The Burden and Spectrum of Paediatric Musculoskeletal Disease in North Tanzania

Pediatric Musculoskeletal disease (pMSKD) encompasses 150 conditions that can lead to disability, social isolation, and economic hardship. Whilst a plethora of data have been produced about the burden of disease in high-income countries, few studies have focused on low-income countries(LIC). Up to 60% of the need for musculoskeletal health care is not being met in LICs. This study aimed to determine the prevalence of pMSKD in children aged 5-18 in a rural Tanzanian community and assess the spectrum and burden of pMSKD in children aged 5-18 admitted to a regional hospital in northern Tanzania. A 10-week door-to-door community cross-sectional study screened for pMSKD using the Paediatric Gait, Arms, Legs, Spine tool. An 8-week hospital-based prospective study screened inpatients on pediatric wards at Kilimanjaro Christian Medical Centre(KCMC). Additionally, a retrospective medical records study of children with pMSKD admitted to KCMC in the year 2017 was conducted.  362 children were screened in the community. There were 17 events equating to a prevalence of 4.7% (95%CI=2.5-6.9%). All events related to fractures. The hospital-based prospective identified no pMSKD. In 2017, 199 cases of pMSKD were admitted- 26% of all pediatric admissions.  Review of 163 patients’ notes revealed: 106(65%) fractures; 31(19%) osteoarticular infections; 9(5.5%) mal-unions; 6(5.7%) congenital defects; 4(2.5%) rheumatic diseases; 3(1.8%) pathological fractures; 4(2.5%) others.  This is the first study of its kind in Tanzania and highlights the broad spectrum and burden pMSKD in Northern Tanzania and the need for larger epidemiological studies to quantify the problem and guide resource allocation effectively.