Estimating prevalence and predictors of musculoskeletal disorders in Tanzania – A pilot study

Background: Musculoskeletal (MSK) disorders account for 20% of all years lived with disability worldwide. There have been few prevalence studies of MSK disorders in Africa, and none published from Tanzania. Screening for MSK disorders is not routinely conducted in healthcare facilities and there are no registered rheumatology consultants in northern Tanzania. This pilot study aimed to provide an initial estimate of the community-based prevalence, and predictors, of MSK disorders and to assess the functional status and disability associated with MSK disorders. Methods: A cross-sectional pilot study was conducted in a single village in the Hai District Kilimanjaro region from March to June 2019, involving the administration of Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) physical examinations during household and school visits. Individuals positive by GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and the Modified Health Assessment Questionnaire (MHAQ) tools. Multivariable logistic regression analyses were used to understand the influence of demographic variables (age and sex), tribe and religion on GALS/pGALS, REMS and MHAQ outcomes. Results: A total of 1854 participants were enrolled. Of the 1172 individuals enrolled at the household level, 95 showed signs of MSK disorders during the GALS/pGALS examination (8.1%, 95% CI: 6.6 – 9.8) and 37 during the REMS examination (3.2%, 95% CI: 2.2 – 4.3), respectively. Among all 682 participants enrolled in schools, seven showed signs of MSK disorders during the GALS/pGALS examination (1.0%, 95% CI: 0.4 – 2.1) and three during the REMS examination (0.4%, 95% CI: 0.0 – 1.3), respectively. In the household enrolled population female gender and increasing age were significantly associated with GALS and REMS positive findings. Among the GALS positive individuals, increasing age was significantly associated with REMS positive status and increasing MHAQ scores, indicating worse function and greater disability. Conclusions: Our pilot study confirms the prevalence of MSK disorders in this study population and predictors of MSK disorders that are comparable to those seen elsewhere in the world. These pilot data can inform the design of future investigations of the determinants of MSK disorders and their impacts on health, livelihood, and well-being in Tanzania.