Comparison of Burden of Caregiving among Different Levels of Amputation in Selected Hospitals in South- West Nigeria

Research Article

Phys Med Rehabil Int. 2017; 4(4): 1124.

Comparison of Burden of Caregiving among Different Levels of Amputation in Selected Hospitals in South- West Nigeria

Ojoawo AO*, Abdulfattah RI and Olaoye OA

Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Nigeria

*Corresponding author: Ojoawo Adesola O, Department of Medical Rehabilitation, Faculty of Basic Medical Sciences, College of Health Sciences, Obafemi Awolowo University, Nigeria

Received: September 12, 2017; Accepted: October 05, 2017; Published: October 12, 2017


The task of caring for a relative with amputation might be somewhat daunting for the caregiver. This study compared the burden of caregiving among informal caregivers of individuals with different levels of amputation in selected hospitals in south western Nigeria.

The cross sectional survey involved 66 individuals with amputation and their caregivers. Zarit Burden Interview was used to assess the caregiver burden. Data were analysed using descriptive and inferential statistics. Alpha level was set at 0.05.

The mean caregivers burden (55.6) of the amputees in this study was a little more than average but significantly (t=2.842 p< 0.05) higher for females (59.44 ± 10.53) than for males (54.25 ± 9.27). There was significant difference (F= 4.80, p < 0.05) in caregiver burden among different levels of amputation with above knee being the highest (63.43 ± 9.51) and below knee (52.38 ± 8.29) been the lowest.

It can be concluded from the study that mean burden care, given to an average amputee may be estimate as just above average but above knee and female amputee may require more care.


All over the world, 200 to 500 million major amputations are performed each year and approximately, 70,000 new major amputations are performed annually in the United States [1] while as at 1991, there are 132 amputees per 1000 of the total population, in the United Kingdom [2]. Data from Nigeria is sparse [3] but Onuba et al [4] reported that 0.38% of all orthopaedic operations were amputations while Thanni [5] reported 1.6 per 100,000 as the estimated prevalence of extremity amputation in Nigeria. Amputation might be required for several reasons. Peripheral vascular disease (PVD) predominates and it is seen in about 64% of cases, diabetes 20%, trauma 7%, malignancy 3%, infection 2%, and congenital deformities taking about 4% [6]. From the above, peripheral vascular disease and diabetes gangrene put together -84%- accounts for majority of the lower limb amputation. Patients with these diseases usually also have many other associated medical problem, such as, atherosclerosis of cerebral vessels causing possible hemiplegia and diminish mental ability, cardiac involvement, low exercise tolerance, reduced vision, poor respiratory function and possibly osteoarthritis [7].

Amputation causes physical, psychological and emotional dysfunction [8], necessitating caregiver’s support for rehabilitation and general care. Many studies associated amputation care with psychological burden [9], financial burden [10], physical and mental stress on family and social relationship [11]. Highlighting the heavy burden borne by caregivers and drawing attention to their often unmet needs may help to raise awareness within the health care community of the impact of amputation on patient’s family. They may also provide a useful resource for defining structured intervention geared at assessing, preventing or managing problems related to stressful caregiving situations across the care continuum [12].

More, so studies have focused on caregivers of patients affected by Alzheimer’s disease and dementia [13], stroke [14] and Parkinson’s disease [12,15] but few studies have analysed the factors associated with caregiver burden in individuals with amputation [11]. Study on caregiver burden in children and adolescents with mental health problems was carried out in Nigeria by Dada, et al. [16]. Another study on health and wellbeing of caregivers of children with cerebral palsy was carried out by Raina, et al. [17]. Also, the quality of life of Nigerians with amputation has been studied by Babatunde, et al., [2] but, there is a dearth of studies in Nigeria on the burden of caregivers of patients with amputation. The aim of this study, therefore, is to assess the caregiver burden in patients with either above elbow, below elbow, above knee or below knee amputation. The association between caregiver burden and selected factors will also be determined.

Materials and Methods


Caregivers caring for individuals with amputation were recruited for the study from the following selected hospitals: Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife, Seventh Day Adventist Hospital, Ile-Ife, National Orthopaedic Hospital Igbogbi, Lagos, Nigerian Army Reference Hospital Yaba, Lagos.

Inclusion criteria

Inclusion criteria were caregivers who are: caring for the individuals with amputation for at least two weeks; family members of the individuals with amputation, caring for individuals who had either above elbow, below elbow, above knee or below knee amputation and are still on admission, able to speak or understand the English and/or Yoruba languages and who gave consent to participate in the survey.

Exclusion criteria

Caregivers who: are unable to speak or understand the English and/or Yoruba Languages; were also caring for other individuals with similar condition or chronic medical, neurological, orthopaedic conditions but not amputation are caring for partial hand or foot amputation and/or amputation of one or more digits.

Sampling technique:

Respondents were recruited using non-probability purposive sampling technique.

Sample size calculation [18]:

The sample size was calculated using the formula:

N= 4(Z)²p(1-p)/ D²

Where p= pre-study estimate of proportion, N= sample size of the single study group, Z= standard normal deviation (1.96). D= total width of expected confidence interval (0.2).

N= 4 (1.96)² × 0.2 (1-0.2) = 61.5/0.2²

The sample size will be rounded up to 70 to accommodate for non-response.


The instruments used in this study included a self-administered questionnaire, Zarit Burden Interview (ZBI) [19] which consists of two sections. The first section (Section A) was used to collect sociodemographic information such as: age, sex, level of education and occupation of both amputee and caregiver, length of hospital stay, amputation type, side of affectation and cause of amputation. The second section (Section B) was adopted from the caregiver strain interview- Zarit Burden Interview is a 22-item instrument with 5 domains which consist of employment, financial, physical, social and time domains. Respondents rated the frequency to which items applied to them on a 5-point scale; ranging from ‘never’ to ‘near always’. Scores were assigned to each item with the lowest score being 22 and the highest score being 105.


Ethical approval was obtained from the Health Research Ethics Committee of the Institute of Public Health of Obafemi Awolowo University Ile-Ife. The procedure was explained to the respondent prior to assessment and informed consent was obtained before data collection. Participants who met the criteria for inclusion in this study were asked to fill the Zarit Burden Interview questionnaire.

Data analysis

Data was analysed using SPSS version 17. Descriptive statistics of mean, standard deviation, frequency and percentage was used to summarize the data that will be obtained in the study. Analysis of variance was used to compare the care givers burden among different level of amputation. Independent –t-test was used to examine the difference between caregivers burden of male and female amputees.


Presented in Table 1 is the frequency distribution and sociodemographic factor of caregivers and amputees. There were 45 female caregivers, and 48 male amputees; 48 (72.7%) caregivers had tertiary education and 43 (65.3%) amputees had tertiary education. Civil servants form the largest percentage among the amputees (25.8%) and business.