Epidemiology of Traumatic Spinal Cord Injury in Developing Countries: A Systematic Review

Abstract

Background/Aims: To describe the epidemiology of spinal cord injury (SCI) in the developing world. Methods: Developing countries were selected based on the definition proposed by the International Monetary Fund. A literature search was performed in July 2012 in Medline and Embase. Further article procurement was obtained via the reference lists of the identified articles, websites, and direct contact with the authors of the identified studies. We designed search strategies using the key words: SCI, epidemiology, incidence, and prevalence. According to the inclusion criteria, 64 studies from 28 countries were included. Results: The incidence of SCI in developing countries is 25.5/million/year (95% CI: 21.7-29.4/million/year) and ranges from 2.1 to 130.7/million/year. Males comprised 82.8% (95% CI: 80.3-85.2) of all SCIs with a mean age of 32.4 years (95% CI: 29.7-35.2). The two leading causes of SCI were found to be motor vehicle crashes (41.4%; 95% CI: 35.4-47.4) and falls (34.9%; 95% CI: 26.7-43.1). Complete SCIs were found to be more common than incomplete injuries (complete SCI: 56.5%; 95% CI: 47.6-65.3; incomplete SCI: 43.0%; 95% CI: 34.1-52.0). Similarly, paraplegia was found to be more common than tetraplegia (paraplegia: 58.7%; 95% CI: 51.5-66.0; tetraplegia: 40.6%; 95% CI: 33.3-48.0). Conclusion: Through an understanding of the epidemiology of SCI in developing countries, appropriate preventative strategies and resource allocation may decrease the incidence and improve the care of these injuries.

Traumatic spinal cord injury in the north-east Tanzania – describing incidence, etiology and clinical outcomes retrospectively

“…The estimated annual incidence reported in this study (more than 26 persons per million population) is relatively high as compared to the reported globally and in low income countries (23 and 25.5 persons per million population) respectively [5,12,18]. However there are other country and regional–specific studies that have reported higher annual incidences such as in Cape Town – South Africa and the United States which reports 75 and 54 persons per million population respectively [8,19].…”

“…Recently, New Zealand and the USA registered the highest annual incidence rates of 96 and 54 persons per million population, respectively [11]. A systematic review of the available incidence studies for low income countries ascertained that 25.5 persons per million population suffer TSCI annually [12]. Two prospective hospital-based studies conducted in Gaborone, Botswana and Cape Town, South Africa reported TSCI annual incidences of 13 and 75.6 persons per million population respectively [8,13].…”

Global neurotrauma research challenges and opportunities

“…Unsurprisingly, similar to TBI, information in epidemiological studies from LMICs was limited. Since 2000, at least 7 papers have reviewed the epidemiology of SCI around the world 37-43 and 2 papers have focused on the epidemiology of SCI in LMICs 44,45 . Common conclusions relate to the lack of information available in LMICs owing to the absence of SCI registries -paradoxically, these are regions where incidence of the disease is high according to observational studies.…”

“…The traumatic SCI population is young, especially in LMICs. Underestimation of SCIs is common and with the exception of a few countries that have countrywide registries (Finland, Canada and the United States), incidence estimates are extrapolated from city or regional data that may not be representative of the countries as a whole 45 .…”

Evaluation of Muscle Strength in Medullar Injury: A Literature Review

“…1 In patients with spinal cord injury, muscle atrophy, and loss of strength contribute to the development of disability. Muscle weakness and paralysis limit the performance of functional activities, with decrease in the quality of life.…”