A National Survey of Musculoskeletal Impairment in Rwanda: Prevalence, Causes and Service Implications

Abstract

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.

Chronic haematogenous osteomyelitis in children

“…3 A recent survey of the orthopaedic needs of children in Rwanda suggested that 3% were suffering from a musculoskeletal impairment due to infection. 4,5 Nearly two billion children under the age of 18 live in developing countries, and 400 million in the least-developed countries, compared to only 200 million in industrialised countries. 6 If the prevalence of musculoskeletal impairment due to infection across the leastdeveloped countries is similar to that in Rwanda, in these countries alone approximately 12 million children are affected.…”

The Burden of Musculoskeletal Disease in Sierra Leone

“…The demand in Sierra Leone for musculoskeletal care appears to be great when compared with estimates from previously published population-based and extrapolative studies [2,27,30]; however we are aware of only one other population-based survey of musculoskeletal problems in a developing country [2]. Atijosan et al [2] measured musculoskeletal impairment in Rwanda as 5.2% overall prevalence using a standardized survey, history, and physical examination by a trained physiotherapist.…”

“…By separating traumatic musculoskeletal problems from nontraumatic, better insight into the health needs of a population can be achieved. A previous study of musculoskeletal disease in low-and middle-income countries focused on disability attributable to musculoskeletal problems [2], which may capture short-term problems such as injury. The capacity to deal with disabling, chronic, and acute musculoskeletal conditions will be met only by increasing surgical capacity in low-and middleincome countries [6,19,35].…”

“…Some studies of the burden of musculoskeletal disease have been performed in high-income countries, with few population-based studies in low-and middle-income countries [2,39]. Atijosan et al [2] reported that the prevalence of musculoskeletal impairment in the population in Rwanda was 5.2%, with an estimated 814,000 treatments and 184,000 operations required by the Rwandese population of 8.4 million.…”

“…Atijosan et al [2] reported that the prevalence of musculoskeletal impairment in the population in Rwanda was 5.2%, with an estimated 814,000 treatments and 184,000 operations required by the Rwandese population of 8.4 million. To our knowledge, their study is the only available population-based study of musculoskeletal disease in a low-income country.…”