Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Angela Migowa

Second Supervisor/Advisor

Dr. Anthony Ngugi


Paediatrics and Child Health (East Africa)


Background: A common reason implicated in the severity of presentation and mortality resulting from rheumatic conditions among children is the delayed presentation to a paediatric rheumatologist. Evidence suggests low-quality paediatric musculoskeletal clinical skills could be a cause for diagnostic delay and history suggestive of musculoskeletal disease alone has poor sensitivity in detecting paediatric rheumatic conditions. The paediatric gait, arms, legs, and spine (pGALS) musculoskeletal screening tool was developed to encourage early detection of paediatric rheumatic conditions. It has been validated and translated successfully in other countries. Kiswahili serves as a national language in several East African countries. Translating and validating the pGALS in Kiswahili will be beneficial to many regions. Hence, we determined the sensitivity, specificity, and acceptability of the Kiswahili-pGALS screening tool in detecting abnormal joints among Kiswahili-speaking children aged 5–16 years.

Methods: We conducted a diagnostic utility study. The three English-pGALS screening questions were translated into Kiswahili according to the World Health Organization standard of translation of a tool and maneuvers were performed by a ‘copy me’ approach. This approach entailed asking the participants to imitate the research assistants as various maneuvers were performed.Children between the ages of 5–16 years seen at the Aga Khan University Accident and emergency department and family medicine clinic who spoke Kiswahili and had symptoms suggestive of a musculoskeletal condition were enrolled using systematic random sampling. Children who were already on follow-up with the Aga Khan paediatric rheumatologist were excluded. The participants had the Kiswahili-pGALS and gold-standard review (with the paediatric rheumatologist) on the same day. Guardians were requested to answer questions on acceptability with regards to the time taken to perform the tool and level of discomfort. Those with possible rheumatic conditions as per the gold standard were offered follow-up.

Results: We enrolled one hundred children with a median age of nine years (IQR 7–11). The sensitivity and specificity of the Kiswahili-pGALS screening tool were 76.8% (CI 63.6–87.0%) and 40.0% (CI 23.9–57.9%). The diagnostic accuracy was 62.7% (CI 52.1–72.1%) and the ROC area was 0.58 (CI 0.48–0.68). The median time taken to perform the Kiswahili-pGALS

was 5.0 minutes (IQR 3.5-6.0 minutes). Ninety percent of the guardians found the practice of Kiswahili-pGALS to have ‘no’ to ‘some’ discomfort.

Conclusions: This Kiswahili-pGALS can be adapted for use in the referral process of children with musculoskeletal signs and symptoms to a paediatric rheumatologist for comprehensive evaluation and diagnosis.

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Pediatrics Commons