Exploring barriers to access and use of limb prostheses and orthoses in sub-Saharan Africa: A systematic review

Background: Prosthetic and orthotic devices play a significant role in enhancing the quality of life for individuals with disabilities by improving mobility, health, psychological well-being, and socio-economic opportunities. However, access to these assistive devices remains a considerable challenge, particularly in resource-limited settings. Objectives: The aim of this systematic review was to explore and categorise the existing barriers and challenges that affect access to limb orthoses and prostheses in sub-Saharan African countries. Method: A systematic search of seven databases was conducted to identify relevant studies using the search terms: ‘prosthesis’ or ‘orthosis’ and sub-Saharan African countries and variations of each term. Quality assessment of each study was completed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale and the Oxford Levels of Evidence. Results: Twenty-two journal articles were included for review following database search and screening, evaluating a total of 3726 participants. Results were organised into four generalised themes, and each theme was categorised into sub-themes. Conclusion: The review identifies multifaceted barriers to accessing and utilising limb prostheses and orthoses in sub-Saharan Africa, primarily driven by economic constraints and cultural barriers. The lack of multidisciplinary rehabilitation teams further contributes to fragmented and inefficient service delivery. Orthotic and prosthetic training centers and colleges are underdeveloped, facing problems such as ineffective teaching methods, outdated curricula, inadequate research facilities, and a shortage of experienced professionals. Contribution: This review synthesises evidence on barriers to prosthetic and orthotic access in sub-Saharan Africa, categorising challenges into thematic domains and highlighting gaps in service delivery, education, and workforce capacity to inform policy, practice, and future research directions.