This page shines a spotlight on the key findings of the project overall, as presented to key stakeholders within Tanzania.
Clinical problems affecting the MSK system are common among patients attending hospitals in Tanzania (such as the Kilimanjaro Christian Medical Centre (KCMC)). Yet there is currently little information on how arthritis is understood, its frequency, economic, social and quality of life impacts. By measuring the prevalence and understanding the lived experiences of people with arthritis and joint problems in Tanzania, we describe its effects on the local population.
How common are joint problems in Tanzania?
Our community-based prevalence study found that arthritis is very common. We found that 5.8% of participants had confirmed joint problems, meaning around 1 in 17 people in the community had joint problems.
Women and older people were most likely to experience joint pain. About 1 in 20 people had degenerative ‘wear and tear’ arthritis, most commonly involving knees, fingers, hips and lower back with associated pain and restriction of movement.
Very few of these individuals have sought medical treatment although treatment in the form of painkillers is affordable and effective in controlling pain and helping improve function.
We found that 1 in 100 people had evidence of inflammatory arthritis, most often Rheumatoid Arthritis (RA). These levels of RA are similar to high income countries such as the UK. Few people with RA had sought medical advice, and even fewer were on appropriate treatment. RA is a chronic inflammatory arthritis that destroys joints if untreated. RA needs early diagnosis and effective specialist treatment in order to reduce the risk of deformity and dysfunction.
What is the economic impact of arthritis?
Our economic analysis found those with arthritis and joint problems experience significant detrimental economic impacts:
- People with arthritis have approximately two to three times higher healthcare costs compared to those who do not have arthritis.
- People with arthritis spend more than 10% of their total income on healthcare. The World Health Organisation says this level of expenditure is ‘catastrophic’, meaning they suffer excessive financial hardship and cannot meet their subsistence needs.
- People with arthritis had to take on average 2 days off work per month and/or had their daily activities at home affected each week because of their joint pain and other symptoms.
We also found a significant reduction in quality of life for those with MSK disorder.
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.
We also carried out a methodological sub study to explore what people in Tanzania regard as important for their welling. Our sub study found that people in Tanzania and Malawi, in rural and urban areas, valued very similar things in their life. They valued their financial security highly and also their ability to meet the basic needs of life such as food, water and shelter. They also valued the attachment they felt to their families, contacts with friends, and being able to achieve for themselves and their families. They greatly valued their health and access to health services. They enjoyed participating in community activities, being able to make autonomous decisions, and their faith and spirituality.
How is joint pain experienced and understood?
Many people thought their joint pain was caused by working a long time in cold conditions and mentioned that their pain was worse in the cold weather. A few thought being exposed to pesticides used in coffee cultivation may have put them at risk and some felt that supernatural forces were at work.
“[The pain is intense] during the cold in April, May to June, in July when the sun is out, the pain subsides because the cold has ended completely”Interview Participant
The pain meant people felt severely disabled:
“It hurts me so much ….. I can’t go to the bathroom to pee I think, you can’t sit down and clean yourself, don’t you see it’s a problem my sister? It’s like someone is half dead”Interview Particpant
Others could no longer do what they used to do, such as taking care of children or family, or cultivating their land.
“I used to go to church, but I have not been to church for a month now”Interview Particpant
“It affects [me] a lot, [you used to] find me in my activities there or I cultivate a field, going to sell vegetables or sell other business, now I just sit here at home”Interview Particpant
Their disability meant relying on a lot of help from others. Husbands, wives, children, or wider family can take on the burden of everyday tasks, whereas neighbours can sometimes offer information or greetings. Asking for help, however, was frustrating for many, and some felt they had few people who could offer support.
People tried to manage their pain using allopathic pain killers from a pharmacy or doctor or would try rubbing, or gentle movement to ease their pain. Some used traditional medicines, especially when they could not access painkillers because of the cost.
The costs of attending a hospital or buying pharmaceuticals was a major barrier for many participants.
“What prevents me [from accessing care] is lack of money. I have no support, where will I get money? If I had money, my child do you think I would not go for treatment? I have no money at this time …. I prayed to God… I have no cows I have nothing but a few chickens.”Interview Particpant