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. Limited data on prevalence and case mix of MSK disorders is presently available for East Africa. Data is urgently required to facilitate the planning, provision and funding of the services needed to meet population requirements here. The need is likely to be greatest among the poorer and most isolated members of the community. We describe the case mix of MSK disorders we encountered among people across five regions who had no previous access to clinical care 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. We recorded demographic features for every consultation, along with our diagnosis and intervention. We calculated the percentage of people consulting with MSK issues and describe 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 the most rural sites. The commonest MSK diagnoses we made at first consultation 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 were performed in 11.4%. CONCLUSIONS MSK disease appears to be 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 are urgently required to ensure that care pathways are established with adequate funding and regular rapid access to ensure the provision of appropriate support and intervention.