{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:08:35Z","timestamp":1785431315819,"version":"3.56.0"},"reference-count":37,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background: Mseleni joint disease (MJD) is a degenerative chondrodysplasia of unknown aetiology that is endemic to uMkhanyekude in KwaZulu-Natal, South Africa. Delayed treatment-seeking for MJD results in severe joint pain, which commonly progresses to permanent loss of mobility and reliance on caregivers.\nAim: This study aimed to identify systemic, social and cultural barriers to MJD treatment-seeking from the perspectives of patients and healthcare providers.\nSetting: The research was conducted at the Mseleni Hospital in KwaZulu-Natal, South Africa.\nMethods: A multistage mixed methods study was conducted. Stage One involved quantitative analysis of patient medical records (n = 53) and administration of questionnaires to patients (n = 37). Stage Two involved a thematic analysis of interviews with MJD patients (n = 6), nurses (n = 7) and treating MJD (n = 9). Findings from both stages were analysed thematically to barriers to treatment-seeking for MJD.\nResults: Treatment-seeking barriers fell into three domains: (1) current approaches to treatment and self-management, (2) aetiological perspectives and (3) systemic barriers to healthcare access. Treatment and self-management through traditional medicine and delays in the primary healthcare system were cited as reasons for latent treatment-seeking. Healthcare providers highlighted structural barriers including unstandardised record-keeping, poor cross-facility communication and limited resources, while MJD patients emphasised failed treatments, pain and immobility and inadequate care as key obstacles. Variable aetiological perspectives between MJD patients and healthcare providers were reflected in appraisals of treatment. Gender disparities in sociocultural expectations and stigma-linked to symptoms restricted women\u2019s access to care.\nConclusion: Differing perspectives between MJD patients and healthcare providers contributed to delayed treatment-seeking and hindered the management of MJD. Patients discussed barriers to MJD relative to traditional knowledge, beliefs and lived experience, while healthcare providers discussed barriers relative to systemic and structural factors through a biomedical lens.\nContribution: This study highlights the need to align clinical approaches to treating MJD with patient and provider experiences of this disease to address both individual and systemic barriers to treatment.<\/jats:p>","DOI":"10.4102\/phcfm.v18i1.5297","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T10:51:00Z","timestamp":1778583060000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding barriers to treatment-seeking in Mseleni joint disease: A multistaged study in rural KwaZulu-Natal, South Africa"],"prefix":"10.4102","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5702-8926","authenticated-orcid":false,"given":"Elizabeth S.","family":"Dinkele","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8332-8911","authenticated-orcid":false,"given":"Robea","family":"Ballo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8563-930X","authenticated-orcid":false,"given":"Victor","family":"Fredlund","sequence":"additional","affiliation":[{"name":"Mseleni Hospital, KwaZulu-Natal, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7875-3297","authenticated-orcid":false,"given":"Victoria E.","family":"Gibbon","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Gibbon VE, Harington JS, Penny CB, Fredlund V. Mseleni joint disease: A potential model of epigenetic chondrodysplasia. Jt Bone Spine. 2010;77(5):399\u2013404. https:\/\/doi.org\/10.1016\/j.jbspin.2010.01.013","DOI":"10.1016\/j.jbspin.2010.01.013"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Fredlund V. Total hip replacement for Mseleni joint disease undertaken in a rural hospital: Five-year follow-up. S Afr Fam Prac. 2003;45(9):10\u201314. https:\/\/doi.org\/10.4102\/safp.v45i9.1879","DOI":"10.4102\/safp.v45i9.1879"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"McLaren PA, Gear JSS, Irwig LM, Smit AE. Prevalence of motor impairment and disability in a rural community in KwaZulu. International Rehabilitation Medicine. 1986;8(3):98\u2013104. https:\/\/doi.org\/10.3109\/03790798709166189","DOI":"10.3109\/03790798709166189"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Yach D, Botha JL. Mseleni joint disease in 1981: Decreased prevalence rates, wider geographical location than before, and socioeconomic impact of an endemic osteoarthrosis in an underdeveloped community in South Africa. Int J Epi. 1985;14(2):276\u2013284. https:\/\/doi.org\/10.1093\/ije\/14.2.276","DOI":"10.1093\/ije\/14.2.276"},{"key":"ref4","unstructured":"Fellingham S, Elphinstone C, Wittmann W. Mseleni joint disease: Background and prevalence. S Afr Med J. 1973;47:2173."},{"key":"ref5","unstructured":"Lockitch G, Fellingham SA, Wittman W, De Villiers PD, De Wet IS, Du Toit GT. Mseleni joint disease: The pilot clinical survey. S Afr Med J. 1973;47(47):2283\u20132293."},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Agarwal S, Phadke S, Fredlund V, Viljoen D, Beighton P. Mseleni and Handigodu familial osteoarthropathies: Syndromic identity? Am J Med Gen. 1997;72(4):435\u2013439. https:\/\/doi.org\/10.1002\/(SICI)1096-8628(19971112)72:4<435::AID-AJMG12>3.0.CO;2-S","DOI":"10.1002\/(SICI)1096-8628(19971112)72:4<435::AID-AJMG12>3.0.CO;2-S"},{"key":"ref7","unstructured":"Solomon L, McLaren P, Irwig L, et al. Distinct types of hip disorder in Mseleni joint disease. S Afr Med J. 1986;69(1):15\u201317."},{"key":"ref8","unstructured":"Ballo R, Viljoen D, Machado M, et al. Mseleni joint disease: A molecular genetic approach to defining the aetiology. S Afr Med J. 1996;86(8):956\u2013958."},{"key":"ref9","unstructured":"Nurse G, Jenkins T, Elphinstone C. Mseleni joint disease: Population genetics study. S Afr Med J. 1974;70(12):360\u2013365."},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Mann D, Fredlund V. The social impact of Mseleni joint disease. S Afr Fam Prac. 1988;9(4):a2995. https:\/\/doi.org\/10.4102\/safp.v9i4.2995","DOI":"10.4102\/safp.v9i4.2995"},{"key":"ref11","unstructured":"Lubbe S. Mseleni joint disease: Food and water supplies. S Afr Med J. 1973;47(46):2225\u20132232."},{"key":"ref12","unstructured":"Burger FJ, Elphinstone CD, Fellingham SA, Grey PC, Hogewind ZA. Mseleni joint disease: Biochemical survey. S Afr Med J. 1973;47(48):2331\u20132338."},{"key":"ref13","unstructured":"Mthethwa NS, Mayor Umhlabuyalingana local municipality infrastructure development plan (2020\/2021) [homepage on the Internet]. KwaZulu-Natal; 2022. [cited 2025 Sept 24]. Available from: https:\/\/umhlabuyalingana.gov.za\/wp-content\/uploads\/2020\/05\/2020-2021-DRAFT-UMHLABUYALINGANA-LOCAL-MUNICIPALITY-IDP.pdf"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Waller R. Mseleni joint disease: Social priorities. Brit J Rheumatol. 1998;37(5):585\u2013586. https:\/\/doi.org\/10.1093\/rheumatology\/37.5.585","DOI":"10.1093\/rheumatology\/37.5.585"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Dinkele ES, Ballo R, Fredlund V, Ramesar R, Gibbon V. Mseleni joint disease: An endemic arthritis of unknown cause. Lancet Rheumatol. 2020;2(1):e8\u2013e9. https:\/\/doi.org\/10.1016\/S2665-9913(19)30104-3","DOI":"10.1016\/S2665-9913(19)30104-3"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Kleinman A, Eisenberg L, Good B. Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88(2):251\u2013258. https:\/\/doi.org\/10.7326\/0003-4819-88-2-251","DOI":"10.7326\/0003-4819-88-2-251"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Camara BS, Belaid L, Manet H, et al. What do we know about patient-provider interactions in sub-Saharan Africa? A scoping review. Pan Afr Med J. 2020;37:88. https:\/\/doi.org\/10.11604\/pamj.2020.37.88.24009","DOI":"10.11604\/pamj.2020.37.88.24009"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Kleinman A, Benson P. Anthropology in the clinic: The problem of cultural competency and how to fix it. PLoS Med. 2006;3(10):e294. https:\/\/doi.org\/10.1371\/journal.pmed.0030294","DOI":"10.1371\/journal.pmed.0030294"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Boyer CA, Lutfey KE. Examining critical health policy issues within and beyond the clinical encounter: Patient-provider relationships and help-seeking behaviors. J Health Soc Behav. 2010;51(suppl_1):S80\u2013S93. https:\/\/doi.org\/10.1177\/0022146510383489","DOI":"10.1177\/0022146510383489"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Day C, Gray A, Cois A, Ndlovu N, Massyn N, Boerma T. Is South Africa closing the health gaps between districts? Monitoring progress towards universal health service coverage with routine facility data. BMC Health Serv Res. 2021;21(suppl 1):194. https:\/\/doi.org\/10.1186\/s12913-021-06171-3","DOI":"10.1186\/s12913-021-06171-3"},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Kyu HH, Abate D, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1859\u20131922. https:\/\/doi.org\/10.1016\/S0140-6736(18)32335-3","DOI":"10.1016\/S0140-6736(18)32335-3"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Vos T, Lim SS, Abbafati C, et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990\u20132019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204\u20131222. https:\/\/doi.org\/10.1016\/S0140-6736(20)30925-9","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"ref23","unstructured":"Clarke V, Braun V, Hayfield N. Thematic analysis. Qualitative psychology: A practical guide to research methods. London: SAGE Publications, 2015; p. 222\u2013248."},{"key":"ref24","unstructured":"Wahyuni D. The research design maze: Understanding paradigms, cases, methods and methodologies. J Appl Man Acc Res. 2012;10(1):69\u201380."},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Fincham JE. Mseleni joint disease. Lancet 1986;327(8474):206\u2013207. https:\/\/doi.org\/10.1016\/S0140-6736(86)90671-9","DOI":"10.1016\/S0140-6736(86)90671-9"},{"key":"ref26","unstructured":"Fincham JE, Van Rensburg SJ, Marasas WF. Mseleni joint disease \u2013 A manganese deficiency? S Afr Med J. 1986;60(12):445."},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Nurse G. Slow virus in Mseleni joint disease? Lancet. 1985;326(8458):784. https:\/\/doi.org\/10.1016\/S0140-6736(85)90666-X","DOI":"10.1016\/S0140-6736(85)90666-X"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Schnitzler CM, Pieczkowski WM, Fredlund V, Mesquita JM, Sweet MBE, Smit AE. Histomorphometric analysis of osteopenia associated with endemic osteoarthritis: Mseleni joint disease. Bone. 1988;9(1):21\u201327. https:\/\/doi.org\/10.1016\/8756-3282(88)90023-3","DOI":"10.1016\/8756-3282(88)90023-3"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Sokoloff L, Fincham JE, Du Toit GT. Pathologic features of the femoral head in Mseleni disease. Hum Path. 1985;16(2):117\u2013120. https:\/\/doi.org\/10.1016\/S0046-8177(85)80059-9","DOI":"10.1016\/S0046-8177(85)80059-9"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Bowden JL, Lamberts R, Hunter DJ, Melo LR, Mills K. Community-based online survey on seeking care and information for lower limb pain and injury in Australia: An observational study. BMJ Open. 2020;10(7):e035030. https:\/\/doi.org\/10.1136\/bmjopen-2019-035030","DOI":"10.1136\/bmjopen-2019-035030"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Bunzli S, O\u2019Brien P, Ayton D, et al. Misconceptions and the acceptance of evidence-based nonsurgical interventions for knee osteoarthritis. A qualitative study. Clin Ortho Rel Res. 2019;477(9):1975\u20131983. https:\/\/doi.org\/10.1097\/CORR.0000000000000784","DOI":"10.1097\/CORR.0000000000000784"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Boffa J, Mayan M, Ndlovu S, et al. The role of agency in the implementation of Isoniazid Preventive Therapy (IPT): Lessons from oMakoti in uMgungundlovu District, South Africa. PLoS One. 2018;13(3):e0193571. https:\/\/doi.org\/10.1371\/journal.pone.0193571","DOI":"10.1371\/journal.pone.0193571"},{"key":"ref33","unstructured":"Washington K. Zulu traditional healing, Afrikan worldview and the practice of Ubuntu: Deep thought for Afrikan\/Black psychology. J Pan Afr Stud. 2010;3(8):24\u201339."},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Edwards SD. A psychology of indigenous healing in Southern Africa. J Psych Afr. 2011;21(3):335\u2013347. https:\/\/doi.org\/10.1080\/14330237.2011.10820466","DOI":"10.1080\/14330237.2011.10820466"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Pemunta NV, Tabenyang TC-J. Traditional medicine, colonialism and apartheid in South Africa. In Biomedical hegemony and democracy in South Africa. Brill, Leiden: the Netherlands, 2020; p. 47\u201376.","DOI":"10.1163\/9789004436428_004"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Palmer D, Miedany YE. Measures of outcome in patients with inflammatory arthritis. 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