Survey to assess Medical Doctors' knowledge on Rheumatology patient care and utilization of Rheumatology Services in Zambia 2020-2022

Background: Worldwide, majority of rheumatic and musculoskeletal disease (RMD) patients do not receive care from a rheumatologist. The study assessed doctors’ knowledge and capability to diagnose RMDs, and prescription practices of disease modifying anti-rheumatic drugs (DMARDs). Methods: This was an online based survey with doctors purposively surveyed using the Zambia Medical Association’s email list. Results: A total of 3,519 emails were sent to individual doctors, 1,317 (37%) opened their emails, and 156 (4%) clicked the survey link and completed it. Of these, 28% were females, 60% were aged 25-35 years, while 47% had less than 5 years’ experience. On medical training; 67% had only a primary medical qualification (only two, 1% were rheumatologists, and three, 2% orthopedic surgeons). Over 63% respondents were from the major cities, 65% saw less than five RMD patients and only 17% saw more than 20 patients over a six months period. Knowledge on use of laboratory biomarkers was low, and confidence to diagnose RMDs ranged between 5 – 44% with scleroderma and systemic vasculitis being list. Only 5% were very confident to prescribe DMARDs, and 69% had never prescribed any over a 12 months period, while less than 30% knew methotrexate as the recommended first line treatment for rheumatoid arthritis. 96% were not aware of any DMARDS covered by the National Health Insurance. Conclusion: Knowledge of rheumatic diseases, including biomarker tests and DMARDs used in diagnosis and treatment respectively, is lacking. There is a clear need for enhanced rheumatology training and expansion of services across Zambia.