title: A national survey of musculoskeletal impairment in Rwanda: prevalence, causes and service implications.
abstract: BACKGROUND
  Accurate information on the prevalence and causes of musculoskeletal impairment (MSI) is lacking in low income countries. We present a new survey methodology that is based on sound epidemiological principles and is linked to the World Health Organisation's International Classification of Functioning.
  
  
  METHODS
  Clusters were selected with probability proportionate to size. Households were selected within clusters through compact segment sampling. 105 clusters of 80 people (all ages) were included. All participants were screened for MSI by a physiotherapist and medical assistant. Possible cases plus a random sample of 10% of non-MSI cases were examined further to ascertain diagnosis, aetiology, quality of life, and treatment needs.
  
  
  RESULTS
  6757 of 8368 enumerated individuals (80.8%) were screened. There were 352 cases, giving an overall prevalence for MSI of 5.2%. (95% CI 4.5-5.9) The prevalence of MSI increased with age and was similar in men and women. Extrapolating these estimates, there are approximately 488,000 MSI diagnoses in Rwanda. Only 8.2% of MSI cases were severe, while the majority were moderate (43.7%) or mild (46.3%). Diagnostic categories comprised 11.5% congenital, 31.3% trauma, 3.8% infection, 9.0% neurological, and 44.4% non-traumatic non infective acquired. The most common individual diagnoses were joint disease (13.3%), angular limb deformity (9.7%) and fracture mal- and non-union (7.2%). 96% of all cases required further treatment.
  
  
  CONCLUSIONS
  This survey demonstrates a large burden of MSI in Rwanda, which is mostly untreated. The survey methodology will be useful in other low income countries, to assist with planning services and monitoring trends.
authors.affiliation: Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Oluwarantimi
authors.initials: O
authors.lastname: Atijosan
authors.forename: Dorothea
authors.initials: D
authors.lastname: Rischewski
authors.forename: Victoria
authors.initials: V
authors.lastname: Simms
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
authors.forename: Bonaventure
authors.initials: B
authors.lastname: Linganwa
authors.forename: Assuman
authors.initials: A
authors.lastname: Nuhi
authors.forename: Allen
authors.initials: A
authors.lastname: Foster
authors.forename: Chris
authors.initials: C
authors.lastname: Lavy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D006301:Health Services Needs and Demand / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008403:Mass Screening / Q000295:instrumentation* / Q000458:organization & administration; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D015995:Prevalence; D012432:Rwanda / Q000453:epidemiology