From treatable conditions to limb loss: gaps in clinical care pathways

¹Department of Microbiology, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya, ²Department of Applied Health Sciences, School of Health Sciences, Kisii University, Kisii, Kenya, ³Department of Nursing, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya

^&Corresponding author
Silas Onyango Awuor, Department of Microbiology, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya

Commentary    

Amputation is often regarded as a last-resort, life-saving intervention. However, in many healthcare settings, it reflects missed opportunities in prevention and early treatment. Patients frequently present with manageable conditions such as infected wounds, diabetic foot ulcers, or ischemic limbs yet progress to advanced disease requiring surgical removal of limbs [1,2]. This pattern underscores systemic weaknesses in clinical care pathways rather than solely disease severity. The burden is particularly pronounced in low- and middle-income countries (LMICs), where healthcare systems face constraints in diagnostics, workforce, and continuity of care [3]. Nevertheless, similar trends are increasingly reported globally, driven in part by the growing burden of chronic diseases and antimicrobial resistance [4,5].

Delayed diagnosis and fragmented care

Timely diagnosis is central to limb preservation. Yet many patients experience significant delays before receiving definitive care due to multiple referrals, limited access to specialized services, and inadequate early screening [6,7]. Fragmented care pathways further exacerbate the problem. Patients often move across different levels of care without coordinated management, resulting in delayed interventions and disease progression [8].

Microbiological gaps and antimicrobial resistance

Limited access to microbiological diagnostics forces reliance on empirical antibiotic therapy, which may be inappropriate [6]. This contributes to treatment failure and fuels antimicrobial resistance (AMR) [9,10]. Antimicrobial resistance (AMR) significantly worsens outcomes in wound infections and diabetic foot disease, increasing the likelihood of complications and amputation [6,9]. Without effective antimicrobial stewardship, this cycle continues to undermine clinical care.

Lack of multidisciplinary care models

Limb preservation requires coordinated, multidisciplinary care involving clinicians, microbiologists, surgeons, and wound care specialists. Evidence shows that such models reduce amputation rates, yet they remain inconsistently implemented, especially in resource-limited settings [1,6,7].

Missed opportunities in prevention

Preventive strategies such as early screening, patient education, and prompt treatment of minor wounds are often underutilized [2,10]. Socioeconomic barriers and delayed health-seeking behaviour further contribute to late presentations and poor outcomes [3].

The way forward

Reducing preventable amputations requires strengthening diagnostic and laboratory capacity [6,9], implementing antimicrobial stewardship programs [9,10], scaling multidisciplinary care models [1,7], enhancing preventive care and early intervention [2] and finally improving referral systems and continuity of care [10].

Conclusion     

Limb loss should not be a common outcome of treatable conditions. Addressing gaps in clinical care pathways is essential to reducing preventable amputations and improving patient outcomes. This is both a clinical and public health priority.

Competing interests     

The authors declare no competing interests.

Authors' contribution     

Silas Onyango Awuor: conceptualization, resources, visualization. Silas Onyango Awuor and FAO: methodology, writing-original draft preparation, witing-review and editing, final editing. All the authors have read and approved the final version of this manuscript.

References