Abstract
BackgroundThe extent of disease burden of musculoskeletal conditions (MSC) not due to injury has not been well determined in sub-Saharan Africa. The 1999 Global Burden of Disease study estimated the prevalence of osteoarthritis and rheumatoid arthritis to be 150/100,000 compared to 1,500/100,000 in Europe. The objective of the study was to determine the prevalence of MSC and the functional implications in a sample of people attending community health centres in Cape Town, South Africa.MethodsA cross-sectional, descriptive study was conducted in clinics in two resource poor communities. Phase I consisted of screening and those who screened positive for peripheral or spinal joint pain went on to complete Phase II, which included the Stanford Health Assessment Questionnaire.Results1005 people were screened in Phase I. Of these, 362 (36%) reported MSC not due to injury in the past three months. Those with MSC had higher rates of co-morbidities in every category than those without. The mean Disability Index for those with MSC was mild to moderate and moderate to severe in those over 55 years.ConclusionsAlthough the sample may not be representative of the general community, the prevalence is considerably greater than those reported elsewhere even when the population of the catchment area is used as a denominator, (367/100 000). The common presentation of MSC with co-morbid diabetes and hypertension requires holistic management by appropriately trained health care practitioners. Any new determination of burden of disease due to MSC should recognise that these disorders may be more prevalent in developing countries than previously estimated.
Highlights
The extent of disease burden of musculoskeletal conditions (MSC) not due to injury has not been well determined in sub-Saharan Africa
The burden of disease (BoD) methodology has been used to quantify the impact of these conditions and it reports the burden in terms of Disability Adjusted Life Years (DALYs), which reflect both the mortality and morbidity associated with a condition
In the 1990 Global BoD study, MSC were estimated to account for 4.3% of the DALYs and osteoarthritis (OA) was the third largest contributor (27.3%) to the YLDs in developed countries
Summary
The extent of disease burden of musculoskeletal conditions (MSC) not due to injury has not been well determined in sub-Saharan Africa. MSC contributed only 1% to DALYs and OA was not listed amongst the top ten major contributors to YLDs in the developing world [4] This discrepancy relates to the estimated all age prevalence rates of 325 for Rheumatoid Arthritis (RA) and 1 161/100 000 for OA in Europe compared to 34 and 110/100 000 in Sub-Saharan Africa. In the 2000 South African Burden of disease study[5], MSC were estimated to contribute relatively little to the burden of all conditions examined and were ranked 20th out of 24 conditions This burden was not calculated from empirical data but was based on the ratios of YLDs to YLLs estimated by the World Health Organisation (WHO) for the Afro E region, of which South Africa is a part, for each of the disease categories[5]. It becomes necessary to examine to what extent these estimates might be correct
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