Perceptions, practices, and gaps in osteomyelitis care in rural Rwanda: insights from patients and healthcare workers

BACKGROUND: Osteomyelitis is a chronic, debilitating bone infection that contributes substantially to morbidity and disability in low- and middle-income countries (LMICs). In Rwanda, the condition remains under-recognized due to delayed healthcare-seeking, reliance on traditional medicine, and limited diagnostic capacity at peripheral health facilities. This study explored perceptions, practices, and systemic gaps in osteomyelitis care from both patient and healthcare provider perspectives to inform strategies for early detection and improved management. METHODS: A cross-sectional qualitative study was conducted in two hospitals in Nyamasheke District, Western Province, Rwanda. Purposive sampling identified 40 patients diagnosed with osteomyelitis (March-September 2024) and 8 healthcare providers involved in osteomyelitis care. Data were collected through semi-structured interviews, transcribed verbatim, translated into English, and analyzed thematically using the constant comparison method in ATLAS.ti version 24. Credibility was ensured through member checking, peer debriefing, and triangulation of responses. Percentages are used for descriptive purposes only and do not represent population prevalence. RESULTS: The majority of patients (85%) reported delayed medical consultation, initially relying on traditional remedies due to financial hardship, stigma, and misconceptions about the disease. 6 out of 8 healthcare providers (75%) cited diagnostic limitations, lack of standardized treatment protocols, and poor referral feedback as major barriers. Both groups emphasized inadequate public awareness, insufficient follow-up, and limited rehabilitation support for disabled patients. CONCLUSION: Osteomyelitis care in Rwanda is undermined by sociocultural beliefs, financial barriers, and systemic weaknesses across diagnostic and referral pathways. These findings suggest that interventions such as enhanced provider training for early detection, locally adapted management guidelines and strengthened referral practices, and the integration of community-based education and rehabilitation services may help reduce osteomyelitis-related morbidity in resource-limited settings; however, the effectiveness of these approaches warrants further evaluation.