"Our group has a long-term vision that MSK trauma care across the world should be safe, accessible, effective, and appropriate based on the resources of local health-care systems. Setting research priorities was a key goal of the ORCA so that we can coordinate collaborative research in MSK trauma care across SSA. It is essential to develop a strategic agenda to enable researchers to focus their efforts on priorities that are important to African stakeholders and those treating these injuries on daily basis. Additionally, these questions will hopefully assist funding bodies to prioritize where research funding may be best used." - Orthopaedic Research Collaboration Africa




In low and middle-income countries (LMICs), individuals suffer from a disproportionately higher number of musculoskeletal (MSK) injuries compared with those living in a high-income setting. However, despite the higher burden of death and disability from MSK injuries in LMICs, there has been little policy, research, and funding invested in addressing this distinctly overlooked problem. Using a consensus-based approach, the aim of this study was to identify research priorities for clinical trials and research in MSK trauma care across sub-Saharan Africa.


A modified Delphi technique was utilized; it involved an initial scoping survey, a 2-round Delphi process, and, finally, review by an expert panel with members of the Orthopaedic Research Collaboration in Africa. This study was conducted among MSK health-care practitioners treating trauma in sub-Saharan Africa.


Participants from 34 countries across sub-Saharan Africa contributed to the 2 rounds of the Delphi process, and priorities were scored from 1 (low priority) to 5 (high priority). Public health topics related to trauma care ranked higher than those focused on clinical effectiveness, with the top 10 public health research questions scoring higher than the top 10 questions for clinical effectiveness. Ten public health and 10 clinical effectiveness questions related to MSK trauma care were identified; the highest-ranked questions in the respective categories were related to education and training and to the management of femoral fractures.


This consensus-driven research priority study will guide health-care professionals, academics, researchers, and funders to improve the evidence on MSK trauma care across sub-Saharan Africa and inform funders about priority areas of future research.

There are >5 million deaths per year from traumatic injuries, accounting for 11% of the current global burden of disease1. By the end of 2021, traumatic injuries were expected to be the third-leading cause of death worldwide, with nearly twice the number of fatalities that result from HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome), tuberculosis, and malaria combined1. They occur at a disproportionately higher rate in low and middle-income countries (LMICs), in which 90% of injuries and 83% of global deaths occur2-4. For every injury-related death, up to 50 additional people sustain disabilities, resulting in a loss of >220 million disability-adjusted life years annually2,5. Epidemiological research has reported that nearly 1% of the population in some countries in sub-Saharan Africa (SSA) suffer from some form of injury-related disability6,7. Musculoskeletal (MSK) injuries account for the majority of these injuries. More than 130 million individuals worldwide sustain fractures per year, and 78% of injury-related disabilities are the result of an MSK extremity injury2.

Currently, although there is the obvious substantial burden of death and disability from MSK injuries, there has been little policy, research, and funding invested in addressing this distinctly overlooked problem. Additionally, the evidence underpinning the management of MSK injuries across SSA is poor and is almost exclusively based on evidence from high-income countries, where the resources, health-care training, infrastructure, and presentation of MSK injuries are very different.

One of the challenges faced by surgeons and practitioners wishing to undertake clinical research in SSA is access to funding for high-quality research. The challenge faced by funding institutions is how to identify the priority research questions with the greatest need of funding. Because potential research is often sufficiently disparate, important clinical research ideas may never be disseminated from practitioners to funders.

The Orthopaedic Research Collaboration in Africa (ORCA) in partnership with a nongovernmental organization, the AO Alliance (https://ao-alliance.org), is a collaboration that is dedicated to improving MSK health care via research throughout SSA. It comprises surgeons, researchers, nongovernmental organizations, and policymakers from across SSA, the United Kingdom, and the United States with an interest and expertise in MSK trauma-care research. A key goal of the group is to determine the research priorities of orthopaedic surgeons and other health- care practitioners in SSA in order to set the agenda for studies in MSK trauma care throughout SSA that can be presented to funders. This paper describes the methodology that was used in our research and reports the priorities that were identified.



Abstract for 'Identifying Research Priorities in Musculoskeletal Trauma Care in Sub-Saharan Africa'

Publication: JBJS Open Access. Publisher: Wolters Kluwer Health, Inc. Date: Mar 28, 2022.

Copyright © 2022, Copyright © 2022 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. Reproduced under Creative Commons licence CC BY-NC-ND 4.0.

Read the full open access paper at JBJS Open Access 7(1):e21.00043, January-March 2022. | DOI: 10.2106/JBJS.OA.21.00043



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