Prevalence, causes and impact of musculoskeletal impairment in Malawi: A national cluster randomized survey.
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ABSTRACT:
SUBMITTER: Ngoie LB
PROVIDER: S-EPMC7787380 | biostudies-literature | 2021
REPOSITORIES: biostudies-literature
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Prevalence, causes and impact of musculoskeletal impairment in Malawi: A national cluster randomized survey.
Ngoie Leonard Banza LB Dybvik Eva E Hallan Geir G Gjertsen Jan-Erik JE Mkandawire Nyengo N Varela Carlos C Young Sven S
PloS one 20210106 1
<h4>Background</h4>There is a lack of accurate information on the prevalence and causes of musculoskeletal impairment (MSI) in low income countries. The WHO prevalence estimate does not help plan services for specific national income levels or countries. The aim of this study was to find the prevalence, impact, causes and factors associated with musculoskeletal impairment in Malawi. We wished to undertake a national cluster randomized survey of musculoskeletal impairment in Malawi, one of the UN ...[more]
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Project description: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. FINDINGS: 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. INTERPRETATION: 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.
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Project description:Visual impairment has become a global challenge, especially for developing countries. This study aims to estimate the prevalence, causes and social factors of visual impairment among Chinese adults. Data were from a nationally representative population-based cross-sectional study. The study population were 1,909,199 non-institutionalized adults aged 18 years and older in mainland China. In the survey, low vision and blindness were checked by ophthalmologists according to the WHO best-corrected visual acuity (BCVA) criteria. Population weighted numbers and prevalence of low vision and blindness with 95% confidence intervals (CIs) were estimated where appropriate. Multivariable logistic regression analysis was used to identify the social factors of visual impairment. The weighted prevalence of visual impairment was 17.17 (95% CI, 16.84-17.50) per 1000 Chinese adults aged 18 years and older. Cataract (57.35%), disorders of choroid and retina (9.80%), and disorders of cornea (6.49%) contributed more than 70 percent to the visual impairment in Chinese adults. Older age groups, young or middle-aged male adults, female elders, illiterate, rural dwellers, non-eastern residents, singles, unemployment, and from family with lower income were associated with visual impairment. More efforts are warranted to enhance treatment and rehabilitation among people with eye disorders to prevent visual impairment.
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Project description:ImportanceThis study determines the prevalence of unilateral vision impairment (VI) and unilateral blindness to assist in policy formulation for eye health care services.ObjectiveTo determine the prevalence and causes of unilateral VI and unilateral blindness in Australia.Design, setting, and participantsThis cross-sectional population-based survey was conducted from March 2015 to April 2016 at 30 randomly selected sites across all strata of geographic remoteness in Australia. A total of 1738 indigenous Australians 40 years or older and 3098 nonindigenous Australians 50 years or older were included.Main outcomes and measuresThe prevalence and causes of unilateral vision impairment and blindness, defined as presenting visual acuity worse than 6/12 and 6/60, respectively, in the worse eye, and 6/12 or better in the better eye.ResultsOf the 1738 indigenous Australians, mean (SD) age was 55.0 (10.0) years, and 1024 participants (58.9%) were female. Among the 3098 nonindigenous Australians, mean (SD) age was 66.6 (9.7) years, and 1661 participants (53.6%) were female. The weighted prevalence of unilateral VI in indigenous Australians was 12.5% (95% CI, 11.0%-14.2%) and the prevalence of unilateral blindness was 2.4% (95% CI, 1.7%-3.3%), respectively. In nonindigenous Australians, the prevalence of unilateral VI was 14.6% (95% CI, 13.1%-16.3%) and unilateral blindness was found in 1.4% (95% CI, 1.0%-1.8%). The age-adjusted and sex-adjusted prevalence of unilateral vision loss was higher in indigenous Australians than nonindigenous Australians (VI: 18.7% vs 14.5%; P = .02; blindness: 2.9% vs 1.3%; P = .02). Risk factors for unilateral vision loss included older age (odds ratio [OR], 1.60 for each decade of age for indigenous Australians; 95% CI, 1.39-1.86; OR, 1.65 per decade for nonindigenous Australians; 95% CI, 1.38-1.96), very remote residence (OR, 1.65; 95% CI, 1.01-2.74) and self-reported diabetes (OR, 1.52; 95% CI, 1.12-2.07) for indigenous Australians, and having not undergone an eye examination in the past 2 years for nonindigenous Australians (OR, 1.54; 95% CI, 1.04-2.27). Uncorrected refractive error and cataract were leading causes of unilateral VI in both populations (70%-75%). Corneal pathology (16.7%) and cataract (13.9%) were leading causes of unilateral blindness in indigenous Australians, while amblyopia (18.8%), trauma (16.7%), and age-related macular degeneration (10.4%) were major causes of unilateral blindness in nonindigenous Australians.Conclusions and relevanceUnilateral vision loss is prevalent in indigenous and nonindigenous Australians; however, most cases are avoidable. As those with unilateral vision loss caused by cataract and posterior segment diseases may be at great risk of progressing to bilateral blindness, national blindness prevention programs may benefit from prioritizing examination and treatment of those with unilateral vision loss.
| S-EPMC5885895 | biostudies-literature
Project description:BackgroundPast estimates have put the prevalence of schistosomiasis between 40% and 50% in the Malawi population overall based on studies undertaken ten years or more ago. More recent surveys in known high risk areas find similar levels. However control measures, changing ecology and migration may have led to changes in the prevalence of schistosomiasis in different parts of Malawi. A national schistosomiasis and soil-transmitted helminth (STH) survey was undertaken to measure the distribution, prevalence and intensity of infection in November 2002.MethodsA school was selected randomly from a random sample of 30 Traditional Authorities stratified by six distinct ecological zones, and 1,664 year 3 pupils (9-10 year olds) were questioned about recent illnesses and "red urine". Samples of urine and faeces were examined for the presence of eggs using the standard Kato-Katz technique for soil-transmitted helminths and intestinal schistosomiasis and urine samples using the filtration technique for Schistosoma haematobium.ResultsThe prevalence of Schistosoma mansoni is 0.4% (95% CI 0-1.3%), S. haematobium 6.9% (95% CI 1.9 - 11.9%), hookworm 1.3% (95% CI 0.4-2.3%), Ascariasis 0.5% (95% CI 0.1-1.0%) and trichuriasis 0% in year 3 pupils (modal age 10 years of age). Intensity of infection is low for all infections except for 2.5% who have high intensity S. haematobium infection. The "red urine" question is 67% sensitive and 80% specific for positive S. haematobium microscopy.ConclusionsThe reduction in prevalences may be real as a result of recent control measures, or false if historical results were based on surveys of high risk populations. Another explanation is that this survey used an unrepresentative sample of schools. Detailed analysis suggests this is unlikely. Recommendations include the use of a 30% positive threshold for the "red urine" screening question to be used in schoolchildren in high prevalence areas. This survey, based on a national probability sample excluding the northern region lakeside area, finds much lower overall prevalence and intensity of schistosomiasis and STHs than previous estimates based on selected surveys. Disease control featuring chemotherapy may be having a profound effect. The localised nature of the distribution of the infections means that control programmes may work best if undertaken at district level or below. "Red urine" questionnaire surveys may help identify hot spots.
| S-EPMC535894 | biostudies-literature
Project description:BackgroundMore than a billion people globally are living with disability and the prevalence is likely to increase rapidly in the coming years in low- and middle-income countries (LMICs). The vast majority of those living with disability are children residing in LMICs. There is very little reliable data on the epidemiology of musculoskeletal impairments (MSIs) in children and even less is available for Malawi. Previous studies in Malawi on childhood disability and the impact of musculoskeletal impairment (MSI) on the lives of children have been done but on a small scale and have not used disability measurement tools designed for children. Therefore in this study, we aimed to estimate the MSI prevalence, causes, and the treatment need among children aged 16 years or less in Malawi.MethodsThis study was carried out as a national cross sectional survey. Clusters were selected across the whole country through probability proportional to size sampling with an urban/rural and demographic split that matched the national distribution of the population. Clusters were distributed around all 27-mainland districts of Malawi. Population of Malawi was 18.3 million from 2018 estimates, based on age categories we estimated that about 8.9 million were 16 years and younger. MSI diagnosis from our randomized sample was extrapolated to the population of Malawi, confidence limits was calculated using normal approximation.ResultsOf 3792 children aged 16 or less who were enumerated, 3648 (96.2%) were examined and 236 were confirmed to have MSI, giving a prevalence of MSI of 6.5% (CI 5.7-7.3). Extrapolated to the Malawian population this means as many as 576,000 (95% CI 505,000-647,000) children could be living with MSI in Malawi. Overall, 46% of MSIs were due to congenital causes, 34% were neurological in origin, 8.4% were due to trauma, 7.8% were acquired non-traumatic non-infective causes, and 3.4% were due to infection. We estimated a total number of 112,000 (80,000-145,000) children in need of Prostheses and Orthoses (P&O), 42,000 (22,000-61,000) in need of mobility aids (including 37,000 wheel chairs), 73,000 (47,000-99,000) in need of medication, 59,000 (35,000-82,000) in need of physical therapy, and 20,000 (6000-33,000) children in need of orthopaedic surgery. Low parents' educational level was one factor associated with an increased risk of MSI.ConclusionThis survey has uncovered a large burden of MSI among children aged 16 and under in Malawi. The burden of musculoskeletal impairment in Malawi is mostly unattended, revealing a need to scale up both P&O services, physical & occupational therapy, and surgical services in the country.
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Project description:ObjectiveTo estimate the prevalence of World Health Organization-defined chronic suppurative otitis media (CSOM) and mild hearing impairment in a population representative sample of school-entry age children in rural Malawi. A secondary objective was to explore factors associated with CSOM in this population.MethodsWe performed a community-based cross-sectional study of children aged 4-6 years in Chikhwawa District, Southern Malawi, utilising a village-level cluster design. Participants underwent a structured clinical assessment, including video-otoscopy and screening audiometry. Diagnoses were made remotely by two otolaryngologists who independently reviewed clinical data and images collected in the field. Hearing impairment was classified as failure to hear a pure tone of 25dB or greater at 1, 2 or 4kHz.ResultsWe recruited 281 children across 10 clusters. The prevalence estimates of CSOM, unilateral hearing impairment and bilateral hearing impairment were 5.4% (95%CI 2.2-8.6), 24.5% (95%CI 16.3-30.0), and 12.5% (95%CI 6.2-16.9) respectively. Middle ear disease was seen in 46.9% of children with hearing impairment. A trend towards increased risk of CSOM was observed with sleeping in a house with >2 other children.InterpretationWe found a high burden of middle ear disease and preventable hearing impairment in our sample of school-entry age children in rural Malawi. There are important public health implications of these findings as CSOM and hearing impairment can affect educational outcomes, and may impact subsequent development. The identification and management of middle ear disease and hearing impairment represent major unmet needs in this population.
| S-EPMC5739401 | biostudies-literature
Project description:BackgroundPopulation-based data on prevalence, causes of blindness and extent of ophthalmological coverage is required for efficient implementation and evaluation of ocular health programs. In view of the scarcity of prevalence data for visual impairment and blindness in Malaysia, this study aims to estimate the prevalence and causes of visual impairment (VI) in the elderly, using Rapid Assessment of Avoidable Blindness (RAAB) survey technique.MethodsMalaysia was divided into six regions, with each region consisting of 50 clusters. Multistage cluster sampling method was used and each cluster contained 50 residents aged 50 years and above. Eligible subjects were interviewed and pertinent demographic details, barriers to cataract surgery, medical and ocular history was noted. Subjects had visual acuity assessment with tumbling 'E' Snellen optotypes and ocular examination with direct ophthalmoscope. The primary cause of VI was documented. Results were calculated for individual zones and weighted average was used to obtain overall prevalence for the country. Inter-regional and overall prevalence for blindness, severe VI and moderate VI were determined. Causes of VI, cataract surgical coverage and barriers to cataract surgery were assessed.ResultsA total of 15,000 subjects were examined with a response rate of 95.3%. The age and gender-adjusted prevalence of blindness, severe visual impairment and moderate visual impairment were 1.2% (95% Confidence Interval: 1.0-1.4%), 1.0% (95%CI: 0.8-1.2%) and 5.9% (5.3-6.5%) respectively. Untreated cataract (58.6%), diabetic retinopathy (10.4%) and glaucoma (6.6%) were the commonest causes of blindness. Overall, 86.3% of the causes of blindness were avoidable. Cataract surgical coverage (CSC) in persons for blindness, severe visual impairment and moderate visual impairment was 90%, 86% and 66% respectively.ConclusionIncreased patient education and further expansion of ophthalmological services are required to reduce avoidable blindness even further in Malaysia.
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Project description:PurposeTo determine the prevalence and causes of blindness and vision impairment among people 50 years and older in Nepal.MethodsWe conducted seven provincial-level Rapid Assessment of Avoidable Blindness (RAAB) cross-sectional, population-based surveys between 2018-2021. Provincial prevalence estimates were weighted to give nationally representative estimates. Sampling, enumeration, and examination of the population 50 years and older were done at the province level following standard RAAB protocol.ResultsAcross seven surveys, we enrolled 33,228 individuals, of whom 32,565 were examined (response rate 98%). Females (n = 17,935) made up 55% of the sample. The age-sex-province weighted national prevalence of blindness (better eye presenting visual acuity <3/60) was 1.1% (95% confidence interval [CI] 1.0-1.2%), and any vision impairment <6/12 was 20.7% (95% CI 19.9-21.5%). The prevalence of blindness was higher in women than men (1.3% [95% CI 1.1-1.5%] vs 0.9% [95% CI 0.7-1.0%]). Age-sex weighted blindness prevalence was highest in Lumbini Province (1.8% [95% CI 1.3-2.2%]) and lowest in Bagmati Province (0.7% [95% CI 0.4-0.9%]) and Sudurpaschim Province (0.7% [95% CI 0.4-0.9%]). Cataract (65.2%) was the leading cause of blindness in our sample, followed by corneal opacity (6.4%), glaucoma (5.8%) and age-related macular degeneration (5.3%). Other posterior segment diseases accounted for 8.4% of cases. Cataract was also the leading cause of severe vision impairment (83.9%) and moderate vision impairment (66.8%), while refractive error was the leading cause of mild vision impairment (66.5%).ConclusionThe prevalence of blindness was higher among women than men and varied by province. The Lumbini and Madesh Provinces in the Terai (plains) region had higher prevalence of blindness than elsewhere. Cataract was the leading cause of blindness, severe vision impairment and moderate vision impairment while refractive error was the leading cause of mild vision impairment.
| S-EPMC11824995 | biostudies-literature
Project description:IntroductionTimor-Leste has one of the world's highest estimated tuberculosis (TB) incidences, yet the data which informs this estimate is limited and the true burden of TB disease is not known. TB prevalence surveys offer the best means of determining robust estimates of disease burden. This study aims to provide an estimate of the prevalence of bacteriologically confirmed pulmonary TB in Timor-Leste and provide additional insights into diagnostic coverage and health-seeking behaviour of persons with symptoms suggestive of TB.Methods and analysisA national population-based cross-sectional cluster survey will be conducted in which participants aged 15 years and older will be screened for pulmonary TB using an algorithm consisting of symptom screening and digital X-ray of the chest with computer-aided detection software for X-ray interpretation. Xpert Ultra and liquid culture methods will be used to confirm survey TB cases. Additional data will be collected from persons reporting symptoms suggestive of TB to assess health-seeking behaviour and access to TB diagnosis and care. The survey aims to screen a target sample population of 20 068 people, living within 50 clusters, representing every municipality of Timor-Leste. Bacteriologically confirmed pulmonary TB prevalence will be estimated using WHO-recommended methods.Ethics and disseminationResearch ethics approval has been granted by the human research ethics committee of the Northern Territory, Australia, and the Instituto Nacional da Saúde, Timor-Leste. The results will be published in a peer-reviewed scientific journal and disseminated with relevant stakeholders.Trial registration numberACTRN12623000718640.
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