First chronic pain clinic in Rwanda: a comparison of demographics and case mix with European data
Victoria Tidman1, Jerome Muhizi1, Ben Karenzi1, Joan Hester1, Annette Gibb1, Gilbert Mwaka1, Jane Uwase1, Christian Mukwesi1,&
1Department of Anesthesia and Intensive Care, University of Rwanda, Kigali, Rwanda
Christian Mukwesi, Department of Anesthesia and Intensive Care, University of Rwanda, Kigali, Rwanda
a study that used data from 10 developed countries and 7 developing countries showed there is a higher prevalence of chronic pain in developing countries. However, most developing countries, including Rwanda, do not have a chronic pain service. The first chronic pain clinic in Rwanda was held at the Rwandan Military Hospital (RMH), Kigali, between the dates of 18th September and 30th October 2014. Initially, there were 2 clinics a week. These were led by an advanced pain trainee with a nurse translator in an outpatient department setting. This was augmented by a pain team from Specialists in Pain International Network (SPIN) charity, which allowed extra clinics to run for 5 days. Our aim was to compare the demographics and case mix of chronic pain patients in Rwanda with developed countries.
as it was a novel service in Rwanda, we advertised at local and national level for patients via email, posters and a radio announcement. The eligibility criteria for referral to clinic were pain lasting for more than 3 months that was not responding to conventional treatment. The Rwandan government health insurance covered most of the cost of the clinic visit meaning that it was affordable for all. Patients were seen in clinic for between 30 to 60 minutes. The clinic included a doctor, a nurse and at times a physiotherapist and psychologist. Basic demographics and their pain history were recorded. We excluded cancer pain and follow up patients. To compare our results with European data we used a 2006 survey by Breikvik et al.
the average age of the 44 patients included was 49.8 years, which is very similar to the European data. The 61-70 age group had the highest incidence of chronic pain compared to the 41-50 age group in the European data. This is interesting especially if we consider that the life expectancy in Rwanda is 64.5, significantly less than many European countries. 61% of patients who attended clinic were female, which is higher than the population estimate of 51% women. This is comparable to previous prevalence studies. Nearly 50% of the patients studied in Europe had back pain. Systematic reviews showed that lower back pain (LPB) has an even higher prevalence in developing countries. Therefore, unsurprisingly LBP was the most common complaint in the Rwandan population. Leg pain and headaches also featured frequently. The duration of pain in Rwandan patients tended to be shorter compared to those from Europe.
the case mix in Rwanda is not unlike the case mix in developed countries. Although we cannot assess prevalence of chronic pain in Rwanda from our data, our experience suggests there is a demand for chronic pain management. We plan to collect more data to analyze the case mix and prevalence of chronic pain to guide further development. We continue to support the chronic pain service at the RMH and hope that it can be a role model for developing services in other African countries.
1st International Military Congress of Tropical Medicine and Sub-Saharan Diseases ()
Dates: 23 Oct 16 - 25 Oct 16
Contact person: Pr Salem Bouomrani (Salembouomrani@yahoo.fr)