Relative Frequency and Proportional Distribution of Rehabilitation-Related Conditions in Rural Primary Healthcare: A Retrospective Multi-Center Audit in North-Eastern Nigeria

In the vast network of human health, there is a quiet but critical layer of care dedicated to helping people move again. When a body part stops working properly due to injury, illness, or the wear and tear of daily life, the goal is not just to stop the pain, but to restore function. This is the realm of physical rehabilitation. While many people imagine this care happening in large, high-tech hospitals far away, global health guidelines insist that it should be available right where people live, in their local community clinics. The idea is that if a person can get help early, they are less likely to suffer permanent disability, and the strain on the entire medical system is reduced. However, in many rural parts of the world, this ideal remains out of reach. The services are often concentrated in big cities, leaving those in the countryside to manage complex physical problems with limited tools and no clear path to specialized help.

This gap is particularly sharp in North-Eastern Nigeria, a region where the landscape is defined by farming and the daily physical demands of rural life. For years, health planners in this area have operated without a clear picture of just how many people are struggling with movement-related issues in their local clinics. Without data, it is difficult to know where to send doctors, how many wheelchairs to order, or whether to train local nurses in basic physical therapy. To fill this silence, a team of researchers from several universities and hospitals in the region decided to look back at the records of three rural clinics. They wanted to see who was walking through the doors, what was hurting them, and what was happening to them after they were seen.

The researchers conducted a careful review of patient files from three primary health centers located in the Akko Local Government Area of Gombe State. These centers serve a population of farmers and laborers who live far from the major cities. The team looked at records spanning five years, from the beginning of 2021 through the end of 2025. Because some of the paper records had been damaged or lost over time, particularly for the year 2022, the team had to be creative. They cross-referenced the main patient logs with pharmacy records, looking for people who had been prescribed strong painkillers or muscle relaxants, to find and recover missing files. After cleaning up the data and removing any files that were too damaged to read, they were left with a clear picture of 384 unique patients who had come to these clinics with conditions that needed physical rehabilitation.

The story these records tell is one of a young population carrying a heavy physical burden. The average age of the patients was just 22 years old, with the majority falling between 16 and 25 years of age. This is a stark contrast to what is often seen in wealthier nations, where rehabilitation services are mostly used by older people dealing with age-related decline. In this rural Nigerian setting, the people needing help are the very workers who keep the local economy running. They are the young men and women who spend their days lifting heavy loads, bending over crops, and navigating rough roads on motorcycles. The data showed that nearly half of all the patients were in this young, working age group, suggesting that the physical demands of their daily lives are taking a toll on their bodies much earlier than expected.

When the researchers looked at what exactly was wrong with these patients, the pattern was clear. Almost half of all the cases involved problems with the muscles, bones, and joints. The single most common complaint was pain in the lower back, which accounted for more than a quarter of all the patients. This was followed by general body pain and injuries to soft tissues like muscles and ligaments. The second largest group of patients suffered from degenerative conditions, such as wear and tear in the knees and neck, which are often associated with older age but appeared here in younger people as well. There were also significant numbers of patients with nerve problems, including cases where the sciatic nerve was damaged by an injection given in the buttocks, a common treatment for fever in the region. Additionally, the clinics saw patients recovering from strokes and children with developmental delays, highlighting that the need for rehabilitation covers a wide range of conditions, not just back pain.

Perhaps the most revealing finding of the study was not about what the patients had, but about what happened to them after they were seen. The records showed that the vast majority of these patients, more than 85 percent, were treated right there at the local clinic and never sent anywhere else. They were given pain medication and sent home. Only a small fraction, about 14 percent, were formally referred to a larger, specialized hospital where physical therapists and advanced equipment are available. This creates a bottleneck. The local clinics are doing their best to manage the pain, but without the ability to provide exercises, manual therapy, or specialized devices, the underlying problem often remains. The patients are not getting the full care they need to regain their strength and mobility.

The researchers concluded that this situation represents a missed opportunity for the health system. The rural clinics are seeing a massive volume of people who need physical rehabilitation, but the system is not set up to provide it. The high number of young workers with back pain and other injuries suggests that the local economy is physically punishing its workforce. The low referral rate is not because the patients do not need help, but because the barriers to getting it are too high. Traveling to a city is expensive, the roads are poor, and the cost of transport is often more than a family can afford. As a result, people stay in the local clinics, relying on painkillers that treat the symptom but not the cause.

To fix this, the authors suggest that the solution does not necessarily require building new hospitals in the cities. Instead, they propose bringing the skills closer to the people. They recommend training the local health workers, who are already trusted in the community, to recognize these conditions and provide basic screening and care. They also suggest setting up community-based programs where physical therapists visit the rural clinics regularly, rather than waiting for patients to make the long journey to the city. Finally, they emphasize the need for better record-keeping. The fact that they had to dig through pharmacy logs to find missing patient files shows how fragile the current system is. By moving to simple digital records, health planners could get an accurate, real-time picture of who needs help and where, ensuring that the people of rural North-Eastern Nigeria are not left behind in their recovery.