Challenges and barriers to musculoskeletal injury research in sub-Saharan Africa

Aims: Musculoskeletal (MSK) injuries are a major cause of morbidity and mortality worldwide. However, research into MSK injuries is hampered by significant challenges and barriers, particularly in low-and middle-income countries (LMICs). Our aim was to identify the most important challenges and barriers to MSK injury care research across Malawi, South Africa, and Tanzania. Methods: We conducted a three-stage modified Delphi study. In Stage 1, healthcare professionals and researchers involved in MSK injury care listed challenges and barriers to conducting MSK injury research, which were consolidated in 25 themes. In Stage 2, participants rated each theme on a five-point Likert scale. In Stage 3, to drive consensus, participants re-rated the themes after viewing group and country-specific feedback from the previous stage. Challenges and barriers were ranked by mean score. Consensus was defined as ≥ 75% of respondents rating a theme as 4 or 5 ('important' and 'most important' on the Likert Scale). Results: A total of 396 participants completed Stage 1, 424 completed Stage 2, and 434 completed Stage 3. Across all participants, consensus (≥ 75%) was reached on nine key challenges and barriers to MSK injury research, including: lack of funding, high clinical workloads, limited training and mentorship, poor-quality data collection practices, healthcare facility resource constraints, patient loss to follow-up, limited research opportunities outside academic institutions, poverty and financial barriers, and healthcare delays. At the country level, the challenges of lack of funding, high clinical workload, and inconsistent data collection practices consistently achieved consensus in Malawi, South Africa, and Tanzania. Conclusion: MSK injuries impose a substantial burden in sub-Saharan Africa, yet research remains limited by funding shortages, high clinical workloads, and inconsistent data collection practices. These challenges, consistently identified across Malawi, South Africa, and Tanzania, highlight the need for targeted investment and regional collaboration to strengthen research capacity and improve patient outcomes.