Challenges to fracture service availability and readiness provided by allopathic and traditional health providers: national surveys across The Gambia and Zimbabwe
Burton A, Manyanga T, Wilson H, Jarjou L, Costa ML, Graham SM, Masters J, Jallow MK, Hawley S, Nyassi MT, Mushayavanhu P, Ndekwere M, Ferrand RA, Ward KA, Marenah KS, Gregson CL
Year of publication: 2025
Abstract
Populations in Africa are ageing, hence the number of age-related fragility fractures, including hip fractures, is rising. Hip fractures are an indicator condition for older adult health provision, as they require a multifaceted pathway of care. To enable health service planning, detailed national-level understanding of current fracture service provision is needed.
Age- and sex-specific incidence rates and future projections for hip fractures in Zimbabwe
Wilson H , Manyanga T, Burton A, Mushayavanhu P, Chipanga J, Hawley S, Ward KA, Graham SM, Masters J, Bandason T, Costa ML, Ndekwere M, Ferrand RA, Gregson CL
Year of publication: 2025
Paper: Age- and sex-specific incidence rates and future projections for hip fractures in Zimbabwe
Abstract
Population ageing in Africa is increasing healthcare demands. Hip fractures require multidisciplinary care and are considered an indicator condition for age related health services. We aimed to estimate current hip fracture incidence in Zimbabwe, compare rates against other regional estimates and estimate future fracture numbers.
Prevalence, factors and quality of life associated with frailty and pre-frailty in middle-aged and older adults living with HIV in Zimbabwe: A cross-sectional study
Manyara A, Manyanga T, Burton A, Wilson H, Chipanga J, Bandason T, Grundy C, Madela Y, Ward KA, Cassim B, Ferrand RA, Gregson CL
Year of publication: 2024
Abstract
Objectives: We investigated associations between HIV, frailty and health-related quality of life (HRQoL). Methods: This cross-sectional study recruited men and women aged≥40 years in Zimbabwe. A researcher collected clinical and HRQoL data, and performed physical assessments and HIV testing. Frailty was defined using five criteria: unintentional weight loss, exhaustion, low physical activity, low gait speed, low handgrip strength. The presence of three or more criteria defined frailty, one to two pre-frailty, and zero non-frail. Data analysis used adjusted regression modelling.
Results: Of 1034 adults (mean ± SD, 62.0 ± 14.0 years), 21.6% (n = 223) were living with HIV: 93.3% knew their status, of whom 96.2% were on antiretroviral therapy (ART) and 89.7% of these had a viral load <50 copies/mL. Mean age at HIV diagnosis was 44.6 ± 10.4 years (only 8.1% were ≥70 years), people had been living with HIV for 9.8 ± 5.0 years and had been on ART for 9.4± 5.2 years. Overall, HIV was not associated with frailty: adjusted odds ratio(aOR) was 0.99 [95% confidence interval (CI): 0.42–2.33] for frailty versus non-frailty. However, each 5 years lived with HIV was associated with twice the odds of frailty/pre-frailty (aOR = 2.03, 95% CI: 1.03–4.13), independent of age and ART duration. Furthermore, each 5 years of ART use was associated with60% lower odds of frailty/pre-frailty (aOR = 0.39, 95% CI: 0.19–0.78), independent of age and years lived with HIV. Older age, minimal education and poverty were associated with frailty. Frailty was associated with lower HRQoL in people both with and without HIV.
Conclusion: Reduced survival and good viral suppression may explain the lack of association between HIV and frailty. Early ART initiation could reduce future risk of frailty.
Fractures in sub-Saharan Africa: epidemiology, economic impact and ethnography (Fractures-E3): study protocol
Burton A, Drew S, Cassim B, Jarjou LM, Gooberman-Hill R, Noble S, Mafirakureva N, Graham SM, Grundy C, Hawley S, Wilson H, Manyanga T, Marenah K, Trawally B, Masters J, Mushayavanhu P, Ndekwere M, Paruk F, Lukhele M, Costa M, Ferrand RA, Ward KA, Gregson CL
Year of publication: 2023
Abstract
The population of older adults is growing in sub-Saharan Africa. Ageing exponentially increases fragility fracture risk. Of all global regions, Africa is projected to observe the greatest increase in fragility fractures. Fractures cause pain, disability and sometimes death, and management is expensive, often requiring complex healthcare delivery. For countries to plan future healthcare services, understanding is needed of fracture epidemiology, associated health service costs and the currently available healthcare resources.
The healthcare system costs of hip fracture care in South Africa
Mafirakureva N, Paruk F, Cassim B, Lukhele M, Gregson CL, Noble SM
Year of publication: 2023
Paper: The healthcare system costs of hip fracture care in South Africa
Abstract
Summary: Despite rapidly ageing populations, data on healthcare costs associated with hip fracture in Sub-Saharan Africa are limited. We estimated high direct medical costs for managing hip fracture within the public healthcare system in SA. These findings should support policy decisions on budgeting and planning of hip fracture services.
Incidence and number of fragility fractures of the hip in South Africa: estimated projections from 2020 to 2050
Hawley S, Dela S, Burton A, Paruk F, Cassim B and Gregson CL
Year of publication: 2022
Abstract
Summary: Sub-Saharan Africa is undergoing rapid population ageing and better understanding of the burden of musculoskeletal conditions is needed. We have estimated a large increase in the burden of hip fractures for South Africa over the coming decades. These findings should support preparation of hip fracture services to meet this demand.
Introduction: A better understanding of the burden of fragility fractures in sub-Saharan Africa is needed to inform healthcare planning. We aimed to use recent hip fracture incidence data from South Africa (SA) to estimate the future burden of hip fracture for the country over the next three decades. Methods: Hip fracture incidence data within the Gauteng, KwaZulu-Natal and Western Cape provinces of SA were obtained from patients aged ≥ 40 years with a radiograph-confirmed hip fracture in one of 94 included hospitals. Age-, sex- and ethnicity-specific incidence rates were generated using the 2011 SA census population for the study areas. Incidence rates were standardised to United Nations (UN) population projections, for the years 2020, 2030, 2040 and 2050, and absolute numbers of hip fractures derived. Results: The 2767 hip fracture patients studied had mean (SD) age 73.7 (12.7) years; 69% were female. Estimated age- and ethnicity-standardised incidence rates (per 100,000 person-years) for the overall SA population in 2020 were 81.2 for females and 43.1 for males. Overall projected incidence rates were discernibly higher by the year 2040 and increased further by the year 2050 (109.0 and 54.1 for females and males, respectively). Estimates of the overall annual number of hip fractures for SA increased from approximately 11,000 in 2020 to approximately 26,400 by 2050. Conclusion: The hip fracture burden for SA is expected to more than double over the next 30 years. Significant investment in fracture prevention services and inpatient fracture care is likely to be needed to meet this demand.
Fragility fractures in sub-Saharan Africa: time to break the myth, published. 2019
Gregson CL, Cassim B, Micklesfield LK, Lukhele M, Ferrand RA, Ward KA on behalf of the SAMSON Collaborative Working Group Abstract
Year of publication: 2019
Abstract
The number of older adults (aged ≥60 years) in Sub-Saharan Africa is two times higher than in northern Europe; a figure that is expected to increase from 46 million in 2015 to 157 million by 2050. In sub-Saharan Africa, at age 60 years, life expectancy is 16 years for women and 14 years for men, suggesting that for individuals who survive challenges in early life, a long period of old age is now a reality. As sub-Saharan Africa undergoes an epidemiological transition as a result of rapid urbanisation, the burden of non-communicable diseases, including osteoporosis, is rising. Similar to many chronic diseases such as hypertension, osteoporosis often remains undiagnosed until a fracture occurs. Increasing evidence is dispelling the outdated myth that fragility fractures are not a problem in sub-Saharan Africa.