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