Prevalence and causes of musculoskeletal impairment in Fundong District, North-West Cameroon: results of a population-based survey

Epidemiology and Prevalence of Musculoskeletal Disabilities Following Motor Vehicle Accidents in Aljouf Region, Saudi Arabia

Background and Objectives: Motor vehicle accidents (MVAs) are the leading cause of disability, particularly among young adults in Saudi Arabia. Persistent disabilities account for around 7% of all injuries attributed to MVAs in Saudi Arabia in the last twenty years. Limited studies on musculoskeletal disabilities following MVAs have been carried out in Saudi Arabia. This study aims to explore the epidemiology and prevalence of musculoskeletal disabilities in motor vehicle accident (MVA) patients in the Aljouf region, Saudi Arabia. Materials and Methods: This retrospective cross-sectional study evaluated all MVA victims treated in the Aljouf region, Saudi Arabia, from January 2020 to December 2022. A total of 3252 medical records were collected, with 731, 1197, and 1324 musculoskeletal injury cases per year, of which 88, 168, and 153 records from 2020, 2021, and 2022 were analysed, respectively. Results: The study found that patients aged 25-34 and 35-44 years were the most likely to experience disability following MVAs. The difference between age groups during a single year was statistically significant (p < 0.001). Most patients were male (89.8%, 82.7%, and 79.7%) during 2020, 2021, and 2022, respectively. The majority of injuries involved the upper extremities (38.6%, 36.9%, and 40.5%), followed by lower extremities (36.4%, 35.7%, and 34.6%), head and neck (21.6%, 26.2%, and 34.6%), thoracic region (20.5%, 24.4%, and 17%), and finally lumbosacral spine (6.8%, 5.4%, and 6.5%) during 2020, 2021, and 2022, respectively, with a significant difference for each year (p < 0.001). The study found a link between the likelihood of developing high disability grades and injury severity scores. The patients with very severe ISS ≥ 25 (OR: ∞ CI 95%: 39.81-∞; p < 0.001), severe ISS = 16-24 (OR: ∞ CI 95%: 20.90-∞; p < 0.001), and moderate ISS = 9-15 (OR: ∞ CI 95%: 1.2-∞; p = 0.02) were at greater risk of developing high grades of disability. Conclusions: This study highlighted the musculoskeletal disabilities in the Aljouf region following MVAs. Severe musculoskeletal disabilities were rare, but fractures were the most common following MVAs. More efforts should be directed towards education on early transportation and transfer to the nearest medical centres, seeking assistance immediately after MVAs for patient safety, and disability prevention.

What Proportion of East African Refugees Report Musculoskeletal Problems? A Cross-sectional Survey

BACKGROUND

Musculoskeletal conditions are the leading cause of disability worldwide and disproportionally affect individuals in low-income and middle-income countries. There is a dearth of evidence on musculoskeletal problems among refugees, 74% of whom reside in low-income and middle-income countries.

QUESTIONS/PURPOSES

(1) What proportion of refugees in Nyarugusu Camp, Kigoma, western Tanzania, are affected by musculoskeletal problems and what are the characteristics of those individuals? (2) What are the characteristics of these musculoskeletal problems, including their causes, location, and duration? (3) What forms of healthcare do those with musculoskeletal problems seek, including those for both musculoskeletal and nonmusculoskeletal problems?

METHODS

We conducted a cross-sectional study among refugees in Nyarugusu Camp, using the Surgeons OverSeas Assessment of Surgical Need tool. The Surgeons OverSeas Assessment of Surgical Need tool is a validated population-based survey tool developed for use in limited-resource settings that is intended to determine the prevalence of surgical disease in a community. It uses a cluster random sampling methodology with house-to-house data collection in the form of a verbal head-to-toe examination that is performed by a trained community healthcare worker. A total of 99% responded, and 3574 records were analyzed. The mean age of respondents was 23 ± 18 years, with under 18 as the most-represented age group (44% [1563]). A total of 57% (2026) of respondents were women, 79% (2802 of 3536) were generally healthy, and 92% (3297 of 3570) had visited a camp medical facility. Only records endorsing musculoskeletal problems (extremity or back) were included in this analysis. Using all refugees surveyed as our denominator and refugees who endorsed a musculoskeletal problem (extremity or back) as the numerator, we calculated the proportion of refugees who endorsed a musculoskeletal problem. We then analyzed the characteristics of those endorsing musculoskeletal problems, including their healthcare-seeking behavior, and the characteristics of the musculoskeletal problems themselves.

RESULTS

Among 3574 refugees interviewed, 22% (769) reported musculoskeletal problems, with 17% (609) reporting extremity problems and 7% (266) reporting back problems. Among all people surveyed, 8% (290) reported current extremity problems while 5% (188) reported current back problems. Among those reporting musculoskeletal problems, respondents younger than 18 years were the most-represented age group for extremity problems (28% [169 of 609]) whereas respondents between 30 and 44 years of age were the most-represented age group for back problems (29% [76 of 266]). Wounds from an injury or trauma (24% [133 of 557]) and acquired disability (24% [133 of 557]) were the most-common causes of extremity problems, whereas acquired disability (53% [97 of 184]) followed by a wound not from injury or trauma (25% [45 of 184]) were the most common causes of back problems. Fifty percent (303) of those with extremity problems characterized it as disabling, whereas 76% (203) of those with back problems did.

CONCLUSION

Over one of five refugees endorsed musculoskeletal problems, which are most often caused by acquired disease and injury. These musculoskeletal problems are often characterized as disabling, yet only slightly more than half have sought treatment for problems. This warrants further research on care-seeking behavior in this setting, and emphasizes that investing in the spectrum of musculoskeletal health systems, including medical management and rehabilitation services, is critical to decreasing disability caused by musculoskeletal problems.

LEVEL OF EVIDENCE

Level IV, prognostic study.

Exploring the Use of Washington Group Questions to Identify People with Clinical Impairments Who Need Services including Assistive Products: Results from Five Population-Based Surveys

This study analyses the use of the self-reported Washington Group (WG) question sets as a first stage screening to identify people with clinical impairments, service and assistive product (AP) referral needs using different cut-off levels in four functional domains (vision, hearing, mobility and cognition). Secondary data analysis was undertaken using population-based survey data from five countries, including one national survey (The Gambia) and four regional/district surveys (Cameroon, Chile, India and Turkey). In total 19,951 participants were sampled (range 538–9188 in individual studies). The WG question sets on functioning were completed for all participants alongside clinical impairment assessments/questionnaires. Using the WG “some/worse difficulty” cut-off identified people with mild/worse impairments with variable sensitivity (44–79%) and specificity (73–92%) in three of the domains. At least 64% and 60% of people with mild/worse impairments who required referral for surgical/medical and rehabilitation/AP services, respectively, self-reported “some/worse difficulty”, and much fewer reported “a lot/worse difficulty.” For moderate/worse impairment, both screening cut-offs improved identification of service/AP need, but a smaller proportion of people with need were identified. In conclusion, WG questions could be used as a first-stage screening option to identify people with impairment and referral needs, but only with moderate sensitivity and specificity.

The unmet need for treatment of children with musculoskeletal impairment in Malawi

Background

More than a billion people globally are living with disability and the prevalence is likely to increase rapidly in the coming years in low- and middle-income countries (LMICs). The vast majority of those living with disability are children residing in LMICs. There is very little reliable data on the epidemiology of musculoskeletal impairments (MSIs) in children and even less is available for Malawi. Previous studies in Malawi on childhood disability and the impact of musculoskeletal impairment (MSI) on the lives of children have been done but on a small scale and have not used disability measurement tools designed for children. Therefore in this study, we aimed to estimate the MSI prevalence, causes, and the treatment need among children aged 16 years or less in Malawi.

Methods

This study was carried out as a national cross sectional survey. Clusters were selected across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the national distribution of the population. Clusters were distributed around all 27-mainland districts of Malawi. Population of Malawi was 18.3 million from 2018 estimates, based on age categories we estimated that about 8.9 million were 16 years and younger. MSI diagnosis from our randomized sample was extrapolated to the population of Malawi, confidence limits was calculated using normal approximation.

Results

Of 3792 children aged 16 or less who were enumerated, 3648 (96.2%) were examined and 236 were confirmed to have MSI, giving a prevalence of MSI of 6.5% (CI 5.7–7.3). Extrapolated to the Malawian population this means as many as 576,000 (95% CI 505,000-647,000) children could be living with MSI in Malawi. Overall, 46% of MSIs were due to congenital causes, 34% were neurological in origin, 8.4% were due to trauma, 7.8% were acquired non-traumatic non-infective causes, and 3.4% were due to infection. We estimated a total number of 112,000 (80,000-145,000) children in need of Prostheses and Orthoses (P&O), 42,000 (22,000-61,000) in need of mobility aids (including 37,000 wheel chairs), 73,000 (47,000-99,000) in need of medication, 59,000 (35,000-82,000) in need of physical therapy, and 20,000 (6000-33,000) children in need of orthopaedic surgery. Low parents’ educational level was one factor associated with an increased risk of MSI.

Conclusion

This survey has uncovered a large burden of MSI among children aged 16 and under in Malawi. The burden of musculoskeletal impairment in Malawi is mostly unattended, revealing a need to scale up both P&O services, physical & occupational therapy, and surgical services in the country.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03113-8.

The use of the Washington Group on Disability Statistics questionnaires to identify hearing disability: a systematic review

PURPOSE

To investigate the use of instruments from the Washington Group on Disability Statistics (WG) to obtain data on hearing disability (HD).

RESEARCH STRATEGIES

We conducted searches in the PubMed, Scopus, Science Direct, Web of Science, Lilacs databases and the grey literature. The software "The State of the Art through Systematic Review" and "Mendeley" were used to assist in the bibliographic reference organization, selection, and storage.

SELECTION CRITERIA

we followed the guidelines proposed by the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" and we selected studies that met the following inclusion criteria: written in English or Portuguese, within the period of 2001 to 2017 and have used the WG hearing disability question.

DATA ANALYSIS

The variables analyzed into the studies were: WG module, country and year of data collection, sample size and composition, objective of the study, publication journal, HD estimate of prevalence and accuracy measures.

RESULTS

Sixty-five studies are included in the review, conducted with data from 30 countries. The WG Short Set of question was the most often used. Hearing disability prevalence ranged from 0.2 to 2.3% and only three studies estimated the accuracy of the instrument to identify HD.

CONCLUSION

The hearing disability question of WG has been used worldwide and mainly in developing countries. The short variation in the estimated prevalence measurements within studies seems favorable to the WG's goal of generate estimates that allow international comparison. However, the shortage of validity studies indicates the need for further investigations with this purpose.

Disability among Syrian refugees living in Sultanbeyli, Istanbul: Results from a population-based survey

OBJECTIVES

To estimate the prevalence of disability among Syrian refugees living in Sultanbeyli district, Istanbul and compare people with and without disabilities in terms of demographic and socio-economic characteristics.

METHODS

Using the municipality refugee database as the sampling frame, 80 clusters of 50 people (aged 2+ years) were selected using probability proportionate to size sampling of clusters and random selection of households within clusters. Disability assessment included: i) self-reported difficulties in functioning (using the Washington Group Short Set-Enhanced tool and Child Functioning Modules), ii) Rapid Assessment of Musculoskeletal Impairment and iii) screening for symptoms of common mental disorders for children aged 8-17.

RESULTS

The overall prevalence of disability was 24.7% (95% CI 22.1-27.4), when including people self-reporting a lot of difficulty/cannot do in at least functional domain (15%, 95% CI 13.1-17.2), moderate/severe MSI (8.7%, 95% CI 7.6-9.9), and/or symptomatic anxiety, depression and PTSD among children 8-17 (21.0%, 95% CI 18.2-23.9). Men with disabilities were significantly less likely to be in paid work compared to their peers without disabilities (aOR 0.3 95% CI 0.2-0.5). Overall 60% of households included at least one person with a disability. Households with at least one person with a disability had a significantly higher dependency ratio, lower proportion of working-age adults in paid work, and were more likely to be female headed and in receipt of social protection schemes (p<0.05).

CONCLUSION

Disability is common among Syrian refugees in Sultanbeyli. People with disabilities in this setting experience greater vulnerability to poverty and exclusion from work, highlighting an urgent need for inclusive services, programmes and policies that are developed and implemented in partnership with people with disabilities.

Prevalence of osteoarthritis in lower middle- and low-income countries: a systematic review and meta-analysis

Evidence from the Global Burden of Disease studies suggests that osteoarthritis (OA) is a significant cause of disability globally; however, it is less clear how much of this burden exists in low-income and lower middle-income countries. This study aims to determine the prevalence of OA in people living in low-income and lower middle-income countries. Four electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science) were systematically searched from inception to October 2018 for population-based studies. We included studies reporting the prevalence of OA among people aged 15 years and over in low-income and lower middle-income countries. The prevalence estimates were pooled across studies using random effects meta-analysis. Our study was registered with PROSPERO, number CRD42018112870.The search identified 7414 articles, of which 356 articles were selected for full text assessment. 34 studies were eligible and included in the systematic review and meta-analysis. The pooled prevalence of OA was 16·05% (95% confidence interval (CI) 12·55-19·89), with studies demonstrating a substantial degree of heterogeneity (I2 = 99·50%). The pooled prevalence of OA was 16.4% (CI 11·60-21.78%) in South Asia, 15.7% (CI 5·31-30·25%) in East Asia and Pacific, and 14.2% (CI 7·95-21·89%) in Sub Saharan Africa. The meta-regression analysis showed that publication year, study sample size, risk of bias score and country-income categories were significantly associated with the variations in the prevalence estimates. The prevalence of OA is high in low-income and lower middle-income countries, with almost one in six of the study participants reported to have OA. With the changing population demographics and the shift to the emergence of non-communicable diseases, targeted public health strategies are urgently needed to address this growing epidemic in the aging population.

Musculoskeletal impairment among Syrian refugees living in Sultanbeyli, Turkey: prevalence, cause, diagnosis and need for related services and assistive products

Background

Epidemiological data on musculoskeletal impairment (MSI) and related service and assistive product (AP) needs for displaced populations are lacking. This study aimed to estimate the prevalence, aetiology, and specific MSI diagnosis and the need for related services and APs among Syrian refugees living in Sultanbeyli, a district in Istanbul, Turkey.

Methods

A population-based survey used probability proportionate to size and compact segment sampling to select 80 clusters (‘street’) of 50 individuals (aged 2+), for total sample size of approximately 4000 participants. An updated version of the Rapid Assessment of MSI tool (RAM) was used to screen all participants using six questions. Any participant who screened positive underwent a standardised examination by a physiotherapist to assess the presence, aetiology, severity and specific diagnosis of MSI and an assessment of need for related services and APs.

Results

The all-age prevalence of MSI was 12.2% (95% CI 10.8–13.7) and this increased significantly with age to 43.8% in people 50 and older. Over half (51%) of MSI was classified as moderate, 30% as mild and 19% as severe. The war in Syria was identified as the direct cause for 8% of people with MSI. The majority (56%) of MSI diagnoses were acquired non-traumatic causes. There was high unmet need for rehabilitation services; for example, 83% of people with MSI could benefit from physiotherapy but were not receiving this service. Overall, 19% of people with MSI had an unmet need for at least one AP. Apart from availability of walking sticks/canes, coverage was low with less than half the people with MSI who needed APs and services had received them. The most common reasons for not seeking services and APs were ‘need not felt’, lack of service availability and of awareness of services, and financial barriers.

Conclusions

MSI is common among the Syrian refugee population living in Sultanbeyli District, particularly older adults, however less than half have been able to access relevant services and APs. These findings can inform the planning of health services for migrant populations, including the essential integration of rehabilitation and APs, and increase access to these vital services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13031-021-00362-9.

Prevalence, causes and impact of musculoskeletal impairment in Malawi: A national cluster randomized survey

BACKGROUND

There is a lack of accurate information on the prevalence and causes of musculoskeletal impairment (MSI) in low income countries. The WHO prevalence estimate does not help plan services for specific national income levels or countries. The aim of this study was to find the prevalence, impact, causes and factors associated with musculoskeletal impairment in Malawi. We wished to undertake a national cluster randomized survey of musculoskeletal impairment in Malawi, one of the UN Least Developed Countries (LDC), that involved a reliable sampling methodology with a case definition and diagnostic criteria that could clearly be related to the classification system used in the WHO International Classification of Functioning, Disability and Health (ICF).

METHODS

A sample size of 1,481 households was calculated using data from the latest national census and an expected prevalence based on similar surveys conducted in Rwanda and Cameroon. We randomly selected clusters across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the distribution of the population. In the field, randomization of households in a cluster was based on a ground bottle spin. All household members present were screened, and all MSI cases identified were examined in more detail by medical students under supervision, using a standardized interview and examination protocol. Data collection was carried out from 1st July to 30th August 2016. Extrapolation was done based on study size compared to the population of Malawi. MSI severity was classified using the parameters for the percentage of function outlined in the WHO International Classification of Functioning (ICF). A loss of function of 5-24% was mild, 25-49% was moderate and 50-90% was severe. The Malawian version of the EQ-5D-3L questionnaire was used, and EQ-5D index scores were calculated using population values from Zimbabwe, as a population value set for Malawi is not currently available. Chi-square test was used to test categorical variables. Odds ratio (OR) was calculated with a linear regression model adjusted for age, gender, location and education.

RESULTS

A total of 8,801 individuals were enumerated in 1,481 households. Of the 8,548 participants that were screened and examined (response rate of 97.1%), 810 cases of MSI were diagnosed of which 18% (108) had mild, 54% (329) had moderate and 28% (167) had severe MSI as classified by ICF. There was an overall prevalence of MSI of 9.5% (CI 8.9-10.1). The prevalence of MSI increased with age, and was similar in men (9.3%) and women (9.6%). People without formal education were more likely to have MSI [13.3% (CI 11.8-14.8)] compared to those with formal education levels [8.9% (CI 8.1-9.7), p<0.001] for primary school and [5.9% (4.6-7.2), p<0.001] for secondary school. Overall, 33.2% of MSIs were due to congenital causes, 25.6% were neurological in origin, 19.2% due to acquired non-traumatic non-infective causes, 16.8% due to trauma and 5.2% due to infection. Extrapolation of these findings indicated that there are approximately one million cases of MSI in Malawi that need further treatment. MSI had a profound impact on quality of life. Analysis of disaggregated quality of life measures using EQ-5D showed clear correlation with the ICF class. A large proportion of patients with moderate and severe MSI were confined to bed, unable to wash or undress or unable to perform usual daily activities.

CONCLUSION

This study has uncovered a high prevalence of MSI in Malawi and its profound impact on a large proportion of the population. These findings suggest that MSI places a considerable strain on social and financial structures in this low-income country. The Quality of Life of those with severe MSI is considerably affected. The huge burden of musculoskeletal impairment in Malawi is mostly unattended, revealing an urgent need to scale up surgical and rehabilitation services in the country.

Estimating assistive product need in Cameroon and India: results of population-based surveys and comparison of self-report and clinical impairment assessment approaches

OBJECTIVES

To estimate population need and coverage for distance glasses, hearing aids and wheelchairs in India and Cameroon, and to explore the relationship between assistive product (AP) need measured through self-report and clinical impairment assessment.

METHODS

Population-based surveys of approximately 4000 people each were conducted in Mahabubnagar district, India and Fundong district, Cameroon. Participants underwent standardised vision, hearing and musculoskeletal impairment assessment to assess need for distance glasses, hearing aids, wheelchairs. Participants with moderate or worse impairment and/or self-reported difficulties in functioning were also asked about their self-reported AP need.

RESULTS

6.5% (95% CI 5.4-7.9) in India and 1.9% (95% CI 1.5-2.4) in Cameroon of the population needed at least one of the three APs based on moderate or worse impairments. Total need was highest for distance glasses [3.7% (95% CI 2.8-4.7) India; 0.8% (95% CI 0.5-1.1), Cameroon] and lowest for wheelchairs (0.1% both settings; 95% CI 0.03-0.3 India, 95% CI 0.04-0.3 Cameroon). Coverage for each AP was below 40%, except for distance glasses in India, where it was 87% (95% CI 77.1-93.0). The agreement between self-report and clinical impairment assessment of AP need was poor. For instance, in India, 60% of people identified through clinical assessment as needing distance glasses did not self-report a need. Conversely, in India, 75% of people who self-reported needing distance glasses did not require one based on clinical impairment assessment.

CONCLUSIONS

There is high need and low coverage of three APs in two low-and middle-income settings. Methodological shortcomings highlight the need for improved survey methods compatible with the international classification of functioning, disability and health to estimate population-level need for AP and related services to inform advocacy and planning.

The global burden of musculoskeletal injury in low and lower-middle income countries: A systematic literature review

Background:

While the global burden of musculoskeletal injury is increasingly recognized, few epidemiologic studies have specifically recorded its incidence or prevalence, particularly in low- and middle-income countries. Understanding the burden of musculoskeletal injury relative to other health conditions is critical to effective allocation of resources to mitigate the disability that results from trauma. The current study aims to systematically review the existing primary literature on the incidence and prevalence of pelvic and appendicular fractures, a major component of musculoskeletal injury, in low- and lower-middle income countries (LMICs).

Methods:

This study conforms to the systematic review and traditional meta-analysis guidelines outlined in the PRISMA-P statement. Incidence rates were calculated as the occurrence of new fracture cases per 100,000 person-years, and prevalence as total fracture cases per population sample, reported as percentages.

Results:

The literature search yielded 3497 total citations. There were 21 full-text articles, representing 14 different countries, selected for data extraction. Included studies reported a wide range of incidence and prevalence rates, with an overall mean fracture incidence ranging from 779 (95% CI: 483.0–1188.7) to 1574 (95% CI: 1285.1–1915.1) per 100,000 person-years.

Conclusion:

Better understanding the unmet burden of musculoskeletal injury in LMICs is critical to effectively allocating resources and advocating for underserved populations. To address existing gaps and heterogeneity within the literature, future research should incorporate population-based sampling with broader geographic representation in LMICs to more accurately capture the burden of disease.

A case-control study of musculoskeletal impairment: association with socio-economic status, time use and quality of life in post-conflict Myanmar

Background

Musculoskeletal impairments (MSI) are a major global contributor to disability. Evidence suggests entrenched cyclical links between disability and poverty, although few data are available on the link of poverty with MSI specifically. More data are needed on the association of MSI with functioning, socio-economic status and quality of life, particularly in resource-poor settings where MSI is common.

Methods

We undertook a case-control study of the association between MSI and poverty, time use and quality of life in post-conflict Myanmar. Cases were recruited from two physical rehabilitation service-centres, prior to the receipt of any services. One age- (+/− 5 years of case’s age) and sex- matched control was recruited per case, from their home community. 108 cases and 104 controls were recruited between July – December 2015. Cases and controls underwent in-depth structured interviews and functional performance tests at multiple time points over a twelve-month period. The baseline characteristics of cases and controls are reported in this manuscript, using multivariate logistic regression analysis and various tests of association.

Results

89% of cases were male, 93% were lower limb amputees, and the vast majority had acquired MSI in adulthood. 69% were not working compared with 6% of controls (Odds Ratio 27.4, 95% Confidence Interval 10.6–70.7). Overall income, expenditure and assets were similar between cases and controls, with three-quarters of both living below the international LMIC poverty line. However, cases’ health expenditure was significantly higher than controls’ and associated with catastrophic health expenditure and an income gap for one fifth and two thirds of cases respectively. Quality of life scores were lower for cases than controls overall and in each sub-category of quality of life, and cases were far less likely to have participated in productive work the previous day than controls.

Conclusion

Adults with MSI in Myanmar who are not in receipt of rehabilitative services may be at increased risk of poverty and lower quality of life in relation to increased health needs and limited opportunities to participate in productive work. This study highlights the need for more comprehensive and appropriate support to persons with physical impairments in Myanmar.