Socioeconomic burden of osteoarthritis in Sub-Saharan Africa and the determinants of healthcare inequities: a scoping review protocol

Abstract

Introduction

Access to musculoskeletal healthcare services in Sub-Saharan Africa is inadequate. As osteoarthritis is the most prevalent chronic osteoarticular disease globally, it’s essential to understand its social and economic impact, as well as the determinants of inequities in access to healthcare services in Sub-Saharan Africa. The absence of systematised knowledge on this topic makes this review pertinent. However, due to data scarcity, assessing this burden is challenging. The objective of this scoping review is to map and summarise the available literature up to 2025 on the socioeconomic burden and health inequity determinants among the Sub-Saharan African population with osteoarthritis.

Methods and analysis

A predefined search strategy will be applied to MEDLINE (via PubMed), Embase, African Journals Online and African Index Medicus to incorporate articles relevant to adults diagnosed with osteoarthritis who are residents of sub-Saharan Africa. We will also include grey literature sources such as Google Scholar, Research Square, manuals, books, medical society websites, secondary databases, theses and dissertation repositories and conference proceedings. Study selection will be conducted in two stages by a pair of reviewers who will independently screen titles and abstracts according to the eligibility criteria, followed by a full-text review of the selected studies. The search period was from October 2025 to January 2026. Data extraction will be performed using a standardised charting form developed by the review team.

Ethics and dissemination

This scoping review maps evidence on OA-related socioeconomic impacts and healthcare inequities in Sub-Saharan Africa. As a secondary data analysis, ethical approval is not required. Findings will be disseminated via peer-reviewed journals and academic conferences to clinicians and policymakers.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• This review includes quantitative, qualitative and grey literature to provide a comprehensive map of evidence.

• The search strategy imposes no language restrictions, minimising potential publication bias.

• Study selection and data extraction will be performed by two independent reviewers to ensure reliability.

• A formal critical appraisal of the methodological quality of included studies will not be conducted.

• The scoping methodology focuses on the breadth of evidence rather than providing a synthesised measure of effect.

Introduction

Osteoarthritis (OA) is the most common form of arthritis and, globally, represented 57% of all arthritic conditions, excluding gout, in 2021 to 2022.¹ It is a joint disease in adults characterised by cartilage degradation and bone remodelling, chronic pain and loss of mobility. Hip and knee OA impose a significant burden due to disability and the frequent need for surgical interventions, which are rarely covered by public healthcare systems in low-income countries.² With the increase in life expectancy, OA is predicted to become more prevalent in the coming decades. People are experiencing more years with disability and are perceiving adverse impacts on their health and well-being.³ The increasing life expectancy in Sub-Saharan Africa (SSA) projects OA as one of the leading causes of disability in the population over 40 years of age.⁴

OA is also known to negatively impact (work) participation and increase healthcare utilisation, making it a significant economic and individual burden that should be considered from a public health perspective.⁵

Despite the growing global burden of OA—with 595 million cases in 2020 and projections of substantial increases by 2050—epidemiological data on the disease in SSA are notably limited.⁴ Musculoskeletal health has been neglected in most of the region due to scarce resources and lack of information.⁶ The predominance of rural populations and the primary economic sector being the largest source of employment in SSA⁷ amplify the impact of OA on productivity and family income, burdening already fragile social security systems. Furthermore, access to surgical treatments and rehabilitation is severely restricted, with less than 10% of the SSA population (excluding South Africa) having access to joint replacement surgeries.⁸

It is fundamental to understand the social and economic impact of OA and the factors perpetuating inequities in access to healthcare, specifically in SSA, in order to inform the development of effective strategies.⁴ A preliminary search of the databases did not identify any scoping reviews dealing with this topic. Considering the absence of published scoping reviews focused on OA and its impact on the SSA population, this scoping review aims to map available evidence and identify knowledge gaps, serving as a basis for future in-depth research.

Review question

“What is the available evidence on the socioeconomic impact and health inequities related to osteoarthritis among adults in Sub-Saharan Africa?”

Inclusion criteria

Participants

The review will consider studies that include only adult patients (aged 18 years or older) diagnosed with OA (using clinical and radiological criteria defined by the Osteoarthritis Research Society International (OARSI), American College of Rheumatology (ACR), National Institute for Health and Care Excellence (NICE), Kellgren–Lawrence System e WHO SAGE symptom-based algorithm).

Studies lacking a clear definition of OA or those that do not provide segregated data specifically for OA diagnosis will be excluded.

Concept

The main concept of interest in this scoping review is the socioeconomic burden of OA and the associated inequities in healthcare. To ensure conceptual clarity, the following definitions are adopted in this study:

• Occupational exposures: Physical (eg, heavy lifting and load carrying; frequent kneeling, squatting and knee bending; prolonged standing; walking on hard surfaces; and whole-body vibration) encountered in the work environment that may contribute to joint degradation.

• Environmental and lifestyle factors: External conditions (eg, pollution promotes systemic inflammation, increases oxidative stress and alters cartilage metabolism) and individual habits (eg, physical activity patterns) that influence health outcomes.

• Demographic and socioeconomic vulnerability: Factors such as age, gender, low income, place of residence, culture and limited education that increase the risk of inadequate healthcare access.

• Workforce: Includes both formal and informal workers whose productivity and participation are affected by the disease.

Context

The context of this review is SSA. Studies will be included if they are conducted within countries geographically located in the SSA region and involve residents of these countries.

Types of sources

This scoping review will encompass published work from traditional databases, grey literature and non-peer-reviewed sources, including theses, dissertations and conference proceedings.

Methods

This scoping review protocol was registered on the Open Science Framework (OSF) platform (Registration DOI: 10.17605/OSF.IO/EGDZJ).

We will follow the methodological framework by Arksey and O’Malley,⁹ as adapted by Levac et al¹⁰, to conduct this scoping review. Results will be presented according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)¹¹ and the updated methodological guide of the Joanna Briggs Institute (JBI) Centre of Excellence¹²

Search strategy

The search strategy and the initial and secondary searches were conducted in collaboration with a research librarian. We will conduct a search in the following databases: MEDLINE (via PubMed), Embase, Scopus and LILACS, according to their respective syntax rules. In addition, there are other sources, such as African Journals Online (AJOL) and African Index Medicus (AIM). We will include grey literature, such as Google Scholar, Research Square, manuals, books, medical society websites, thesis and dissertation repositories, and conference proceedings. Searches will be complemented by checking the reference lists of selected studies for full-text review (cross-referencing) and by contacting authors who publish in the field of OA epidemiology. There will be no restrictions on language. The literature search was conducted between October 2025 and January 2026 for studies published from inception to January 2026. At the time of this submission, the study is in the data extraction and synthesis stage. The complete search strategy, including all keywords and Boolean operators for each database, is detailed in table 1.

Table 1. Search strategy.

Database	Strategy
MEDLINE	(“Osteoarthritis”(MeSH Terms))OR “Osteoarthritis”(Title/Abstract)OR “osteoarthrosis”(Title/Abstract)OR “Arthrosis”(Title/Abstract)OR “Arthritis”(MeSH Terms))OR “Arthritis”(Title/Abstract)OR “Polyarthritis”(Title/Abstract)) AND (((((“sub saharan african people”(MeSH Terms))OR “africa south of the sahara”(MeSH Terms))OR “Angola”(MeSH Terms))OR “Angola”(Title/Abstract)OR “Benin”(MeSH Terms))OR “Benin”(Title/Abstract)OR “Botswana”(MeSH Terms))OR “Botswana”(Title/Abstract)OR “burkina faso”(MeSH Terms))OR “bukina faso”(Title/Abstract)OR “cabo verde”(MeSH Terms))OR “cabo verde”(Title/Abstract)OR “central african republic”(MeSH Terms))OR “Cameroon”(MeSH Terms))OR “Cameroon”(Title/Abstract)OR “Chad”(MeSH Terms))OR “Chad”(Title/Abstract)OR “Congo”(MeSH Terms))OR “Congo”(Title/Abstract)OR “cote d ivoire”(MeSH Terms))OR “cote d ivoire”(Title/Abstract)OR “democratic republic of the congo”(MeSH Terms))OR “Djibouti”(MeSH Terms))OR “Djibouti”(Title/Abstract)OR “equatorial guinea”(MeSH Terms))OR “equatorial guinea”(Title/Abstract)OR “Eritrea”(MeSH Terms))OR “Eritrea”(Title/Abstract)OR “Eswatini”(MeSH Terms))OR “Eswatini”(Title/Abstract)OR “Ethiopia”(MeSH Terms))OR “Ethiopia”(Title/Abstract)OR “Gabon”(MeSH Terms))OR “Gabon”(Title/Abstract)OR “Gambia”(MeSH Terms))OR “Gambia”(Title/Abstract)OR “Ghana”(MeSH Terms))OR “Ghana”(Title/Abstract)OR “Ghana”(Title/Abstract)OR “Guinea”(MeSH Terms))OR “Guinea”(Title/Abstract)OR “guinea bissau”(MeSH Terms))OR “guine bissau”(Title/Abstract)OR “Kenya”(MeSH Terms))OR “Kenya”(Title/Abstract)OR “lesotho”(MeSH Terms))OR “lesotho”(Title/Abstract)OR “Liberia”(MeSH Terms))OR “Liberia”(Title/Abstract)OR “Malawi”(MeSH Terms)) AND (“Or”(All Fields))AND “Malawi”(Title/Abstract))) OR “Mali”(MeSH Terms))OR “Mali”(Title/Abstract)OR “Mauritania”(MeSH Terms))OR “Mauritania”(Title/Abstract)OR “Mozambique”(MeSH Terms))OR “Mozambique”(Title/Abstract)OR “Namibia”(MeSH Terms))OR “Namibia”(Title/Abstract)OR “Niger”(MeSH Terms))OR “Niger”(Title/Abstract)OR “Nigeria”(MeSH Terms))OR “Nigeria”(Title/Abstract)OR “Rwanda”(MeSH Terms))OR “Rwanda”(Title/Abstract)OR “sao tome and principe”(MeSH Terms))OR “sao tome and principe”(Title/Abstract)OR “Senegal”(MeSH Terms))OR “Senegal”(Title/Abstract)OR “sierra leone”(MeSH Terms)) AND “sierra leone”(Title/Abstract)) OR “Somalia”(MeSH Terms))OR “Somalia”(Title/Abstract)OR “south africa”(MeSH Terms))OR “south africa”(Title/Abstract)OR “south sudan”(MeSH Terms))OR “south sudan”(Title/Abstract)OR “Tanzania”(MeSH Terms))OR “Tanzania”(Title/Abstract)OR “Togo”(MeSH Terms))OR “Togo”(Title/Abstract)OR “Uganda”(MeSH Terms))OR “Uganda”(Title/Abstract)OR “Zambia”(MeSH Terms))OR “Zambia”(Title/Abstract)OR “Zimbabwe”(MeSH Terms))OR “Zimbabwe”(Title/Abstract))
EMBASE	('osteoarthritis’/exp OR osteoarthritis OR 'osteoarthrosis’/exp OR osteoarthrosis OR 'arthrosis’/exp OR arthrosis OR 'arthritis’/exp OR arthritis OR 'polyarthritis’/exp OR polyarthritis) AND (’sub-saharan’ OR 'africa south of the sahara’ OR angola OR benin OR botswana OR 'burkina faso’ OR 'cabo verde’ OR 'central african republic’ OR cameroon OR chad OR congo OR 'cote divoire’ OR 'democratic republic of the congo’ OR djibouti OR 'equatorial guinea’ OR eritrea OR eswatini OR ethiopia OR gabon OR gambia OR ghana OR guinea OR 'guine bissau’ OR kenya OR lesotho OR liberia OR malawi OR mali OR mauritania OR mozambique OR namibia OR niger OR nigeria OR rwanda OR ’sao tome and principe’ OR senegal OR ’sierra leone’ OR somalia OR ’south africa’ OR ’south sudan’ OR 'tanzania’ OR togo OR uganda OR 'zambia’ OR zimbabwe) AND (embase)/lim NOT ((embase)/lim AND (medline)/lim) AND ('article’/it OR 'article in press’/it OR 'review’/it)
SCOPUS	(TITLE-ABS-KEY ((osteoarthritis OR osteoarthrosis OR arthrosis OR arthritis OR polyarthritis)) AND TITLE-ABS-KEY ((“sub-saharan africa” OR “africa south of the sahara” OR angola OR benin OR botswana OR “burkina faso” OR “cabo verde” OR “central african republic” OR cameroon OR chad OR congo OR “cote divoire” OR “democratic republic of the congo” OR djibouti OR “equatorial guinea” OR eritrea OR eswatini OR ethiopia OR gabon OR gambia OR ghana OR guinea OR “guine bissau” OR kenya OR lesotho OR liberia OR malawi OR mali OR mauritania OR mozambique OR namibia OR niger OR nigeria OR rwanda OR “sao tome and principe” OR senegal OR “sierra leone” OR somalia OR “south africa” OR “south sudan” OR “Tanzania” OR togo OR uganda OR “Zambia” OR zimbabwe))) AND (LIMIT-TO (DOCTYPE, “ar”) OR LIMIT-TO (DOCTYPE, “re”))
Google Scholar	(Osteoarthritis OR osteoarthrosis OR Arthrosis OR Arthritis OR Polyarthritis) AND (“subsaharan” OR subsaharan)

Study selection

All identified citations will be collated in Rayyan AI (artificial intelligence), a web-based and mobile collaboration platform that leverages artificial intelligence to streamline and accelerate the systematic literature review process for researchers, where duplicates will be removed automatically and remaining duplicates will be manually identified and removed. Study selection will be performed in two stages. In the first stage, a pair of independent reviewers (AG and FS) will independently screen and select studies based on titles and abstracts identified during the search phase, according to the eligibility criteria. In the second stage, the same reviewers will independently conduct a full-text review of the selected studies. Discrepancies will be resolved by consensus during a meeting. If reviewers cannot reach a consensus, a third review author will be called on to act as an arbiter.

Data extraction and synthesis

Data will be extracted using a standardised form, developed by the review team and adapted to accommodate both quantitative and qualitative evidence (online supplemental appendix 1). Information collected will include details about authors, title, journal, publication year and study objective. If necessary, we will contact authors of selected studies for clarification of doubts, as well as for suggestions of other studies not yet selected for the scoping review. For quantitative data, we will extract numerical results (eg, prevalence, productivity, loss days). For qualitative data, we will extract primary findings and supporting participant quotes related to the experience of OA and barriers to care. To allow for a meaningful synthesis, quantitative findings will be ‘qualitized’—converted into textual descriptions or themes. This allows for the integration of numerical data with the thematic results of qualitative studies. Finally, both types of data will be combined into a single narrative synthesis, organised by the key pillars of our review (socioeconomic impact, health inequities and workforce participation).

To assess inequity, we will use the PROGRESS acronym¹³ :

1. P (Place) – Place of residence.

2. R (Race) – Race, culture, ethnicity and language.

3. O (Occupation) – Occupation.

4. G (Gender and sex) – Gender and sex.

5. R (Religion) – Religion.

6. E (Education) – Education.

7. S (Socioeconomic status) – Socioeconomic status.

8. S (Social capital) – Social capital.

To assess the socioeconomic burden, we will select the following data:

1. Prevalence of OA in working-age populations.

2. Demographic characteristics (to identify the most affected occupational groups).

3. Socioeconomic impact on household income (formerly 'access to income’).

4. Work productivity metrics (specifically absenteeism and presenteeism).

5. Work participation status (return to work or premature retirement).

6. Social security integration (access to disability benefits or sick leave).

Data analysis and presentation

We will use the PRISMA-ScR protocol as a guide for reporting our scoping review. Extracted data will be presented in diagrammatic or tabular form in a manner that aligns with the objective of this scoping review. The charting table will report on the distribution of papers by year of publication, country of origin, study design, research methods and the key findings/outcomes. A narrative summary will accompany the tabulated and/or charted results and will describe how the results relate to the review’s objective and question.

Ethics and dissemination

This scoping review will map the available literature regarding the socioeconomic impacts and determinants of healthcare inequity associated with OA in the SSA population. As this study involves the analysis of secondary data from previously published literature, formal ethical approval is not required. The findings will be disseminated through peer-reviewed publications and conference presentations to clinical practitioners, public health researchers and regional policymakers. This review aims to identify knowledge gaps and provide a comprehensive perspective from low- and middle-income countries within SSA that are frequently under-represented in international literature.

Strengths

This scoping review fills a critical gap in the global literature as one of the first studies to synthesise evidence on the socioeconomic impact of osteoarthritis in SSA, shifting the focus from a purely biomedical paradigm toward the social determinants of health. This work does not merely aim to quantify existing studies but to organise the evidence in a way that demonstrates to policymakers exactly where the health system is failing patients with osteoarthritis.

Limitation

Several limitations regarding the available evidence in the SSA context must be acknowledged. First, there is a known scarcity of epidemiological data and a limited number of regional databases, which often leads to an under-representation of SSA countries in international peer-reviewed literature. Consequently, significant data may reside within government reports and grey literature, which can be challenging to access and systematically retrieve. Furthermore, the wide cultural, economic and geographic diversity across the region may complicate the interpretation of results, as the socioeconomic impacts of OA can vary substantially between different national health systems. Finally, there is a risk that critical social determinants—such as gender inequality, poverty levels and specific cultural barriers—may be insufficiently explored in the existing studies, potentially limiting the depth of our analysis regarding the drivers of healthcare inequity in this population.

Data availability statement

Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available.