scoping Review

Africa carries a growing and distinct burden of limb amputation driven by three converging forces: the rapidly escalating epidemic of type 2 diabetes mellitus and peripheral vascular disease, road traffic accidents (for which Africa has the world's highest mortality rate), and armed conflict and landmine injuries across multiple sub-regions. Despite this burden, the rehabilitation continuum that should follow amputation, prosthetics and orthotics fitting, physiotherapy, occupational therapy, psychological support, and community reintegration, barely exists as an organised system across most of the continent. Patients survive the surgery and are too frequently abandoned by the health system thereafter. This is not a clinical failure; it is a health systems and policy failure. No pan-African synthesis of the amputee rehabilitation pathway currently exists. The only sub-Saharan systematic review identified in preliminary searching (Boateng et al., Primary Care Diabetes, 2022) addresses the contribution of diabetes to amputation causation, not the rehabilitation continuum. Country-level studies exist, concentrated in South Africa, Tanzania, Nigeria, and Ghana, but these do not constitute a synthesised evidence base, and the majority of African countries are entirely unrepresented in the rehabilitation literature. The purpose of this scoping review is to map the full extent of evidence on post-amputation rehabilitation across all 54 African countries, what is known, where, and about what, and to identify the evidence gaps that are themselves a finding. The review culminates in a structured Policy Recommendations Panel directed at African national governments, the African Union, WHO AFRO, international funders, training institutions, and the research community.