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

<title>Abstract</title> <p> Background Global health guidelines state that comprehensive primary care must incorporate promotive, preventive, curative, and rehabilitative services. In sub-Saharan Africa, physical rehabilitation infrastructure remains concentrated within urban tertiary centers, creating geographic barriers for rural communities. As a result, frontline rural Primary Health Care (PHC) facilities manage a substantial volume of musculoskeletal and neurological cases, though this clinical burden remains undocumented due to manual record vulnerabilities and diagnostic tracking gaps. This study evaluated the relative frequency, socio-demographic distribution, and referral patterns of rehabilitation-related conditions presenting to rural primary clinics in North-Eastern Nigeria. Methods A multi-center, retrospective audit of institutional health charts was conducted across three rural PHC centers (Garko, Barambu, and Pandaya) in the Akko Local Government Area of Gombe State, North-Eastern Nigeria. Charts covering a five-year timeline (January 2021 to December 2025) were analyzed. To address data missingness and reconstruct a 2022 calendar year archive gap caused by document degradation, a parallel recovery pipeline cross-referencing pharmacy logs and nursing sub-registries was executed. An <italic>a priori</italic> sample size estimation established an initial target pool of 410 records, which yielded a final, fully cleaned analytic cohort of N = 384 patients following the exclusion of 26 compromised files. Raw clinical logs were extracted using a uniform digital proforma and mapped into standardized pathological classifications via an explicit diagnostic translation matrix. Quantitative analysis was performed using non-parametric and descriptive statistics in SPSS Version 26.0. Results A total of 384 unique medical records matching the case definition were validated, fulfilling the statistical sample target. Normality testing using the Shapiro-Wilk test confirmed that the age distribution was highly right-skewed (W = 0.842, p &lt; 0.001). The cohort presented a median age of 22.0 years (Interquartile Range [IQR]: 18.0–34.5 years) and showed a minor female predominance (52.6%, n = 202). Physical rehabilitation demand was heavily concentrated within the young, economically active workforce aged 16–25 years (43.8%, n = 168). Primary Musculoskeletal and Orthopedic Disorders comprised the largest share of the clinical workload (49.2%, n = 189), led by mechanical Low Back Pain (28.1%, n = 108), Generalized Body Pain (11.5%, n = 44), and acute soft-tissue trauma (9.6%, n = 37). Regional Degenerative and Soft-Tissue Patterns represented the second largest overall grouping (24.2%, n = 93), led by suspected Knee Osteoarthritis (9.6%,n = 37). Peripheral Nerve and Neuromuscular Presentations accounted for 12.3% (n = 47), featuring Post-Injection Sciatic Nerve Palsy (6.8%, $n = 26$), while Primary Neurological Conditions comprised 8.6% (n = 33), dominated by post-stroke hemiplegia (7.8%, n = 30). Operational tracking revealed an extensive care containment barrier: 85.9% (n = 330) of all cases were managed locally through palliative pharmacotherapy, whereas only 14.1% (n = 54) received a formal outward referral to specialized tertiary rehabilitation institutions. Conclusion Rural primary healthcare centers in North-Eastern Nigeria manage a substantial, unrecorded burden of physical disability that selectively affects young adult workers. The high level of local containment and low referral rates highlight an operational bottleneck linked to spatial and economic access barriers. Health administrators should upgrade primary data collection tools, provide basic screening and triage training for frontline health workers, and decentralize physical rehabilitation services through community-based frameworks to support rural populations. </p>