Epidemiological determinants of children's orthopedic care in rural central India

Abstract

Background: Musculoskeletal disorders of children in rural India are often highlighted through anecdotal reports of delayed presentations. This study was conducted to identify prevalence and factors that influenced children's orthopedic care in a secondary hospital in rural Central India. Methodology: A retrospective survey was conducted to identify the prevalence of musculoskeletal disorders and delayed presentation among children at our institution from July 2011 to June 2016. Actionable epidemiological determinants were identified with the Delphi method and a prospective cohort was analyzed for delayed presentation. Results: Among 2281 children 71% presented with trauma. The incidence of delayed presentation among the trauma cases was 28%. Remaining had neuromuscular (17%), infectious (3.75%), metabolic (1.5%), congenital (3.25%), and miscellaneous (3.5%) disorders. Delayed presentation in 19 children from a prospective cohort of 100 patients showed significant association with distance traveled to reach the clinic and poor transport infrastructure in rural areas (P = 0.025) but did not differ by socioeconomic scale (SES) (P = 0.085), lack of health insurance coverage (P = 0.348) or primary indigenous treatment (P = 0.535). In this cohort, 84% belonged to middle and low-SES families, 33% had insurance coverage, 79% received primary traditional remedies and 68% traveled from distant rural locations. Conclusions: Trauma care and neuromuscular diseases constituted the bulk of musculoskeletal disorders in children in this survey from rural India. Poor transport infrastructure led to delayed presentation in the prospective cohort but lower SES, lack of health insurance, and rampant primary indigenous treatment in rural areas are likely contributory factors.

Keywords

• children's musculoskeletal disorders
• delayed presentations
• epidemiological determinants
• orthopedic care in low-middle income countries