Background: Musculoskeletal impairment (MSI) is an important cause of morbidity and mortality worldwide, especially in developing countries. Prevalence studies for MSI in the developing world have used varying methodologies and are seldom directly comparable. This study aimed to develop a new tool to screen for and diagnose MSI and to pilot test the methodology for a national survey in Rwanda.

BackgroundAccurate information on the prevalence and causes of musculoskeletal impairment (MSI) is lacking in low income countries. We present a new survey methodology that is based on sound epidemiological principles and is linked to the World Health Organisation's International Classification of Functioning.MethodsClusters were selected with probability proportionate to size. Households were selected within clusters through compact segment sampling. 105 clusters of 80 people (all ages) were included. All participants were screened for MSI by a physiotherapist and medical assistant. Possible cases plus a random sample of 10% of non-MSI cases were examined further to ascertain diagnosis, aetiology, quality of life, and treatment needs.Findings6757 of 8368 enumerated individuals (80.8%) were screened. There were 352 cases, giving an overall prevalence for MSI of 5.2%. (95% CI 4.5–5.9) The prevalence of MSI increased with age and was similar in men and women. Extrapolating these estimates, there are approximately 488,000 MSI diagnoses in Rwanda. Only 8.2% of MSI cases were severe, while the majority were moderate (43.7%) or mild (46.3%). Diagnostic categories comprised 11.5% congenital, 31.3% trauma, 3.8% infection, 9.0% neurological, and 44.4% non-traumatic non infective acquired. The most common individual diagnoses were joint disease (13.3%), angular limb deformity (9.7%) and fracture mal- and non-union (7.2%). 96% of all cases required further treatment.InterpretationThis survey demonstrates a large burden of MSI in Rwanda, which is mostly untreated. The survey methodology will be useful in other low income countries, to assist with planning services and monitoring trends.

The recently adopted UN Convention on the Rights of Persons with Disabilities acknowledges the need to address social exclusion and poverty of persons with disabilities. However, policy makers, especially in low-income countries, often lack information about the socioeconomic situation of this vulnerable group of society. This study aimed to assess the association between poverty and musculoskeletal impairment (MSI) in Rwanda. A nationwide population-based matched case-control study was undertaken in Rwanda. Data were collected on education, literacy, employment, household expenditure and assets for 345 cases and 532 matched controls. Conditional logistic regression was performed, and the results indicated that adults with MSI in Rwanda are more likely to have no employment (odds ratio (OR)=3.3, 95% CI 2.1-5.2) while children with MSI are less likely to attend school (OR=0.4, 95% CI 0.2-0.9). Cases with MSI are disadvantaged vis-à-vis housing conditions and household size, potentially indicating crowding. However, cases with MSI were not poorer than controls in terms of assets or expenditure. These data suggest that increased efforts should be undertaken in Rwanda in order to ensure that children with disabilities are included in schools and that adults with disabilities can find appropriate employment opportunities.

Summaryobjective To estimate the prevalence of epilepsy in Rwanda, as part of a survey of musculoskeletal impairment (MSI).methods Cross-sectional nationally representative survey. Clusters of 105 people were selected with probability proportional to size, using the 2002 national census as the sampling frame. Within each cluster, 80 people were selected through compact segment sampling. Physiotherapists examined all participants using a standard questionnaire to assess the presence of seizures through self-report, as well as aetiology, treatment needs and severity of the seizures. Health-related quality of life was assessed using the EuroQol generic health index (EQ5D).results The response rate was 80.8%, with 6757 individuals screened. The estimated prevalence of epilepsy was 0.7% (95% confidence intervals 0.5-0.9%). A quarter (23%) of cases reported that onset of epilepsy was at birth, for 32% onset was between birth and age 5, 23% between ages 5 and 16, and 21% above the age of 16. In 4.3% of people with epilepsy, an accident during a seizure caused permanent MSI, as identified by a case history and physical examination. The majority of people with epilepsy (59.6%) had never received medical treatment for it. Epilepsy was associated with a significantly reduced quality of life.conclusions Epilepsy is a significant and neglected health problem in Rwanda at all ages. Investing in treatment for epilepsy would prevent some disability causing accidents from occurring.

There is a need for an evidence-based protocol for the clearance of the spine in the obtunded and high-risk pediatric trauma patient. High-resolution CT with sagittal and coronal reconstructions should be the basis for cervical spinal clearance, in combination with the interpretation of films by an expert radiologist. All spinal regions should be imaged, and clearance should be formally documented. The role of magnetic resonance imaging in routine clearance remains controversial. Multicenter prospective studies are needed to develop consensus for an evidenced-based protocol for clearance in this high-risk group.