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

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

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

The spectrum and burden of in-patient paediatric musculoskeletal diseases in Northern Tanzania

Background: Musculoskeletal diseases (MSD) are a major contributor to the global burden of disease and disability, and disproportionally affect low- and middle-income countries; however, there is a dearth of epidemiological data. Affected children often face increased morbidity, social isolation and economic hardship. Aim: To assess the spectrum and burden of paediatric MSD in children aged 5–18 years admitted to a major referral hospital in Tanzania. Methods: This was a retrospective cohort study of children aged 5–18 years admitted to Kilimanjaro Christian Medical Centre (KCMC) whose initial diagnosis was recognised as a musculoskeletal condition by the International Classification of Diseases-10 between 1 January and 31 December 2017. Results: During 2017, 163 cases of confirmed paediatric MSD were admitted to KCMC, representing 21.2% of all admissions of children aged 5–18 years (n = 769). Bone disease was the most common diagnosis. They comprised 106 (65.0%) traumatic fractures, 31 (19.0%) osteo-articular infections, 9 (5.5%) malunions and 3 (1.8%) pathological fractures. Congenital defects and rheumatic disease were relatively uncommon, accounting for only 6 (3.7%) and 4 (2.5%) MSD admissions, respectively. Conclusion: The majority of cases of MSD were related to fractures, followed by osteo-articular infections, while recognised cases of rheumatic disease were rare. The study, although small, identified the sizeable burden and spectrum of paediatric MSD admitted to a hospital in Tanzania over a 12-month period and highlights the need for larger studies to inform the optimal allocation of health resources

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

Abstracts of Tanzania Health Summit 2020

This book contains the abstracts of the papers/posters presented at the Tanzania Health Summit 2020 (THS-2020) Organized by the Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender, and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS) held on 25–26 November 2020. The Tanzania Health Summit is the annual largest healthcare platform in Tanzania that attracts more than 1000 participants, national and international experts, from policymakers, health researchers, public health professionals, health insurers, medical doctors, nurses, pharmacists, private health investors, supply chain experts, and the civil society. During the three-day summit, stakeholders and decision-makers from every field in healthcare work together to find solutions to the country’s and regional health challenges and set the agenda for a healthier future. Summit Title: Tanzania Health SummitSummit Acronym: THS-2020Summit Date: 25–26 November 2020Summit Location: St. Gasper Hotel and Conference Centre in Dodoma, TanzaniaSummit Organizers: Ministry of Health Community Development, Gender, Elderly and Children (MoHCDGEC); President Office Regional Administration and Local Government (PORALG); Ministry of Health, Social Welfare, Elderly, Gender and Children Zanzibar; Association of Private Health Facilities in Tanzania (APHFTA); National Muslim Council of Tanzania (BAKWATA); Christian Social Services Commission (CSSC); & Tindwa Medical and Health Services (TMHS)