Elliott Iain S, Groen Reinou S, Kamara Thaim B, Ertl Allison, Cassidy Laura D, Kushner Adam L, Gosselin Richard A
University of Florida, Gainesville, FL, USA,
Clin Orthop Relat Res. 2015 Jan;473(1):380-9. doi: 10.1007/s11999-014-4017-8. Epub 2014 Oct 25.
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.
We attempted to quantify the burden of potentially treatable musculoskeletal conditions in patients in Sierra Leone.
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.
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.
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.
肌肉骨骼疾病是全球疾病负担中导致残疾的主要原因，但发展中国家关于这一负担程度的数据匮乏。海外外科医生手术需求评估（SOSAS）调查旨在测量低收入和中等收入国家患者中包括肌肉骨骼疾病在内的可手术治疗疾病的发病率和患病率，并于2012年在西非国家塞拉利昂进行。
我们试图量化塞拉利昂患者中潜在可治疗的肌肉骨骼疾病负担。
在塞拉利昂使用SOSAS进行了一项基于两阶段整群抽样的横断面调查。从每个随机选择的家庭中选取两人进行从头到脚的口头检查。对塞拉利昂SOSAS调查中与肌肉骨骼相关的问题进行分析，以确定研究人群中肌肉骨骼问题的患病率。患病率报告为目前有肌肉骨骼问题的受访者数量以及过去一年中有肌肉骨骼问题的受访者数量。受访者表示“不需要”护理、“接受了护理”或面临阻碍他们接受护理的障碍。
目标是1875户家庭，1843户接受了调查，共产生3645名个体受访者。在个体受访者中，462人（n = 3645；占总数的12.6%；95%置信区间，12% - 13%）在过去一年中有创伤性肌肉骨骼问题，236人（n = 3645；占总数的6%；95%置信区间，5% - 7%）有非创伤性病因的肌肉骨骼问题。在有创伤性或非创伤性肌肉骨骼问题的受访者中，359人（n = 562；占总数的63.9%；95%置信区间，59.5 - 68.3%）需要护理但无法获得，报告的主要障碍是经济问题。
全球卫生领域的资源分配决策是基于低收入和中等收入国家的疾病负担数据做出 的。这里提供的塞拉利昂数据可能为低收入和中等收入国家，特别是撒哈拉以南非洲地区的肌肉骨骼疾病负担范围提供一些可推广的见解，并提供具体证据表明肌肉骨骼健康应纳入全球卫生讨论。然而，该地区不同国家可能存在重要差异，鉴于这些地区疾病负担沉重且管理资源有限，进一步研究以阐明这些差异似乎至关重要。
