Arthritis in East Africa: An Observational Study

BACKGROUND The burden of musculoskeletal (MSK) disease in East Africa remains largely unknown. Early evidence from Tanzania suggests that it may have a substantial adverse impact on health care outcomes with both social and economic consequences. There is limited data on prevalence and case mix of MSK disorders in East Africa. Data is urgently required to facilitate the planning, provision, and funding of the services needed to meet population requirements. The need is likely to be greatest among the poorer and most isolated members of the community. In this study, we describe the prevalence of MSK disease found in people with limited or no access to regular clinical care across five rural regions in East Africa. METHODS Over a four-week period in 2022, we undertook a series of clinics in five separate locations across impoverished areas of Zambia and Kenya. These ranged from city slums to isolated rural communities. For every consultation, we recorded demographic features (age and gender), diagnosis, and intervention. We then calculated the percentage of people who presented with MSK complaints, analysed their demographics and classified the case mix of MSK disorders along with interventions provided.  RESULTS We completed a total of 1089 community consultations in Zambia and Kenya. Of these, a total of 271 people (24.9%) reported primary MSK issues. This population was mainly female (66%) and had a median (range) age of 58 (13-90) years. The percentage of patients who consulted with MSK issues were significantly influenced by geographic location, rising from 8% in urban areas to 52% in rural areas. The most common diagnoses were osteoarthritis (49.8%), mechanical low back pain (27.7%), and soft tissue rheumatism (10.0%), with 3.0% having evidence of inflammatory joint disease (IJD). Therapeutic intervention was provided in 62.3% and procedures performed in 11.4%. CONCLUSIONS MSK disease is a common reason for seeking medical intervention in East Africa, especially among older females who have accumulated a significant mechanical burden from physical exertion and childbearing. Therapeutic intervention was frequently required, although smaller numbers had evidence of IJD. Increased awareness of the burden of MSK disease on poorer populations is necessary. Training programs in rheumatology with support from local hospitals and medical personnel are urgently required to develop care pathways with adequate funding. Describing the prevalence of MSK disease in rural and underserved regions of East Africa is just the first step in ensuring regular, direct access to healthcare and appropriate intervention.