Musculoskeletal functional ability in three diverse Sub-Saharan Africa Populations; assessing muscle strength & function to understand healthy ageing
Lead Research Organisation:
University of Southampton
Department Name: Human Development and Health
Abstract
Around the world people are living longer than ever before. There are now 1 billion people aged over 60 years. In Africa, rising life expectancy is most rapid. The United Nations declaration of the Decade of Health Ageing 2021-2030 states there has never been a timelier opportunity to act to ensure the health of ageing adults, their families and communities. But ageing brings risk of disease, with muscles, bones and joints commonly affected (musculoskeletal disease), which limits walking and daily life. Often diseases exist together, such as with HIV and/or diabetes, this is known as multimorbidity. Multimorbidity is a high priority for global health research. Importantly, one third of all multimorbidity cases across the world include musculoskeletal disease. Currently musculoskeletal diseases account for disability than cancer and heart disease combined.
Loss of muscle strength and function is a common manifestation of ageing (known as sarcopenia), which leads to falls and fragility fractures (broken bones from low impact injuries), disability, frailty, and sometimes death. Despite this, little is known about how muscle ages in people living in sub-Saharan Africa (SSA), nor the risk factors for muscle loss or the impact on quality of life. We will study three different populations in The Gambia, Zimbabwe and South Africa. Aiming to:
i. How commonly muscle strength is impaired, physical functional is limited and sarcopenia is experienced.
ii. Understand to what extent losses in muscle strength and ability reduce the ability to perform activities of daily life, increase the risk of frailty and disability and how these impact quality of life.
iii. Identify clinical, nutritional and metabolic risk factors for losses muscle function, to inform approaches to reduce future disability, and promote healthy ageing in SSA.
Work package 1: What is the epidemiology of muscle strength, mass and function in each country? We collaborate with a team currently planning extensive community surveys in The Gambia, Zimbabwe and South Africa, which will measure spine fractures in 5040 men and women aged 40 years and over. We have a unique and time-limited opportunity to add to these surveys, data collection and detailed measurements of muscle strength, mass and function, to answer our specific study questions. We will collect data from questionnaires (e.g. joint and back pain, ability to work around the house, quality of life), body composition scans (to quantify fat and muscle mass), X-rays (to quantify osteoarthritis), muscle strength, walking and balance tests (to measure frailty), and blood tests. We will quantify levels of all musculoskeletal multimorbidities including sarcopenia, and determine how these affect disability and quality of life.
Work package 2: What are the clinical, nutritional and metabolic risk factors for low muscle strength, mass and function? Identifying risk factors for muscle impairment will aid understanding of the mechanisms underlying muscle dysfunction and highlight biomarkers that can predict disease and disability, with potential use in clinical settings. We will examine clinical (e.g. HIV, diabetes, physical inactivity, osteoarthritis) and nutritional risk factors (e.g. malnutrition, food insecurity, obesity), and measure 184 markers of metabolism and inflammation using the latest proteomic analysis of blood samples, to see which predict age-related losses in muscle.
We will feedback our findings to local communities, national health leads and policy makers, and international researchers.
This project grant offers a unique and highly-cost effective opportunity, taking advantage of a funded research platform. This MRC investment would permit detailed and novel study of muscle in some of the most rapidly ageing populations in the world. This presents a time-limited opportunity to answer these important research questions focusing on muscle health and functional ability.
Loss of muscle strength and function is a common manifestation of ageing (known as sarcopenia), which leads to falls and fragility fractures (broken bones from low impact injuries), disability, frailty, and sometimes death. Despite this, little is known about how muscle ages in people living in sub-Saharan Africa (SSA), nor the risk factors for muscle loss or the impact on quality of life. We will study three different populations in The Gambia, Zimbabwe and South Africa. Aiming to:
i. How commonly muscle strength is impaired, physical functional is limited and sarcopenia is experienced.
ii. Understand to what extent losses in muscle strength and ability reduce the ability to perform activities of daily life, increase the risk of frailty and disability and how these impact quality of life.
iii. Identify clinical, nutritional and metabolic risk factors for losses muscle function, to inform approaches to reduce future disability, and promote healthy ageing in SSA.
Work package 1: What is the epidemiology of muscle strength, mass and function in each country? We collaborate with a team currently planning extensive community surveys in The Gambia, Zimbabwe and South Africa, which will measure spine fractures in 5040 men and women aged 40 years and over. We have a unique and time-limited opportunity to add to these surveys, data collection and detailed measurements of muscle strength, mass and function, to answer our specific study questions. We will collect data from questionnaires (e.g. joint and back pain, ability to work around the house, quality of life), body composition scans (to quantify fat and muscle mass), X-rays (to quantify osteoarthritis), muscle strength, walking and balance tests (to measure frailty), and blood tests. We will quantify levels of all musculoskeletal multimorbidities including sarcopenia, and determine how these affect disability and quality of life.
Work package 2: What are the clinical, nutritional and metabolic risk factors for low muscle strength, mass and function? Identifying risk factors for muscle impairment will aid understanding of the mechanisms underlying muscle dysfunction and highlight biomarkers that can predict disease and disability, with potential use in clinical settings. We will examine clinical (e.g. HIV, diabetes, physical inactivity, osteoarthritis) and nutritional risk factors (e.g. malnutrition, food insecurity, obesity), and measure 184 markers of metabolism and inflammation using the latest proteomic analysis of blood samples, to see which predict age-related losses in muscle.
We will feedback our findings to local communities, national health leads and policy makers, and international researchers.
This project grant offers a unique and highly-cost effective opportunity, taking advantage of a funded research platform. This MRC investment would permit detailed and novel study of muscle in some of the most rapidly ageing populations in the world. This presents a time-limited opportunity to answer these important research questions focusing on muscle health and functional ability.
Technical Summary
In sub-Saharan Africa (SSA) shifting demographics, rapid urbanization and associated lifestyle changes are generating an exponential rise in non-communicable diseases of ageing, of which musculoskeletal diseases are a significant proportion. There is an urgent need to reduce the time people spend living with locomotor disabilities and dependence, and to maximize functional ability amongst the growing ageing populations in resource poor countries in SSA. This proposal focuses on three countries, The Gambia, South Africa and Zimbabwe. Hypothesis: In the diverse ageing populations, high levels of adiposity and chronic infection with low levels of dietary diversity and physical activity are, in differing combinations, responsible for growing levels of sarcopenia and poor functional ability.
WP1: What is the epidemiology of muscle strength, mass and function in each country? We collaborate with a team currently planning extensive community-based population prevalence surveys in The Gambia, Zimbabwe and South Africa. We have a unique and time-limited opportunity to add to these surveys. We will collect data from questionnaires, DXA scans, muscle strength and function, physical performance and blood tests. We will quantify musculoskeletal multimorbidities including sarcopenia and determine associations with disability and HRQoL.
WP2: What are the clinical, nutritional and metabolic risk factors for low muscle strength, mass and function? Identifying risk factors for muscle impairment will aid understanding of mechanisms underlying muscle dysfunction. We will examine clinical, nutritional and metabolomic markers, and determine predictors of sarcopenia.
Findings fed-back to local communities, national health leads and policy makers.
This project grant offers a highly-cost effective opportunity, taking advantage of a funded research platform. This MRC investment would permit detailed and novel study of muscle in some of the most rapidly ageing populations in the world.
WP1: What is the epidemiology of muscle strength, mass and function in each country? We collaborate with a team currently planning extensive community-based population prevalence surveys in The Gambia, Zimbabwe and South Africa. We have a unique and time-limited opportunity to add to these surveys. We will collect data from questionnaires, DXA scans, muscle strength and function, physical performance and blood tests. We will quantify musculoskeletal multimorbidities including sarcopenia and determine associations with disability and HRQoL.
WP2: What are the clinical, nutritional and metabolic risk factors for low muscle strength, mass and function? Identifying risk factors for muscle impairment will aid understanding of mechanisms underlying muscle dysfunction. We will examine clinical, nutritional and metabolomic markers, and determine predictors of sarcopenia.
Findings fed-back to local communities, national health leads and policy makers.
This project grant offers a highly-cost effective opportunity, taking advantage of a funded research platform. This MRC investment would permit detailed and novel study of muscle in some of the most rapidly ageing populations in the world.
Publications
Burton A
(2023)
Fractures in sub-Saharan Africa: epidemiology, economic impact and ethnography (Fractures-E3): study protocol
in Wellcome Open Research
Cronin O
(2022)
Role of the Microbiome in Regulating Bone Metabolism and Susceptibility to Osteoporosis.
in Calcified tissue international
Dlamini SN
(2022)
Targeted proteomics of appendicular skeletal muscle mass and handgrip strength in black South Africans: a cross-sectional study.
in Scientific reports
Harvey NC
(2022)
UKRI MRC National Musculoskeletal Ageing Network: strategic prioritisation to increase healthy lifespan and minimise physical frailty.
in Archives of osteoporosis
Madanhire T
(2023)
The Impact of Human Immunodeficiency Virus and Menopause on Bone Mineral Density: A Longitudinal Study of Urban-Dwelling South African Women.
in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
Mukwasi-Kahari C
(2023)
Impaired Bone Architecture in Peripubertal Children With HIV, Despite Treatment With Antiretroviral Therapy: A Cross-Sectional Study From Zimbabwe.
in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
Norris SA
(2022)
Nutrition in adolescent growth and development.
in Lancet (London, England)
Ward KA
(2023)
Disparities in the Prevalence of Osteoporosis and Osteopenia in Men and Women Living in Sub-Saharan Africa, the UK, and the USA.
in Current osteoporosis reports
Ward KA
(2022)
Challenges to current and future bone health in young women living with HIV.
in The Lancet. Global health
Ward Kate A.
(2022)
Challenges to current and future bone health in young women living with HIV
in LANCET GLOBAL HEALTH
Title | Fractures-E3 film |
Description | This video features reflections from the investigator team who met in Harare in March 2023 discussing dissemination, public and stakeholder engagement and the way forward for a mixed-methods study aiming to establish frequency of vertebral and hip fractures, risk factors, health costs, consequences, care pathways and available health services in South Africa, Zimbabwe and The Gambia. |
Type Of Art | Film/Video/Animation |
Year Produced | 2023 |
Impact | This video is accessible through multiple platforms; The Health Research Unit Zim (THRU ZIM), Fractures-e3 website and University of Bristol and THRU ZIM YouTube channels and aims to engage and disseminate information on the aims and activities of Fracture-E3 study to the wider public. |
URL | https://www.youtube.com/watch?v=rivJV3rtE6A&t=232s |
Description | National Nutrition Agency, The Gambia |
Geographic Reach | Africa |
Policy Influence Type | Contribution to new or improved professional practice |
Description | Research England International Science Partnership Award |
Amount | £32,000 (GBP) |
Organisation | United Kingdom Research and Innovation |
Sector | Public |
Country | United Kingdom |
Start | 03/2023 |
End | 03/2034 |
Description | CZI Ancestry of Musculoskeletal Tissues |
Organisation | University of Oxford |
Department | Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Diseases (NDORMS) |
Country | United Kingdom |
Sector | Academic/University |
PI Contribution | I am lead for MRC Gambia site. |
Collaborator Contribution | Leading the work and capacity building, community engagement |
Impact | Not yet |
Start Year | 2022 |
Description | MRC Unit The Gambia Genomics collaboration |
Organisation | Medical Research Council (MRC) |
Department | MRC Unit, The Gambia |
Country | Gambia |
Sector | Public |
PI Contribution | A new collaboration with Dr Abdul Sesay Head of Genomics, MRCG. He and team are collaborating on the DNA extraction methods for MUFASSA |
Collaborator Contribution | Leading and advising laboratory work |
Impact | TRaining of team for DNA extraction. Work still in progress |
Start Year | 2022 |
Description | A talk by Prof Celia Gregson in collaboration with MUFASSA was given at MRC National Musculoskeletal Ageing Network Seminar entitled "Musculoskeletal research in sub-Saharan Africa" |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | The talk was intended to inform and communicate the findings of Fractures-E3 and MUFASSA studies. |
Year(s) Of Engagement Activity | 2023 |
Description | A talk by Prof Celia Gregson in collaboration with MUFASSA was given to NAPAZ and ECSACOP entitled "Challenges of musculoskeletal multimorbidities in sub-Saharan Africa: findings from the Fractures-E3 and MUFASSA studies" |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | The talk was intended to disseminate findings from MUFASSA and Fractures-E3 projects to the wider public and to raise further interest and debate. |
Year(s) Of Engagement Activity | 2023 |
Description | Associate Editor of the Journal of Bone and Mineral Research |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | Kate was Associate Editor of the Journal of Bone and Mineral Research 2018-2022 inclusive. |
Year(s) Of Engagement Activity | 2022 |
Description | BoneUp podcast interview |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | Kate was interviewed for an hour-long podcast, talking about my research programme in global musculoskeletal health. |
Year(s) Of Engagement Activity | 2021 |
Description | BoneUp podcast interview at Bone Research Society |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | I was interviewed as part of a podcast from the Bone Research Society Annual Conference in Manchester. I am President of the Society. |
Year(s) Of Engagement Activity | 2022 |
Description | Conference presentation |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Winfrida Tombe-Mdewa (NIHR Academy Member): - Oral presentation at the Public Health association of South Africa 2022 Conference - A cost effectiveness analysis of maternal multiple micronutrient supplementation in South Africa |
Year(s) Of Engagement Activity | 2022 |
Description | Conference presentation |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | - 13th South African Child Health Priorities Association Conference. 24-26 November 2022. School of Public Health, Johannesburg. Oral presentation title: Perceptions of community-based organizations of mothers' social needs around maternal and child nutrition in urban South Africa |
Year(s) Of Engagement Activity | 2022 |
Description | Fractures-E3 Website and SAMSON twitter account associated with MUFASSA project |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | The MUFASSA project is associated with other studies; @SAMSON_tweets and Fractures-E3. Including information and link to MUFASSA project through the associated websites and social media accounts increases the visibility of the project. |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.fractures-e3.com/mufassa/ |
Description | Gave a joint talk at the Global Health Symposium (University of Southampton and University of Witwatersrand, South Africa) |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | The talk was entitled "Muscle and bone magic: ageing with strength". |
Year(s) Of Engagement Activity | 2023 |
Description | Gave a joint-talk at World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases conference (WCOIOF-ESCEO) in Barcelona, Spain |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Prof Ward gave a talk on behalf of the MUFASSA study group to Over 50 participants from the international communities of professionals, policy makers, and post-graduate students. Her talk entitled: 'Muscle and functional ability in sub-Saharan Africa: The MUFASSA study'. The talk stimulated increased interest in the research. The talk stimulated a lot of interest and questions about the study. |
Year(s) Of Engagement Activity | 2023 |
Description | International Federation of Musculoskeletal Research Societies 2022 online webinar |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Professional Practitioners |
Results and Impact | It provides a framework for tackling some of the biggest challenges facing the musculoskeletal community as regards education, knowledge-sharing and collaborative working, and contains links to a wide range of key resources, including the IFMRS Knowledge Network. |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.ifmrs.org/ |
Description | Invited Speaker - International Osteoporosis Foundation |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | I was an invited speaker to at the IOF meeting. Fracture Prevention Services in LMICs. |
Year(s) Of Engagement Activity | 2022 |
Description | Invited Speaker for an online symposium |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | I was an invited speaker to an online International Federation of Musculoskeletal Sciences talk. The Sub-Saharan African Musculoskeletal Network and research in Africa. |
Year(s) Of Engagement Activity | 2022 |
Description | Invited Talk at London School for Hygiene and Tropical Medicine Global Health Leaders Session |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Media (as a channel to the public) |
Results and Impact | I was an invited speaker to an online symposium hosted by London School of Hygiene and Tropical Medicine. |
Year(s) Of Engagement Activity | 2022 |
Description | Invited author of International Federation of Musculoskeletal Science Research blog April 2023 |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Blog |
Year(s) Of Engagement Activity | 2023 |
URL | https://mailchi.mp/4a5a93c693f3/ifmrs_february2023-13889862 |
Description | Invited to be a panel member of the MRC African Research Leader panel (2024) |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | The panel supports exceptional early to mid-career African researchers to conduct excellent global health research across sub-Saharan Africa (SSA). |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.ukri.org/opportunity/african-research-leaders/ |
Description | Meeting with the community leaders in the Gambia |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | Met with the community leaders in the Gambia to talk about the project. |
Year(s) Of Engagement Activity | 2023 |
Description | Menopause Study Dissemination Event 2023 NOFSA, THRU-Zim, Uo Bristol |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Policymakers/politicians |
Results and Impact | Understanding the impact of HIV infection and the effect of menopause on the health, and particularly musculoskeletal health, of African women. (The MENOPAUSE Study) |
Year(s) Of Engagement Activity | 2023 |
URL | https://osteoporosis.org.za/nofsa-events/the-menopause-study-online-event/ |
Description | Organizing Bone Research Society and European Calcified Tissues Society joint annual meeting. |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | Organised BRS annual meeting |
Year(s) Of Engagement Activity | 2023 |
URL | https://boneresearchsociety.org/meetings/198/ |
Description | Prof Ward KW gave a presentation about MUFASSA at the London School of Hygiene and Tropical Medicine for their African Alliance on Multimorbidity 'Musculoskeletal health and multimorbidity' |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | The talk was intended to publicise the findings of MUFFASA research to the wider audience and to initiate further discussions. |
Year(s) Of Engagement Activity | 2023 |
Description | Prof Ward did a Unit Seminar when she was in The Gambia entitled 'Ensuring healthy musculoskeletal ageing: The Fractures E3 and MUFASSA studies |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Study participants or study members |
Results and Impact | The talk was a unit seminar for educational purposes. |
Year(s) Of Engagement Activity | 2023 |
Description | Prof Ward gave a talk at National Nutrition Agency, Banjul, The Gambia |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | The talk was entitled "'Ensuring healthy musculoskeletal ageing in diverse populations" which sparked questions and discussion afterwards. |
Year(s) Of Engagement Activity | 2024 |
Description | Prof Ward gave a talk at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases conference (WCOIOF-ESCEO) in Barcelona, Spain |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | Prof Kate Ward gave a talk on determining sarcopenia prevalence in The Gambia, South Africa and Zimbabwe, and musculoskeletal ageing. |
Year(s) Of Engagement Activity | 2023 |
Description | Radio interview |
Form Of Engagement Activity | A broadcast e.g. TV/radio/film/podcast (other than news/press) |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Public/other audiences |
Results and Impact | - Radio Interview with Radio 786, on the 9th of January about the importance of investing in early child nutrition in South Africa |
Year(s) Of Engagement Activity | 2023 |
Description | Website - MUFASSA study |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | The website is intended to inform and disseminate information about the MUFASSA project to the wider public. |
Year(s) Of Engagement Activity | 2023 |
URL | https://www.southampton.ac.uk/global-health/research/mufassa.page |