Musculoskeletal Impairment of Traumatic Etiology in Rwanda: Prevalence, Causes, and Service Implications

Matheson, James; Atijosan, Oluwarantimi; Kuper, Hannah; Rischewski, Dorothea; Simms, Victoria; Lavy, Christopher

doi:10.1007/s00268-011-1293-2

Cited by 12 publications

(8 citation statements)

References 14 publications

(24 reference statements)

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“…Self-reporting is also likely to be affected by social and environmental factors and may be less reliable in terms of informing likely medical/rehabilitation needs than the clinical assessments of the KIM. The estimated prevalence from this study was lower than a survey in Rwanda, which showed a higher prevalence of MSI (26/1000 for ages 0-16) [ 21 ].…”

Section: Discussioncontrasting

confidence: 72%

Childhood musculoskeletal impairment in Malawi from traumatic and non-traumatic causes: a population- based assessment using the key informant method

Linder

Atijosan-Ayodele

Chokotho

et al. 2021

BMC Musculoskelet Disord

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Background Musculoskeletal impairment (MSI) in children is an under-recognised public health challenge. Although preventable, road injuries and other traumas continue to cause significant impairments to children worldwide. The study aimed to use the Key Informant Method (KIM) to assess prevalence and causes of MSI in children in two districts in Malawi, estimating the associated need for services provision, with a focus on traumatic aetiology. Methods The KIM was conducted in the districts of Thyolo (Southern Malawi) and Ntcheu (Central Malawi) in 2013. Five hundred key informants were trained to identify children who may have one of a range of MSI. The identified children were referred to a screening camp where they were examined by medical experts with standardised assessment protocols for diagnosing each form of impairment. Results 15,000 children were referred to screening camps. 7220 children were assessed (response rate 48%) for an impairment of whom 15.2% (1094) had an MSI. 13% of children developed MSI from trauma, while 54% had a neurological aetiology. For MSI of traumatic origin the most common body part affected was the elbow. Less than half of children with MSI (44.4%) were enrolled in school and none of these children attended schools with resources for disability. More than half of children with MSI (60%) had not received required services and 64% required further physical therapy. Conclusions The KIM method was used to identify a high prevalence of MSI among children in two districts of Malawi and estimates an unmet need for dedicated MSI services.

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Section: Discussioncontrasting

confidence: 72%

Childhood musculoskeletal impairment in Malawi from traumatic and non-traumatic causes: a population- based assessment using the key informant method

Linder

Atijosan-Ayodele

Chokotho

et al. 2021

BMC Musculoskelet Disord

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“…However, we preferred the definition of delay to remaining within the health care system [ 13 ]. By including it, our findings can inform rehabilitation service development in Rwanda, potentially benefiting 70,000 Rwandans living with injury-related musculoskeletal impairment, of whom almost half have not accessed adequate treatment [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

et al. 2020

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Background Whilst injuries are a major cause of disability and death worldwide, a large proportion of people in low- and middle-income countries lack timely access to injury care. Barriers to accessing care from the point of injury to return to function have not been delineated. Methods A two-day workshop was held in Kigali, Rwanda in May 2019 with representation from health providers, academia, and government. A four delays model (delays to seeking, reaching, receiving, and remaining in care) was applied to injury care. Participants identified barriers at each delay and graded, through consensus, their relative importance. Following an iterative voting process, the four highest priority barriers were identified. Based on workshop findings and a scoping review, a map was created to visually represent injury care access as a complex health-system problem. Results Initially, 42 barriers were identified by the 34 participants. 19 barriers across all four delays were assigned high priority; highest-priority barriers were “ Training and retention of specialist staff ”, “ Health education/awareness of injury severity ”, “ Geographical coverage of referral trauma centres ”, and “ Lack of protocol for bypass to referral centres ”. The literature review identified evidence relating to 14 of 19 high-priority barriers. Most barriers were mapped to more than one of the four delays, visually represented in a complex health-system map. Conclusion Overcoming barriers to ensure access to quality injury care requires a multifaceted approach which considers the whole patient journey from injury to rehabilitation. Our results can guide researchers and policymakers planning future interventions.

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“…Measured variables included age, sex, mechanism of injury, injury type, hospital vital signs, hospital admissions, surgical interventions, medical treatments, discharge date, and disposition. If more than one anatomical region was indicated as injured, each region was recorded 8. We did not collect post-discharge outcomes, such as subsequent emergency visits, hospitalizations, or post-discharge death,.…”

Section: Methodsmentioning

confidence: 99%

“…MSIs resulting from trauma are frequently undertreated, causing difficulty for patients to resume normal work and life activities 8. This is related both to cost and a shortage of technology and supplies 9.…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal Injuries and Outcomes Pre- and Post- Emergency Medicine Training Program

Mattson

Nteziryayo

Aluisio

et al. 2019

WestJEM

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Introduction: Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in lowand middle-income countries (LMIC). Rwanda recently launched its first emergency medicine training program (EMTP) at the University Teaching Hospital-Kigali (UTH-K), which may help to treat such injuries; yet no current epidemiological data is available on MSI in Rwanda. Methods: We conducted this pre-post study during two data collection periods at the UTH-K from November 2012 to July 2016. Data collection for MSI is limited and thus is specific to fractures. We included all patients with open, closed, or mixed fractures, hereafter referred to as MSI. Gathered information included demographics and outcomes including death, traumatic complications, and length of hospital stay, before and after the implementation of the EMTP. Results: We collected data from 3609 patients. Of those records, 691 patients were treated for fractures, and 674 of them had sufficient EMTP data measured for inclusion in the analysis of results (279 from pre-EMTP and 375 from post-EMTP). Patient demographics demonstrate that a majority of MSI cases are male (71.6% male vs 28.4% female) and young (64.3% below 35 years of age). Among mechanisms of injury, major causes included road traffic accidents (48.1%), falls (34.2%), and assault (6.0%). There was also an observed association between EMTP and trends of the three primary outcomes: a reduction of death in the emergency department (ED) from those with MSI by 89.9%, from 2.51% to 0.25% (p = 0.0077); a reduction in traumatic complications for MSI patients by 71.7%, from 3.58% to 1.01% (p = 0.0211); and a reduction in duration of stay in the ED among those with MSI by 52.7% or 2.81 days on average, from 5.33 to 2.52 days (p = 0.0437). Conclusion: This study reveals the current epidemiology of MSI morbidity and mortality for a major Rwandan teaching hospital and the potential impacts of EM training implementation among those with MSI. Residency training programs such as EMTP appear capable of reducing mortality, complications, and ED length of stay among those with MSI caused by fractures. Such findings underscore the efficacy and importance of investments in educating the next generation of health professionals to combat prevalent MSI within their communities. [

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Musculoskeletal Impairment of Traumatic Etiology in Rwanda: Prevalence, Causes, and Service Implications

Cited by 12 publications

References 14 publications

Childhood musculoskeletal impairment in Malawi from traumatic and non-traumatic causes: a population- based assessment using the key informant method

Childhood musculoskeletal impairment in Malawi from traumatic and non-traumatic causes: a population- based assessment using the key informant method

Identifying, Prioritizing and Visually Mapping Barriers to Injury Care in Rwanda: A Multi‐disciplinary Stakeholder Exercise

Musculoskeletal Injuries and Outcomes Pre- and Post- Emergency Medicine Training Program

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