Demographics, Causes, and Outcome of Traumatic Brain Injury among Trauma Cases in Cameroon: A Multi-Center Five Year's Retrospective Study

Buh, Franklin Chu; Taïwé, Germain Sotoing; Maas, Andrew I. R.; Motah, Mathieu; Youm, Eric; Wanyu, Bertrand Yuwong; Wang, Kevin W.; Hutchinson, Peter J.; Sumbele, Irene Ule Ngole

doi:10.1089/neur.2022.0053

Cited by 5 publications

(7 citation statements)

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“…The results of our study are highly illustrative of the specific challenges and disparities in care in low-resource settings. The main transportation means of TBI cases were through non-medical means (91%), similar to reports by Motah et al [ 15 ] and Buh et al [ 24 ]. Only one patient was transferred from the scene of the accident to the study centre by ambulance.…”

Section: Discussionsupporting

confidence: 86%

“…As noted by Ashkan et al [ 22 ] and Amram et al [ 23 ], low educational levels constitute one of the specific risk factors for RTIs and assaults and are greatly understudied in low-resource settings. RTIs were the main cause of TBI (85%) and often involved commercial bike riders, which is in line with a 5-year retrospective study conducted in Cameroon by Buh et al [ 24 ]. In Cameroon, many youths are involved in hazardous occupations like commercial bike riding as better jobs are difficult to obtain.…”

Section: Discussionsupporting

confidence: 84%

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Traumatic Brain Injury in Cameroon: A Prospective Observational Study in a Level I Trauma Centre

Buh,

Sumbele,

Maas

et al. 2023

Medicina

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Background and Objective: About 14 million people will likely suffer a traumatic brain injury (TBI) per year by 2050 in sub-Saharan Africa. Studying TBI characteristics and their relation to outcomes can identify initiatives to improve TBI prevention and care. The objective of this study was to define the features and outcomes of TBI patients seen over a 1-year period in a level-I trauma centre in Cameroon. Materials and Methods: Data on demographics, causes, clinical aspects, and discharge status were collected over a period of 12 months. The Glasgow Outcome Scale-Extended (GOSE) and the Quality-of-Life Questionnaire after Brain Injury (QoLIBRI) were used to evaluate outcomes six months after TBI. Comparisons between two categorical variables were done using Pearson’s chi-square test. Results: A total of 160 TBI patients participated in the study. The age group 15–45 years was most represented (78%). Males were more affected (90%). A low educational level was seen in 122 (76%) cases. Road traffic incidents (RTI) (85%), assaults (7.5%), and falls (2.5%) were the main causes of TBI, with professional bike riders being frequently involved (27%). Only 15 patients were transported to the hospital by ambulance, and 14 of these were from a referring hospital. CT-imaging was performed in 78% of cases, and intracranial traumatic abnormalities were identified in 64% of cases. Financial constraints (93%) was the main reason for not performing a CT scan. Forty-six (33%) patients were discharged against medical advice (DAMA) due to financial constraints. Mortality was 14% (22/160) and high in patients with severe TBI (46%). DAMA had poor outcomes with QoLIBRI. Only four patients received post-injury physical therapy services. Conclusions: TBI in Cameroon mainly results from RTIs and commonly affects young adult males. Lack of pre-hospital care, financial constraints limiting both CT scanning and medical care, and a lack of acute physiotherapy services likely influenced care and outcomes adversely.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 84%

Traumatic Brain Injury in Cameroon: A Prospective Observational Study in a Level I Trauma Centre

Buh,

Sumbele,

Maas

et al. 2023

Medicina

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“…Most African countries have underdeveloped healthcare systems, and those with moderately developed systems often lack universal healthcare coverage. The cost of managing TBI is prohibitively high for most people, and studies have shown that many patients in LMICs in Africa do not undergo the necessary neuroimaging for diagnosis due to the high cost of CT and MRI scans 31 . Furthermore, there is a high prevalence of patients being discharged against medical advice due to high out-of-pocket expenses and low insurance coverage for TBI care, leading to substandard care in countries like Kenya, Cameroon, and Tanzania 31 – 33 .…”

Section: Resultsmentioning

confidence: 99%

Management of traumatic brain injury in Africa: Challenges and opportunities

Muili,

Kuol,

Jobran

et al. 2024

International Journal of Surgery

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Traumatic brain injury (TBI) is a major public health concern globally, with significant implications for morbidity, mortality, and long-term disability. While extensive research has been conducted on TBI management in high-income countries, limited attention has been given to the specific challenges and opportunities faced by healthcare systems in Sub-Saharan Africa (SSA). This perspective study aims to provide a comprehensive overview of the current status of TBI management in SSA, focusing on the unique challenges and potential opportunities for improvement. The findings highlight several key challenges faced by SSA healthcare systems in managing TBIs, including limited resources, inadequate infrastructure, and a shortage of trained healthcare professionals. Furthermore, social and cultural factors, such as ignorance of driving laws, financial constraints, and limited access to modern technology services. However, the study also identifies potential opportunities for improving TBI management in SSA. These include strengthening healthcare infrastructure, enhancing pre-hospital care and transportation systems, and increasing public awareness and education about TBI. This perspective study emphasizes the urgent need for tailored interventions and strategies to address the unique challenges faced by SSA in managing TBIs. Addressing the challenges and opportunities in brain injury management in sub-Saharan Africa requires a comprehensive approach which can be through investing in health infrastructure, addressing socioeconomic inequalities, implementing prevention strategies, and fostering evidence-based research collaboration. Through this, the region can significantly improve TBI care and outcomes, thereby improving the well-being of people affected by TBI in sub-Saharan Africa.

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“…Consistent in the narrative is the rural–urban disparity in trauma care access and the disadvantage of the poor [ 13 ]. Buh et al [ 14 ] in Cameroon identified disparities in TBI care provision attributable to financial constraints regarding computed tomography (CT) scanning and continuation of care, since health insurance for all is not available. Furthermore, neurosurgical care which is one of the pillars in the management of traumatic brain injury is not sufficient in Africa.…”

Section: Management Of Traumatic Brain Injurymentioning

confidence: 99%

“…It should consist of caregiver’s education, acute therapy interventions focusing on therapies for joint mobilization, strengthening exercises, ambulation, neuro-muscular stimulation, bed positioning, chest physiotherapy, and chest proprioceptive neuromuscular facilitation. These acute therapies would help to prevent complications linked to immobility and provide better outcomes in the rehabilitation phase after discharge from intensive care units and hospitals [ 14 ]. Other early rehabilitative goals are summarized in Table 1 .…”

Section: The Need For An African Perspective On Early Neurorehabilita...mentioning

confidence: 99%

Early neuro-rehabilitation in traumatic brain injury: the need for an African perspective

Buh

Hutchinson

Anwar

2023

BMC Med

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Background Traumatic brain injury (TBI) is a global public health challenge, affecting about 69 million individuals annually and being one of the leading causes of mortality. It has adverse consequences in terms of cognitive and physical functioning, which makes rehabilitation interventions an integral part of its management. Early neuro-rehabilitation guidelines for traumatic brain injury have not yet been developed and implemented in most of Africa especially Sub-Saharan Africa. Body We aimed with this Opinion to propose a collective reflection on the development and implementation of early neuro-rehabilitation guidelines as an integral part of the care in traumatic brain injury. The different aspects to be considered for reflection have been highlighted: Traumatic brain injury severity to be considered in early neuro-rehabilitation; who should be assessed and receive early neurorehabilitation, barriers to be considered for early neurorehabilitation; what early neurorehabilitation to be considered; the different phases involved in rehabilitation after mild, moderate, and severe TBI; and lastly, what perspective for the creation of neurorehabilitation teams. In conclusion, neuro-rehabilitation should start at the time of admission and should continue from the intensive care unit through the community for the moderate-to-severe traumatic brain injury population. However, mild TBI should also be considered for long-term follow-up in the community due to the fact that some mild traumatic brain injury patients might develop chronic cognitive problems or fatigue with time. Conclusion Neurorehabilitation should start at the time of admission and continue from the intensive care unit through the community for the moderate-to-severe traumatic brain injury population. There is a need to develop, agree on, and implement guidelines on early neuro-rehabilitation interventions for patients with moderate to severe traumatic brain injury in the African region, where disparities in care are common reality.

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Demographics, Causes, and Outcome of Traumatic Brain Injury among Trauma Cases in Cameroon: A Multi-Center Five Year's Retrospective Study

Cited by 5 publications

References 50 publications

Traumatic Brain Injury in Cameroon: A Prospective Observational Study in a Level I Trauma Centre

Traumatic Brain Injury in Cameroon: A Prospective Observational Study in a Level I Trauma Centre

Management of traumatic brain injury in Africa: Challenges and opportunities

Early neuro-rehabilitation in traumatic brain injury: the need for an African perspective

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