The WHO ILAR COPCORD Latin America

Abstract

T he Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) was launched through the concerted effort of the International League of Associations for Rheumatology (ILAR) and World Health Organization (WHO) in the early 1980s to acquire data on musculoskeletal (MSK) pain and disability. Its focus was on the developing world. COPCORD was designed a lowcost low-infrastructure model and was to be carried out in 3 successive stagesVcollect population data in a house-to-house survey (stage 1), educate community and identify risk factors (stage 2), and implement control and preventive strategies (stage 3). The key issues were identification of a welldefined sampling frame (not necessarily randomized) population and a grassroots rheumatologyoriented physician. COPCORD surveys have been completed in 22 countries. Started in the Philippines, COPCORD rapidly swept across the Asia-Pacific region and has traditionally enjoyed a vantage position with the Asia-Pacific League of Associations for Rheumatology. After slow beginnings, rapid strides were made in Latin America, and the recent COPCORD surveys in Mexico and Guatemala, with sufficient population samples, have unraveled newer insights in community rheumatology and epidemiology in particular. COPCORD Guatemala was a well-planned and executed survey of 8000 population and equally divided between urban and rural communities. Importantly, the whole survey was completed in a timely fashion (9 months) using the COPCORD Bhigwan (India) fast-track model. Earlier in 1996, a 7000+ population survey was completed in the village of Bhigwan in 5 weeks’ time. The model advocates a carefully designed and a prioriYrehearsed strategy, well-coordinated team effort (physicians and a large team of trained local health volunteers), and a field operation in which the 3 phases of stage 1 survey are completed in parallel. Speedy execution is a critical factor (population survey) to ensure robust community compliance and response, comprehensive data capture, and a truly suitable ‘‘point prevalence’’ data. COPCORD Guatemala should be viewed in a Latin American perspective. Table 1 provides an overview of some of the key prevalence data from COPCORD surveys in the region. All surveys used a similar COPCORD core questionnaire (CCQ) that was earlier adapted (regional use) and validated. The primary outcome was MSK pain and disability. Except for the Guatemala survey, all other COPCORD surveys were carried out in randomized population samples. The diversity in culture, traditions, dialect, and lifestyle in Latin America is striking and a challenge to community surveys and national prevalence statistics, and this was well described by both COPCORD Mexico and Guatemala. Although the crude point prevalence of MSK pain (11.9%), rheumatoid arthritis (RA; 0.7%), osteoarthritis (OA; 2.8%), and gout (0.01%) in Guatemala was intriguingly less compared to that in other Latin American countries (Table 1), nonetheless it represents a significant burden of rheumatic disorders in the community. The frequency of low back pain was abysmally low, and no case of ankylosing spondylitis (AS) was reported. Most of the members of the community in Guatemala lead modest and hard lifestyles (labor-intensive) and probably do not consider low back pain important enough compared with other MSK pain and disorders (Abraham Kutzbach, personal communication). The frequency of HLA B27 is considered to be lower in the community and relatively fewer of cases of AS are seen (AbrahamKutzbach, personal communication). COPCORD Guatemala has reported a higher prevalence of MSK pain and disorders in the rural community. A national COPCORD survey of 19,213 people in 5 study sites (Chihuahua, Nuevo Leon, Sinaloa, Yucatan, and Mexico City) was recently carried out in Mexico. Although national prevalence statistics were reported, there were obvious differences between study sites, for example, the minimum and maximum prevalence rates were 1% (Mexico City) and 2.8% (Yucatan) for RA, 2.5% (Sinaloa) and 20.5% (Chihuahua) for OA, 0.1% (Yucatan) and 0.8% (Chihuahua) for gout, and EDITORIAL