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Rheumatology care of migrants from sub-Saharan Africa: a literature review and qualitative pilot study of patients’ perspectives

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Abstract

Introduction

Rheumatologists practising in the UK National Health Service (NHS) are likely to treat migrant patients from sub-Saharan Africa. This study aimed to conduct a literature review about rheumatoid arthritis prevalence in Africa and understand the experiences of patients with rheumatological conditions, about their past healthcare in sub-Saharan Africa and their transition of care to the United Kingdom (UK).

Methods

A systematic search and a pilot study using semi-structured interviews to gain the views of migrants from sub-Saharan Africa with rheumatological conditions was conducted.

Results

Thirty-two studies reported on the prevalence of rheumatoid arthritis in Africa. Studies were small and out-of-date, and there was significant heterogeneity in prevalence rates. For the qualitative study, seven participants were recruited. Four themes were highlighted: (i) the physical and emotional impact of rheumatological conditions on participants; (ii) limited rheumatology care in sub-Saharan Africa with high costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians; (iii) barriers to rheumatology care in the UK such as migrants’ poor understanding of rheumatological conditions and NHS entitlements; (iv) and ways to improve access to care such as patient, public and general practitioner education.

Conclusion

This study has highlighted the paucity of rheumatoid arthritis prevalence data in Africa and described, for the first time, the migrant’s perspective of rheumatology care in sub-Saharan Africa and the transition of care to the UK. This description begins to allow healthcare providers in the UK to tailor management for this migrant population.

Key Points

• Rheumatological conditions are common in Africa, but there is a paucity of epidemiological data regarding the prevalence of specific conditions such as rheumatoid arthritis.

• UK clinicians need to be mindful when treating migrants that access to rheumatologists and specialist investigations and treatment is limited in sub-Saharan Africa and that there is often limited public and patient understanding of rheumatological conditions.

• Migrants continue to lack understanding of their NHS entitlements and fear data sharing with immigration services which can be a barrier to seeking care.

• This study has exposed the lack of understanding about rheumatological conditions by the public and some general practitioners which needs to be addressed with effective education and awareness campaigns.

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Acknowledgements

We thank the participants for their kindness to give their time to contribute to this study.

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Authors and Affiliations

  1. Rheumatology Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

    Zoe Rutter-Locher

  2. The Centre for Rheumatic Diseases, King’s College London, Weston Education Centre, Cutcombe Road, London, UK

    James Galloway & Heidi Lempp

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  1. Zoe Rutter-Locher
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  3. Heidi Lempp
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Zoe Rutter-Locher. The first draft of the manuscript was written by Zoe Rutter-Locher and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Zoe Rutter-Locher.

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Rutter-Locher, Z., Galloway, J. & Lempp, H. Rheumatology care of migrants from sub-Saharan Africa: a literature review and qualitative pilot study of patients’ perspectives. Clin Rheumatol 40, 3429–3438 (2021). https://doi.org/10.1007/s10067-020-05099-z

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