Exploring the Roots of Pediatric Chronic Osteomyelitis in a Low-Income Country: Uncovering Factors Contributing to Vulnerability and Late Diagnosis

Exploring the Roots of Pediatric Chronic Osteomyelitis in a Low-Income Country: Uncovering Factors Contributing to Vulnerability and Late Diagnosis

Emily Powis , Shravya Kakulamarri, Yuchen Liu, Sam Paek, Leonard Banza, Nicholas Lubega, Kiran Agarwal-Harding
Harvard Global Orthopaedics Collaborative, United States; Kamuzu Central Hospital, Malawi; Beit-CURE Children’s Hospital, Malawi

Purpose:
Chronic osteomyelitis (COM), chronic infection of bone, is prevalent in low and middle-income countries (LMICs), where it often stems from inadequately treated acute osteomyelitis. Affecting about 12 million children, COM significantly drives pediatric surgery in LMICs. Limited resources, including diagnostic tools, surgical capacity, and antibiotics, impede effective treatment.
Methods:
This study investigates the causes of delayed diagnosis and treatment, including barriers within the health system, external challenges, risk factors, and psychosocial effects. Employing a mixed-method approach, the research engaged 18 families from two pediatric orthopaedic outreach programs. Quantitative surveys and in-depth qualitative interviews revealed each family’s experience.
Results:
Findings indicated that poverty delayed diagnosis and treatment. Notably, 72% of families earned less than $29 per month, 83% faced food insecurity, and 78% identified transportation costs as a major barrier to care. Health system inadequacies also played a role, with 75% of patients never receiving a COM diagnosis and about two-thirds lacking antibiotics or surgical management before evaluation by pediatric orthopaedic specialists. Multiple ineffective hospital visits, led to prolonged suffering and eroded trust in the health system, driving families towards traditional healers. The disease itself impoverished families, increased social stigma and disrupted family dynamics, yet families found renewed hope to persevere.
Conclusions:
The study underscores the relationship between poverty and severe COM as ineffective healthcare impoverishes families leading to frustration, altered social dynamics, and loss of hope. Though not representative, this is the first study to explore patient experiences and suggest root causes of severe COM in LMICs.

Keywords: chronic osteomyelitis, sub-saharan africa, LMIC, LIC, infection, orthopaedics, orthopedics