title: Musculoskeletal impairment of traumatic etiology in Rwanda: prevalence, causes, and service implications.
abstract: BACKGROUND
  The present study examines demographics, causes, and diagnoses of traumatic musculoskeletal impairment (MSI) in Rwanda and identifies treatment barriers in order to describe the injury burden and inform service planning.
  
  
  METHODS
  In all, 105 clusters were chosen by multistage stratified cluster random sampling with probability proportional to size. Eighty people from each cluster were identified for screening by a modified compact segment sampling method. A screening questionnaire was applied and suspected cases and 10% of suspected non-cases underwent standardized examination. A structured interview obtained a detailed history, and an algorithmic classification system allocated diagnosis.
  
  
  RESULTS
  Of 8,368 enumerated subjects, 6,756 were screened. Of these, 111 were traumatic MSI cases, with 121 diagnoses, giving a prevalence of 1.64% (95% CI 1.35-1.98). Extrapolation to the Rwandan population estimates 68,716 traumatic MSI cases, mostly in people of working age. Most affected were hand/finger joints (23%), elbow (16%), shoulder region (9%), and knee joint (9%). Some 11% of impairments were severe, 47.7% were moderate, and 41.3% were mild. Most common diagnoses were fracture malunion (21.5%) and post-traumatic joint stiffness (20.7%). The number of treatments needed was 199, including physiotherapy (87.2%) and surgery (53.7%), but 43% (95% CI 34-53) received less treatment than required. Of those who were undertreated, 63% cited cost.
  
  
  CONCLUSIONS
  In Rwanda the prevalence of traumatic MSI of 1.64%, mostly in people of working age, makes usual activities difficult or impossible and is therefore a significant national burden. The results of the present study identify the need for immediate surgical intervention and physiotherapy, with cost as a treatment barrier. This study may direct aid providers toward subsidizing access to orthopedic care and thus reduce the impact of traumatic MSI.
authors.affiliation: Centre for Trauma, Conflict & Catastrophe, St. George's Postgraduate Education Centre, University of London and Royal Lancaster Infirmary, Ashton Road, Lancaster, LA1 4RP, UK. jamesmatheson@doctors.org.uk
authors.forename: James I D M
authors.initials: JI
authors.lastname: Matheson
authors.forename: Oluwarantimi
authors.initials: O
authors.lastname: Atijosan
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
authors.forename: Dorothea
authors.initials: D
authors.lastname: Rischewski
authors.forename: Victoria
authors.initials: V
authors.lastname: Simms
authors.forename: Christopher
authors.initials: C
authors.lastname: Lavy
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries*; D015995:Prevalence; D012432:Rwanda / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D055815:Young Adult