ABSTRACT

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.

Abbreviation

CI: confidence interval; HIC: high-income countries; HIV: human immunodeficiency virus; ICD-10: International Classification of Diseases 10; IQR: interquartile range; JIA: juvenile idiopathic arthritis; KCMC: Kilimanjaro Christian Medical Centre; LMIC: low- and middle-income countries; MSD: musculoskeletal diseases: NAI: non-accidental injury; NIHR: National Institute for Health Research; PAFLAR: Paediatric Society of the African League Against Rheumatism; RTA: road traffic accidents; SCD: sickle cell disease; SLE: systemic lupus erythematosus; SSA: sub-Saharan Africa.

中文翻译：

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坦桑尼亚北部住院小儿肌肉骨骼疾病的范围和负担

摘要

背景

肌肉骨骼疾病 (MSD) 是造成全球疾病和残疾负担的主要因素，对低收入和中等收入国家的影响尤为严重；然而，缺乏流行病学数据。受影响的儿童经常面临更高的发病率、社会孤立和经济困难。

目标

评估坦桑尼亚一家主要转诊医院收治的 5-18 岁儿童 MSD 的谱系和负担。

方法

这是一项回顾性队列研究，对象为 2017 年 1 月 1 日至 12 月 31 日期间在乞力马扎罗基督教医疗中心 (KCMC) 收治的 5-18 岁儿童，其初步诊断被国际疾病分类 10 确认为肌肉骨骼疾病。

结果

2017 年，KCMC 收治了 163 例确诊的儿科 MSD，占所有 5-18 岁儿童入院的 21.2%（n =  769）。骨病是最常见的诊断。其中包括 106 例（65.0%）外伤性骨折、31 例（19.0%）骨关节感染、9 例（5.5%）畸形愈合和 3 例（1.8%）病理性骨折。先天性缺陷和风湿性疾病相对少见，分别仅占 MSD 入院的 6 例（3.7%）和 4 例（2.5%）。

结论

大多数 MSD 病例与骨折有关，其次是骨关节感染，而公认的风湿病病例很少见。该研究虽然规模不大，但确定了坦桑尼亚一家医院在 12 个月内收治的儿科 MSD 的巨大负担和范围，并强调需要进行更大规模的研究以告知卫生资源的最佳分配。

缩写

CI：置信区间；HIC：高收入国家；HIV：人类免疫缺陷病毒；ICD-10：国际疾病分类 10；IQR：四分位距；JIA：幼年特发性关节炎；KCMC：乞力马扎罗基督教医疗中心；LMIC：低收入和中等收入国家；MSD：肌肉骨骼疾病：NAI：非意外伤害；NIHR：国家卫生研究所；PAFLAR：非洲风湿病联盟儿科协会；RTA：道路交通事故；SCD：镰状细胞病；SLE：系统性红斑狼疮；SSA：撒哈拉以南非洲。