1Epidemiology of rheumatic musculoskeletal disorders in the developing world
Section snippets
Background
While much was known about the epidemiology of MSK disorders in the Western world by the early second half of the 20th century, there were few data from the developing world.4 A joint meeting of the ILAR and WHO was held in Geneva in 1981 to initiate a global programme.5, 6 This programme was called COPCORD. The aim was to fill the large gaps in knowledge on the burden of MSK disorders in the developing world, especially in rural economies. This would lead to health education of the community
Prevalence data
The prevalence rates of common pain sites/symptoms and rheumatic disorders from urban and rural surveys are shown in Table 1, Table 2, Table 3, Table 4. Wherever possible, unadjusted crude prevalence rates are shown. COPCORD pilot survey studies from Iran30 and Cuba39 are also included. The data from an Australian aborigines COPCORD survey is included to show the likely picture of rheumatic MSK disorders in similar tribal regions in the Asia-Pacific rim. COPCORD regional surveys in South China
Disability
The CCQ has invariably recorded single-item disability or a modified HAQ. About 25% and 2% of the population (rural/slum/affluent) in the Bangladesh COPCORD34 respectively reported partial or complete inability to perform one of the common ten tasks (lifting usual domestic/occupation-connected weights, squatting, bending, staircase-climbing, walking, bathing, dressing, travelling, lifting glass to mouth, getting in and out of bed) that have been uniformly listed in the CCQ. In the Peru COPCORD,
Treatment resources and access
Both traditional ethnic medicinal systems and modern medicine are now available all over the world. Affordability/socioeconomics and community concepts are important variables. A plethora of treatment resources and methods, including ethnic and local indigenous therapies, have been reported by COPCORD surveys. Not all patients with MSK disorders seek proper attention or therapy; 55% of the men or women who complained of rheumatic symptoms did not recall seeing a doctor ever in the Shanghai
Risk factors
The role of climate, occupation, lifestyle, diet, hypermobility, and trauma in causing MSK pain and disorders have been evaluated and speculated upon by several COPCORD investigators.*2, 11, 16, 17, 28, 34 None of the COPCORDs have carried out prospective cohort studies of causality and risk factors.
Does ethnicity matter? The answer can be best illustrated by the Malaysian COPCORD survey data from a selected semi-urban population comprising people of Malay, Chinese and Indian origin living and
Present and future
The ‘Bone and Joint Decade (BJD) 2000–2010’ was launched to focus attention on MSK health and disease.101, 102 Education, patient empowerment, and reduction in the global burden of MSK disorders are some of the principal goals. The decade is of special relevance to the developing world.*8, *103 In a key international meeting between BJD, ILAR and WHO in Vienna (Austria) in 2005, it was decided to review the current COPCORD status and update its CCQ and methods.104 COPCORD is much more than mere
Summary
The WHO-ILAR COPCORD was designed to capture pain and disability in the developing world, and has completed population surveys (mostly non-randomized) in several countries during the last three decades. The current report is largely based on COPCORD data. Despite changes, the core methods of data collection and recording have remained stable and allow fair comparison between surveys. The prevalence of painful rheumatic MSK disorders has varied from 11.6% (Shantou, China) to 55% (Australian
Acknowledgements
The WHO-ILAR COPCORD owes its success to hundreds of investigators who have toiled the length and breadth of their regions in extremely difficult and challenging scenarios to provide meaningful data. There have been little, if any, government support (being a non-government initiative) or financial incentives. By and large, very few COPCORD surveys have solicited or accepted pharmaceutical sponsorship. Academic and Research Medical Institutions have been in the forefront, but several grass-root
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