Activating Equitable Engagement: from research to policy (and back again): a report on dissemination activities for 'NIHR Global Health Research Group on estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania'

This report details the dissemination outputs, stakeholder engagement events (herein referred to as ‘Engagement Activities’) and their underlying principles conducted by the NIHR Funded Project: NIHR Global Health Research Group on estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania. Engagement activities were designed acknowledging that inequalities and injustices are writ large in the field of Global Health. Just as social, economic, political, racial and gendered inequalities impact individuals’ health experiences, we also recognise that these same inequalities can be reproduced and reinforced by institutions, organisations and (most pertinent to us) research groups purporting to tackle health issues (Büyüm et al. 2020). Engagement activities were therefore designed from a commitment to make Global Health more equitable, with the following interrelated principles underpinning all engagement efforts: i) the ethics of dissemination ii) valuing knowledges iii) decentering western voices iv) nurturing equitable relationships. As such, we paid close attention not only to what we did but how we did it, striving towards a goal of activating equitable engagement

Evidencing the clinical and economic burden of musculoskeletal disorders in Tanzania: Paving the way for urgent rheumatology service development

Since 1990, there has been a dramatic rise in noncommunicable diseases (NCDs) within low-and middleincome countries (LMICs); the burden of NCDs in LMICs rose from accounting for 39% of disability-adjusted life years in 1990 to 66% in 2019 [1]. In response to this growing burden, global, regional and national health institutions have become increasingly active in orchestrating a response to NCDs. The global response to NCDs has prioritized cardiovascular disease, cancer, chronic respiratory disease and diabetes, with the World Health Organization Regional Office in Africa adding region-specific NCD burdens, such as sickle cell disease, to broaden priorities [2]. Amidst this galvanization of efforts to tackle NCDs, musculoskeletal (MSK) conditions have been relatively overlooked and neglected, resulting in an urgent need for service development to respond to MSK conditions in LMICs [1]

Estimating the prevalence and predictors of musculoskeletal disorders in Tanzania: a cross-sectional pilot study

Introduction Musculoskeletal (MSK) disorders account for approximately 20% of all years lived with disability worldwide however studies of MSK disorders in Africa are scarce. This pilot study aimed to estimate the community-based prevalence of MSK disorders, identify predictors, and assess the associated disability in a Tanzanian population. Methods A cross-sectional study was conducted in one village in the Kilimanjaro region from March to June 2019. The Gait, Arms, Legs, Spine (GALS) or paediatric GALS (pGALS) examinations were used during household and school visits. Individuals positive in GALS/pGALS screening were assessed by the regional examination of the musculoskeletal system (REMS) and Modified Health Assessment Questionnaire (MHAQ). Results Among the 1,172 individuals enrolled in households, 95 (8.1%, 95% CI: 6.6 - 9.8) showed signs of MSK disorders using the GALS/pGALS examination and 37 (3.2%, 95% CI: 2.2 - 4.3) using the REMS. Among 682 schools enrolled children, seven showed signs of MSK disorders using the GALS/pGALS examination (1.0%, 95% CI: 0.4 - 2.1) and three using the REMS (0.4%, 95% CI: 0.0 - 1.3). In the household-enrolled adult population, female gender and increasing age were associated with GALS and REMS-positive findings. Among GALS-positive adults, increasing age was associated with REMS-positive status and increasing MHAQ score. Conclusion This Tanzanian study demonstrates a prevalence of MSK disorders and identifies predictors of MSK disorders comparable to those seen globally. These findings can inform the development of rheumatology services and interventions in Tanzania and the design of future investigations of the determinants of MSK disorders, and their impacts on health, livelihoods, and well-being

Trends of frequency, mortality and risk factors among patients admitted with stroke from 2017 to 2019 to the medical ward at Kilimanjaro Christian Medical Centre hospital: a retrospective observational study

Objective The burden of stroke has increased in recent years worldwide, particularly in low-income and middle-income countries. In this study we aim to determine the number of stroke admissions, and associated comorbidities, at a referral hospital in Northern Tanzania. Design This was a retrospective observational study. Setting The study was conducted at a tertiary referral hospital, Kilimanjaro Christian Medical Centre (KCMC), in the orthern zone of Tanzania. Participants The study included adults aged 18 years and above, who were admitted to the medical wards from 2017 to 2019. Outcome The primary outcome was the proportion of patients who had a stroke admitted in the medical ward at KCMC and the secondary outcome was clinical outcome such as mortality. Methods We conducted a retrospective audit of medical records from 2017 to 2019 for adult patients admitted to the medical ward at KCMC. Data extracted included demographic characteristics, previous history of stroke and outcome of the admission. Factors associated with stroke were investigated using logistic regression. Results Among 7976 patients admitted between 2017 and 2019, 972 (12.2%) were patients who had a stroke. Trends show an increase in patients admitted with stroke over the 3 years with 222, 292 and 458 in 2017, 2018 and 2019, respectively. Of the patients who had a stroke, 568 (58.4%) had hypertension while 167 (17.2%) had diabetes mellitus. The proportion of admitted stroke patients aged 18–45 years, increased from 2017 (n=28, 3.4%) to 2019 (n=40, 4.3%). The in-hospital mortality related to stroke was 229 (23.6%) among 972 patients who had a stroke and female patients had 50% higher odds of death as compared with male patients (OR:1.5; CI 1.30 to 1.80). Conclusion The burden of stroke on individuals and health services is increasing over time, which reflects a lack of awareness on the cause of stroke and effective preventive measures. Prioritising interventions directed towards the reduction of non-communicable diseases and associated complications, such as stroke, is urgently needed

Evidencing the clinical and economic burden of musculoskeletal disorders in Tanzania: Paving the way for urgent rheumatology service development

No abstract availabl

Estimating the Quality-of-Life Impact of Musculoskeletal Disorders in Tanzania: Results from a Cross-Sectional Community-Based Survey

Background Sub Saharan Africa is currently facing a preventable crisis caused by rapid rise in people developing non communicable diseases (NCDs). This brings not only clinical but economic, societal and quality-of-life impacts on people’s day-to-day life. Yet, plans to reduce NCDs often overlook the impact of Musculoskeletal (MSK) disorders. Arthritis is one of the commonest MSK disorders, is a leading cause of disability, causing significant absence from work, and incurs substantial medical costs globally. Measuring the quality-of-life impact of these diseases is urgently needed to inform policy. Our study has directly measured and valued the quality-of-life impact of MSK in Tanzania. Methods A cross-sectional community-based survey was undertaken between January–Sept 2021 in the Kilimanjaro region of Tanzania. Clinical screening tools, including the Gait Arms Legs Spine (GALS) and Regional Examination of the Musculoskeletal system (REMS) tools were used for identifying MSK disorders. Two-stage cluster sampling was used to administer health-related quality of life (HRQoL) questionnaires using the Swahili version of the preference-based tool EuroQol EQ-5D-5L and CHU9D, for a sample of all residents (aged over 5 years old) in selected households (N = over 2,500). To establish a reference population account of these measures, a longer questionnaire went to those who had arthritis and who were matched on age and gender (~1:3), n=153 REMS+ and n=441 controls. Thus, responses from participants screening positive with MSK were directly compared to a matched control group in a bid to establish the magnitude of impact. Ethiopia, Uganda, Zimbabwe and UK tariffs were used for conversion to utilities (Tanzania has no tariff). Regression based analysis were undertaken to estimate differences in utility scores between those presenting as REMS+/-. Other explanatory variables included age, occupation, marital status, gender, religion, education. Results The survey revealed a statistically significant reduction in quality-of-life, on average 20%, for those who are REMS+ (slightly less for GALS+). Population norms (~0.90 utility) are in line with HRQoL values from other countries for the average age of our dataset at 30 – 40 years old but those presenting with a positive diagnosis had a significant reduction in health-related utility of ~0.12 to 0.22 depending on what country tariff was used. The attribute ‘pain/discomfort’ was a major contributor to this reduction in HRQoL. Conclusion A good quality of life refers to a person’s ability to look after themselves, get around their community, participate in their usual activities, and avoid pain and distress. Results show that those with MSK for all quality-of-life dimensions had lower utility scores than controls. This is the first study to quantify the significant burden of MSK on health in Kilimanjaro, and likely wider Tanzania. With such a baseline figure, we know that any future interventions aimed at alleviating symptoms including pain or, indeed, any preventive interventions will likely improve this quality-of-life profile. Our findings provide initial evidence to justify the need to plan effective and cost-effective interventions for the prevention and management of MSK in Tanzania, as well as ensure adequate service provision including training of rheumatology sub specialists

Estimating the Economic Impact of Musculoskeletal Disorders in Tanzania: Results from a Community-Based Survey

Background Musculoskeletal (MSK) disorders are a leading cause of disability globally, causing significant clinical and quality of life impacts, absence from work, reduced productivity and substantial personal medical costs. The aim of this study was to identify, measure and value the economic burden of MSK disorders in the Kilimanjaro region, Tanzania. Methods A community-based cross-sectional survey was undertaken between January and September 2021 using two-stage cluster sampling to select a representative sample of all Hai district residents. Clinical screening tools were used to identify and measure MSK disorders through a tiered approach. An economic questionnaire measuring healthcare costs, out-of-pocket costs, absenteeism, presenteeism and work productivity loss was administered to those with likely MSK disorders, and selected controls (individuals without MSK disorders, matched on age and gender). Resource use was valued using country-specific costs. Two-part model regressions were fitted. A descriptive analysis of catastrophic expenditure was also conducted. Results Annual average productivity and healthcare costs were, respectively, 3·5 and 2·5 times higher for those with likely MSK disorders than controls (productivity costs: Int$509 vs. Int$, 151 p-value<0.01; healthcare costs: Int$437 vs. Int$ 177, p-value<0.05). The difference in terms of out-of-pocket expenses was economically substantial in magnitude (Int$483 vs. 343), although not statistically significant. Conclusion The evidence will be used to inform policies addressing MSK disorders, by promoting the design of interventions, service provision, health promotion and awareness activities at local, regional and national level

Musculoskeletal (MSK) disorders with arthritis screening in Tanzania: new insights into the growing clinical, economic and societal burden of non-communicable disease

» Musculoskeletal (MSK) disorders represent a significant global disability burden which the World Health Organisation expect will increase in coming years » Tanzania’s Strategic Plan for tackling non-communicable diseases (NCDs) does not currently include MSK disorders, yet they pose a significant health and economic burden to Tanzanian society » Arthritis is common, but very few people receive a formal diagnosis and even fewer are treated; this lack of prevention and treatment in Tanzania can lead to avoidable lifelong deformity, disability and detrimental economic impacts for those affected. » The Tanzanian Government should consider MSK disorders as part of the growing NCD burden in Tanzania. We recommend the following: - l Increasing awareness of MSK health within communities l Improving awareness of MSK disorders and skills training at primary healthcare facilities l Investing in a clinical capacity for diagnosing and managing MSK disorders l Developing guidelines for referral pathways and treatment for many forms of arthritis in Tanzani

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

Dataset contains individual participant records for the data gathered in the study as described. Variables included are the outcome measures analyses and all additional variables considered in analyses and summarised in the paper

Musculoskeletal (MSK) disorders with arthritis screening in Tanzania: New insights into the growing clinical, economic and societal burden of non-communicable disease

» Musculoskeletal (MSK) disorders represent a significant global disability burden which the World Health Organisation expect will increase in coming years » Tanzania’s Strategic Plan for tackling non-communicable diseases (NCDs) does not currently include MSK disorders, yet they pose a significant health and economic burden to Tanzanian society » Arthritis is common, but very few people receive a formal diagnosis and even fewer are treated; this lack of prevention and treatment in Tanzania can lead to avoidable lifelong deformity, disability and detrimental economic impacts for those affected. » The Tanzanian Government should consider MSK disorders as part of the growing NCD burden in Tanzania. We recommend the following: - l Increasing awareness of MSK health within communities l Improving awareness of MSK disorders and skills training at primary healthcare facilities l Investing in a clinical capacity for diagnosing and managing MSK disorders l Developing guidelines for referral pathways and treatment for many forms of arthritis in Tanzani