In Kenya and across Africa, where thousands of children silently endure the debilitating effects of arthritis, the disease remains an often-overlooked health challenge. Affecting one in a thousand children, pediatric arthritis is underdiagnosed and poorly managed, largely due to shortage of specialists and limited awareness among healthcare providers and communities.
According to Dr. Angela Migowa, Kenya’s first female pediatric rheumatologist and founder of the Hope Arthritis Foundation, Africa’s healthcare systems have historically focused on high-mortality pediatric diseases such as Malaria, HIV, Prematurity and Pneumonia leaving chronic conditions like pediatric arthritis on the periphery and she is determined to change this narrative.
Speaking at the launch of Hope Arthritis Foundation’s strategic plan, she said that there is underdiagnosis and under-recognition of pediatric rheumatology diseases, not only in society but even among healthcare workers.
“This highlights the urgent need to scale up pediatric rheumatology knowledge and skills among non-specialist healthcare workers to promote early diagnosis, referral, and management.”
Dr. Migowa explained that pediatric rheumatic diseases often have life-threatening and poorly understood implications. They can cause permanent disability, impacting children’s growth, development, and overall quality of life. Early diagnosis and prompt treatment are critical to preventing long-term complications.
She explains that Pediatric Rheumatology (PRH) workforce in Kenya does not meet the needs of children sometimes resulting in lack of timely access to PRH care which is associated with poor outcomes for children with rheumatic diseases.
With only two practicing pediatric rheumatologists serving Kenya’s children and just 15 across all of Africa’s 54 countries, access to timely and specialized care is rare. Dr. Migowa warns that this gap often results in delayed diagnoses and inadequate treatment, leaving many children to suffer unnecessary pain and disability.
Because of dearth of specialist, Dr Migowa says that there is a need to understand and scale-up pediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management.
Dr. Migowa’s Hope Arthritis Foundation aims to address these gaps by creating awareness campaigns and training healthcare providers to identify and manage pediatric rheumatic conditions.
Her advocacy emphasizes on giving hope to juvenile arthritis patients and care givers, empowering general practitioners and other non-specialists with the skills needed for early diagnosis and referral.
“By equipping healthcare workers with knowledge and skills, we can drastically improve outcomes for children,” she said.
Pediatric rheumatology is a sub-specialty that focusses on diagnoses and treatment of newborns through to 18-year-old teenage children with autoimmune disorders, including Juvenile Idiopathic Arthritis, lupus, myositis, scleroderma, psoriasis, Behcet’s disease, and various vasculitides such as Kawasaki disease as well as non-specific pain of the muscles or bones among others.
She explains that environmental triggers like pollution, diet changes, untreated infections, and genetic predispositions contribute to the disease. However, Africa’s healthcare focus has historically been on high-mortality conditions such as malaria, pneumonia, and HIV.
She adds that pediatric rheumatic diseases, such as juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, and vasculitis, often manifest with swollen joints, intermittent fevers, rashes, and fatigue. However, in children, symptoms can be subtle, with changes in behavior, such as limping or avoiding play, providing the first clues.
Pediatric rheumatic diseases comprise a complex array of chronic diseases with fluctuating courses that often are challenging to diagnose and manage. The disorders are life-threatening and poorly understood. They can lead to disability that may be permanent and can potentially affect different aspects of growth, development and quality of life. Early diagnosis is essential to properly manage these children to prevent long-term complications.
“For children whose bones are still growing, untreated arthritis can lead to lifelong disability,” she explained. “If juvenile arthritis isn’t caught early and properly managed, children face a life sentence of pain, joint damage, and increasing disability.”
Dr. Migowa advocates for empowering healthcare workers to recognize early signs of pediatric rheumatic diseases.
“Taking a good medical history accounts for 80percent of the diagnosis,” she said, emphasizing the importance of monitoring milestones and behaviors in children adding that, “Parents may notice their child isn’t crawling or walking like before, or they may observe morning stiffness,” Dr. Migowa noted.
Globally, six million people live with arthritis and related diseases, with 78 percent of these cases occurring in Africa and Asia, regions with only 0.2percent of the healthcare workforce.
She explains the impact of delay in diagnosis for children saying that with children whose bones are still growing untreated arthritis can lead to lifelong disability. “If juvenile arthritis isn’t caught early and properly managed, children face a life sentence of pain, joint damage, and increasing disability,” Dr. Migowa warned.
As a member of the Pediatric Society of Africa for Lupus and Rheumatology (PAFLAR) and a pioneer in her field, Dr. Migowa’s efforts are setting the stage for a brighter future for children with rheumatic diseases. Her work is a beacon of hope in a field that remains critically underserved.
“We cannot ignore these children any longer,” she concluded. “With increased awareness, better training, and stronger collaboration, we can rewrite the story of pediatric arthritis in Africa.”
Her work through Hope Arthritis Foundation she believes that with adequate awareness among communities and healthcare workers children battling arthritis may soon have access to the care and support they need to lead full and active lives.
