Orthopaedic-related pathological conditions in the paediatric population presenting at outreach clinics in central South Africa over a 20-year period

Abstract

Background. Outreach, as a component of health service delivery in South Africa (SA), increases diagnostic and treatment capacity for populations living in remote areas. It further allows for close population surveillance of specific health-related conditions. Paediatric orthopaedic outreach for central SA provides a unique opportunity to provide insight into the incidence rates of common paediatric orthopaedic-related conditions. Objective. To investigate the absolute numbers and incidence rates of orthopaedic-related pathological conditions in the paediatric population presenting at outreach in central SA between 1997 and 2016. Methods. A retrospective investigation was conducted, which included all paediatric patients residing in the Northern Cape and Free State provinces accessing public healthcare for orthopaedic-related conditions during outreach services. Patient demographic and clinical data were collected and divided into (i) periods; (ii) age groups; (iii) geographical location; and (iv) presenting pathology. Age group-specific incidence rates (ASIR) and paediatric incidence rates (PIR) were calculated using census data from 2001, 2006 and 2011, and estimated values were adjusted to reflect the percentage of the population expected to use public health facilities per 10 000 paediatric population per year. Results. A total of 3 418 patients were included, with the largest number of patients seen in the Central Free State (n=985). The ASIR for all age groups varied considerably between geographic regions and periods, with the highest rates (2005 - 2008, 21.8 per 10 000 per year) observed in the neonate/infant age group in the northern Free State region. The PIR for pathological groups also varied considerably, with high incidences of congenital talipes equinovarus observed in the northern and eastern Free State regions and a high incidence of cerebral palsy in the central (2001 - 2004, 0.79 per 10 000 per year) and Eastern Free State (2001 - 2004, 0.62 per 10 000 per year). Conclusion. This information can provide a unique context for planning healthcare service delivery and pathology-orientated scientific research.

Keywords

• outreach
• academic medical centre
• urban disadvantaged
• rural disadvantaged
• descriptive paediatric age groups
• childhood orthopaedic disease