Abstract
Background:
Musculoskeletal impairments (MSI) are a major global contributor to disability. Evidence suggests entrenched cyclical links between disability and poverty, although few data are available on the link of poverty with MSI. More data are needed on the association of MSI with functioning, socio-economic status and quality of life, particularly in resource poor settings where MSI is common.
Methods:
We undertook a case-control study of the association between MSI and poverty, time use and quality of life in Myanmar. Cases were recruited from two physical rehabilitation service-centres, prior to the receipt of any services. One age (+/- 5 years) sex matched control was recruited per case, from their home community. 108 cases and 104 controls were recruited between July – December 2015. Participants underwent in-depth structured interviews and functional performance tests at multiple time points over a twelve-month period. Baseline characteristics of participants are reported in this manuscript, using multivariate logistic regression analysis and various tests of association.
Results:
89% of cases were male, 93% were lower limb amputees, and the vast majority had acquired MSI in adulthood. 69% were not working compared with 6% of controls (Odds Ratio 27.4, 95% Confidence Interval 10.6 – 70.7). Overall income, expenditure and assets were similar between cases and controls, with three-quarters of both living below the international LMIC poverty line. However, cases’ health expenditure was significantly higher than controls’ and associated with catastrophic health expenditure and an income gap for one fifth and two thirds of cases respectively. Quality of life scores were lower for cases than controls overall and in each sub-category of quality of life, and cases were far less likely to have participated in productive work the previous day than controls.
Conclusion:
Adults with MSI in Myanmar who are not in receipt of rehabilitative services may be at risk of increased poverty and lower quality of life in relation to increased health needs and limited opportunities to participate in productive work. This study highlights the need for more comprehensive and appropriate support to persons with physical impairments in Myanmar.
Key words: musculoskeletal impairment, physical rehabilitation, quality of life, Myanmar
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