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Title: A profile of patients presenting with spinal pain at Mahalapye and Shoshong World Spine Care clinics in Botswana
Authors: Armstrong, Candice 
Keywords: Spinal pain;Demographic;Disease;Profile;Prevalence;Chiropractic;Botswana;WSC
Issue Date: 2017
Title: A profile of patients presenting with spinal pain at Mahalapye and Shoshong World
Spine Care clinics in Botswana
Background: Spinal pain such as low back and neck pain, are common and can cause
severe long term pain which results in a major burden on individuals and health care
systems (Woolf and Pfledger, 2003; Hondras et al., 2015a). Low-income countries often
have few resources for adequately addressing musculoskeletal (MSK) pain (Louw et al.,
2007). Thus, World Spine Care (WSC), a non-governmental organization, opened two clinics
in Botswana to help improve spinal health care by providing access to MSK specialists
(Haldeman et al., 2015). These clinics have been functional since 2012, and to date the
profile of patients attending these clinics has not been investigated. Studies on patients
attending chiropractic clinics have been carried out internationally (Hartvigsen et al., 2002;
Giles et al., 2002; Coulter and Shekelle, 2005; Holt and Beck, 2005; Mootz et al., 2005;
Sorensen et al., 2006; Garner et al., 2007; Stevens, 2007; Rubinstein et al., 2008; Martinez
et al., 2009; Ailliet et al., 2010; Lischyna and Mior, 2012) and locally (Benjamin, 2007;
Jaman, 2007; Mohamed, 2007; Venketsamy, 2007; Higgs, 2009; McDonald, 2012; Hitge,
2014), and yet very little information exists on the patients presenting to clinics in the public
sector of Botswana. Demographic and disease profiles of patients vary by clinical setting,
from country to country, and within regions of the same country (Hoy et al., 2010a). Thus,
this study aimed to determine the demographic and disease profile of spinal pain patients
attending the WSC clinics in Mahalapye and Shoshong in Botswana.
Method: A retrospective, descriptive study design was used to extract data from the WSC
patient files at the Mahalapye and Shoshong WSC clinics from 1 November 2012 to 31
March 2016. The research proposal was approved by the Institutional Research Ethics
Committee (IREC); REC 53/16 (Appendix A), WSC (Appendix B) and Botswana MoH
(Appendix C). Patient files included had provided consent for their files to be used for
research purposes (Appendix F). Data recorded included demographic characteristics,
factors related to spinal pain, the presenting complaint and the presence of co-morbid
conditions. The data was analysed using Statistical Package for the Social Science (SPSS)
version 24.0. Descriptive statistics in the form of graphs and cross tabulations were used to
describe the demographic and disease profile of the spinal pain patients. Inferential statistics
like chi-square, Fischer’s exact test for categorical variables and Independent student’s t tests for numerical variables were used to determine differences between the two clinics. A
p-value of less than 0.05 was used to indicate statistical significance (Singh, 2016).
Results: The sample size was 65% (n=714). There was a female preponderance (75.2%,
n=537), a mean age of 50.6 years (±SD 16.13). Most patients were married (38%) and the
most common occupations were either farmers (18.2%, n=129) or unemployed (16.3%,
n=115). The majority of patients suffered from chronic (88%), idiopathic (59.5%), low back
pain (69.9%), followed by upper/mid back (19.1%), with the least visits occurring for neck
pain (8%). The most frequent diagnosis was joint dysfunction with associated soft tissue
disorders. The patients reported mild disability with moderate pain intensity and most
patients had not experienced previous spinal pain (60%). The patients did not report a
secondary area of MSK pain (28.6%) and 73.9% of patients presented with at least one comorbid
Patients attending the rural clinic were older on average (52.7 years, ±SD 16.92) than those
at the urban clinic (48.9 years, ±15.29) (p = 0.002). There were more women attending the
urban clinic when compared to the rural clinic (p = 0.009), with those attending the rural
clinic most often reporting a primary school level of education in contrast to those in the
urban clinic having most likely obtained a more than secondary school education (p <
0.001). More patients in the urban clinic had “other mechanical” e.g. joint dysfunction as an
aetiology for their spinal pain when compared to the rural clinic (p = 0.039). In terms of pain
duration, the rural clinic patients were more likely to present with acute and subacute pain
than at the urban clinic (p = 0.001). The rural clinic patients also reported more previous
episodes of spinal pain in contrast to those from the urban clinic (p <0.001).
Conclusion: The spinal pain patients attending the WSC clinics had many similarities to
spinal pain patients internationally and in SA, however unique differences were found
specifically when the urban and rural clinic patients were compared. The findings of this
study can assist WSC to provide more targeted healthcare at each clinic and within this
Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017.
Appears in Collections:Theses and dissertations (Health Sciences)

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