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The Burden of Musculoskeletal Disease in Sierra Leone

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Musculoskeletal disease is a major cause of disability in the global burden of disease, yet data regarding the magnitude of this burden in developing countries are lacking. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey was designed to measure the incidence and prevalence of surgically treatable conditions, including musculoskeletal conditions, in patients in low- and middle-income countries, and was administered in the West African nation of Sierra Leone in 2012.

Purpose

We attempted to quantify the burden of potentially treatable musculoskeletal conditions in patients in Sierra Leone.

Methods

A cross-sectional two-stage cluster-based survey was performed in Sierra Leone using the SOSAS. Two individuals from each randomly selected household underwent a verbal head to toe examination. The musculoskeletal-related questions from the SOSAS survey in Sierra Leone were analyzed to determine the prevalence of musculoskeletal problems in the study population. Prevalence is reported as the number of respondents with a musculoskeletal problem now and number of respondents with a musculoskeletal problem during the past year. Respondents had “no need” for care, they “received care”, or they faced a barrier that prevented them from receiving care.

Results

One thousand eight hundred seventy-five households were targeted, with 1843 undergoing the survey, which yielded 3645 individual respondents. Of the individual respondents, 462 (n = 3645; 12.6% of total; 95% CI, 12%–13%) had a traumatic musculoskeletal problem during the past year, and 236 (n = 3645; 6% of total; 95% CI, 5%–7%) respondents had a musculoskeletal problem of nontraumatic etiology. Of respondents with either a traumatic or nontraumatic musculoskeletal problem, 359 (n = 562; 63.9% of total; 95% CI, 59.5–68.3%) needed care but were unable to receive it with the major barrier reported as financial.

Conclusion

Resource allocation decisions in global health are made based on burden of disease data in low- and middle-income countries. The data provided here for Sierra Leone may offer some generalizable insight into the scope of the burden of musculoskeletal disease for low- and middle-income countries, especially in Sub-Saharan Africa, and provide concrete evidence that musculoskeletal health should be included in the global health discussion. However, there may be important differences across countries in this region, and further study to elucidate these differences seems critical given the large burden of disease and the limited resources available in these regions to manage it.

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Acknowledgments

We thank the Sierra Leone Ministry of Health and Sanitation, Sierra Leone College of Medicine and Allied Health Sciences, and Connaught Hospital, who assisted with local transport and administrative issues. We thank personnel from Statistics Sierra Leone for sharing their expertise, the enumerators and field supervisors for their fine work ethic and enthusiasm, and Lucie Blok of the Royal Tropical Institute for a final look at the survey-questionnaire.

Author information

Authors and Affiliations

  1. University of Florida, Gainesville, FL, USA

    Iain S. Elliott MD

  2. Institute for Global Orthopaedics and Traumatology, San Francisco General Hospital, University of California at San Francisco, 2550 23rd Street, Building 9, 2nd Floor, San Francisco, CA, 94110, USA

    Iain S. Elliott MD & Richard A. Gosselin MD, MPH, MSc

  3. Surgeons OverSeas (SOS), New York, NY, USA

    Reinou S. Groen MD, MIH & Adam L. Kushner MD, MPH

  4. Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, USA

    Reinou S. Groen MD, MIH

  5. Department of Surgery, Connaught Hospital, Freetown, Sierra Leone

    Thaim B. Kamara MD (5)

  6. Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA

    Allison Ertl MS & Laura D. Cassidy PhD, MS

  7. Department of Surgery, Columbia University, New York, NY, USA

    Adam L. Kushner MD, MPH

  8. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Adam L. Kushner MD, MPH

  9. School of Public Health, University of California, Berkeley, Berkeley, CA, USA

    Richard A. Gosselin MD, MPH, MSc

Authors
  1. Iain S. Elliott MD
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  2. Reinou S. Groen MD, MIH
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  3. Thaim B. Kamara MD (5)
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  4. Allison Ertl MS
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  5. Laura D. Cassidy PhD, MS
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  6. Adam L. Kushner MD, MPH
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  7. Richard A. Gosselin MD, MPH, MSc
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Corresponding author

Correspondence to Iain S. Elliott MD.

Additional information

Funding for logistics was provided by Surgeons OverSeas with a donation from the Thompson Family Foundation.

Ethical approval was obtained from the Ethics and Scientific Review Committee of Sierra Leone and the Research Ethics Committee of the Royal Tropical Institute in Amsterdam.

This study was performed in Sierra Leone in association with Connaught Hospital, Freetown, Sierra Leone.

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Elliott, I.S., Groen, R.S., Kamara, T.B. et al. The Burden of Musculoskeletal Disease in Sierra Leone. Clin Orthop Relat Res 473, 380–389 (2015). https://doi.org/10.1007/s11999-014-4017-8

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