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.
Highlights
There is a global lack of accurate information on the prevalence and causes of physical disability in low income countries [1,2]
The prevalence of musculoskeletal impairment (MSI) fell after early childhood and increased rapidly with age so that it was almost nine-fold higher in people aged over 60 years compared to those aged 0–5 years (OR = 8.9, 6.0–13.4)
This study estimates that the prevalence of MSI in Rwanda is 5.2%
Summary
There is a global lack of accurate information on the prevalence and causes of physical disability in low income countries [1,2]. For example one survey which asked detailed questions about difficulties in different aspects of life, showed that Norway had a prevalence of physical disability of 35% while the national census in India, which merely asked whether there was a ‘‘physically handicapped’’ person in the household estimated that the prevalence was 0.2% [5]. With such different ways of measuring and defining disability there is little benefit in making comparisons between countries, or over time within a country. 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
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