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Int Orthop. 2018 Aug;42(8):1967-1973. doi: 10.1007/s00264-018-3915-x. Epub 2018 Apr 2.

Paediatric musculoskeletal disease in Kumi District, Uganda: a cross-sectional survey.

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Harvard Combined Orthopaedic Surgery Residency Program, Boston, MA, USA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Department of Orthopaedic Surgery, University of British Columbia, Victoria, Canada.
Makerere University School of Public Health, Kampala, Uganda.
Kumi Hospital, Kumi, Uganda.
University of California San Francisco Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA.



The purpose of this study is to estimate the burden of musculoskeletal disease among children treated in Kumi District, Uganda, to inform training, capacity-building efforts, and resource allocation.


We conducted a retrospective cohort study by reviewing the musculoskeletal (MSK) clinic and community outreach logs for children (age < 18 years) seen at Kumi Hospital in Kumi, Uganda, between January 2013 and December 2015. For each patient, we recorded the age, sex, diagnosis, and treatment recommendation.


Of the 4852 children, the most common diagnoses were gluteal and quadriceps contractures (29.4% (95% CI 28.1-30.7%), 96% of which were gluteal fibrosis), post-injection paralysis (12.7% (95% CI 11.8-13.6%)), infection (10.5% (95% CI 9.7-11.4%)), trauma (6.9% (95% CI 6.2-7.6%)), cerebral palsy (6.9% (95% CI 6.2-7.7%)), and clubfoot (4.3% (95% CI 3.8-4.9%)). Gluteal fibrosis, musculoskeletal infections, and angular knee deformities create a large surgical burden with 88.1%, 59.1%, and 54.1% of patients seen with these diagnoses referred for surgery, respectively. Post-injection paralysis, clubfoot, and cerebral palsy were treated non-operatively in over 75% of cases.


While population-based estimates of disease burden and resource utilization are needed, this data offers insight into burden of musculoskeletal disease for this region of Sub-Saharan Africa. We estimate that 50% of the surgical conditions could be prevented with policy changes and education regarding injection practices and early care for traumatic injuries, clubfeet, and infection. This study highlights a need to increase capacity to care for specific musculoskeletal conditions, including gluteal fibrosis, post-injection paralysis, infection, and trauma in the paediatric population of Uganda.


Gluteal fibrosis; MSK burden; Pediatric musculoskeletal health; Pediatric orthopaedics; Post-injection paralysis; Uganda


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