Associated organisationsLondon School of Hygiene & Tropical Medicine · University of Bristol · University of KwaZulu-Natal · University of Oxford · University of SouthamptonEurope PMC affiliations are not treated as award recipients or mapped locations.
Funding£3.7M
PeriodApr 2020 — Mar 2025
In plain English
AI plain-English summary
Fragility fractures are already a major and growing problem for older adults in sub-Saharan Africa, yet the region has almost no data on how common they are, who is most at risk, or what they cost. This matters because the WHO has called for urgent action to prevent and manage these fractures in the region, but without basic epidemiological and economic evidence, health services cannot be designed or funded effectively. The myth that fragility fractures are not an African problem is outdated—life expectancy is rising rapidly, and sub-Saharan Africa already has twice as many older adults as northern Europe. The research will establish the prevalence of vertebral fractures (the most common type) and the incidence of hip fractures (the most life-changing), then track survival, disability, and health costs over 12 months. It will also examine risk factors specific to the region, such as HIV and body composition, and use ethnographic methods to understand how patients navigate care, what they believe about fractures, and how health services actually deliver treatment. If successful, the findings will give governments and health planners the hard evidence they need to allocate resources, set priorities, and design fracture services that work in local contexts—turning the WHO’s call for action into something achievable.
View original technical description
Sub-Saharan African (SSA) already has twice the number of older adults than northern Europe, with life expectancy rising rapidly. Ageing exponentially increases fracture risk. The WHO have called for action to prevent and manage fragility fractures in SSA in the next decade; there is an urgent and compelling need for research to inform actions to improve healthcare provision. We will establish vertebral fracture prevalence (the commonest fragility fracture), hip fracture incidence (the most life-challenging fragility fracture) and, over 12-months, their impact on survival, disability and health costs. We will examine the contribution of risk factors of importance in the context of SSA, e.g. HIV, body composition. Ethnographic research will inform understanding of fracture care pathways, patient’s beliefs, patterns of health service delivery and factors influencing implementation of fracture services. To ensure success, our collaboration encompasses international expertise in epidemiology, health economics, anthropology/qualitative methodology, HIV medicine, orthopaedic surgery, gerontology, skeletal imaging, and country-specific research experience within Gambia, Zimbabwe and South Africa. This application builds on our recently-completed South African hip fracture incidence study. The myth that fragility fractures are not an African problem is out-dated; high-quality research is needed, to enable a response to the WHO’s call to be realised.
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