Severe Traumatic Brain Injury at a Tertiary Referral Center in Tanzania: Epidemiology and Adherence to Brain Trauma Foundation Guidelines

Abstract

Background Severe traumatic brain injury (TBI) is a major cause of death and disability worldwide. However, prospective TBI data from sub-Saharan Africa are sparse. This study examines the epidemiology, and explores management of severe TBI patients and adherence to the Brain Trauma Foundation (BTF) Guidelines at a tertiary care referral hospital in Tanzania. Methods Patients with severe TBI hospitalized at Bugando Medical Centre, Mwanza, Tanzania, were recorded in a prospective registry. Epidemiological, clinical, treatment and outcome data were recorded. Results Between September 2013 and October 2015, 371 patients with TBI were admitted. 33% (115/371) had severe TBI. Mean age was 32.0±20.1 years, and the majority were male (80.0%). Vehicular injuries were the most common cause of injury (65.2%). Half of the patients (47.8%) were hospitalized on the same day as their injury. Only 49.6% underwent computed tomography (CT) of the brain, and 58.3% were admitted to the intensive care unit (ICU). Continuous arterial blood pressure (cABP) monitoring and intracranial pressure (ICP) monitoring were not performed on any patient. 38.3% of patients with severe TBI received hyperosmolar therapy and 35.7% underwent craniotomy. Two-week mortality was 34.8%. Conclusion Mortality of patients with severe TBI at Bugando Medical Center, Tanzania, is approximately twice that in high-income countries. ICU care, CT imaging, cABP and ICP monitoring are underutilized or unavailable in the tertiary referral hospital setting. Improving outcomes after severe TBI will require concerted investment in pre-hospital care as well as improvement in availability of ICU resources, CT imaging and expertise in multidisciplinary care.

Mortality of neurological disorders in Tanzania: analysis of baseline data from sample vital registration with verbal autopsy (SAVVY)

“…There were no differences in CSMF among males (4.76%) and females (5.27%) (MRF = 0.90, 95% CI: 0.70-1.16). Compared to adults aged 50 years and above, mortality of ND was estimated to be lower among children aged 0-4 (MRF = 0.71, 95% CI: 0.52-0.97), and comparable in children aged [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (MRF = 1.07, 95% CI: 0.64-1.72) and adults aged 20-49 (MRF = 1.07, 95% CI: 0.64-1.72). Mortality was lower by 23.0% in urban (4.35%) than rural (5.63%) areas (MRF = 0.77, 95% CI: 0.40-0.99).…”

“…Of all ND-related deaths, epilepsy accounted for 18.4%; 4.2% among children < 5 years, 40.9% among children aged [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]36.9% among adults aged 20-49, and 11.8% among adults older than 50 years (Table 1). Unspecified convulsive epilepsy (98.0%) and other generalized epilepsy and unspecified epileptic syndromes (2.0%) were the category reported for all deaths.…”

“…We did not observe traumatic brain injuries or intracranial deaths in this study despite the high mortality of road injuries estimated at 2.4% in all ages and 5.8% (95% CI: 4.7-7.1) in adults aged 15-49 years (results not reported but provided for contextual reasoning). Road injuries are one of the main causes of brain injuries; therefore, lack of information from VA or medical records may have resulted in missing some traumatic brain injury deaths in this study [9,10,47]. With regards to comparability of this study across countries, regions, and internationally, adoptions of newer versions of ICD-10 and the tabulation list of neurological disorders are likely to result in different mortality estimates elsewhere [48].…”

“…In most developing countries, on the other hand, etiological studies reported that most ND originate from infections of the central nervous system (CNS) and brain trauma [4][5][6][7]. The most common reported ND in sub-Saharan Africa (SSA) include stroke, epilepsy, meningitis, paraparesis, neuropathies, and traumatic brain injuries [8][9][10].…”

Prevalence and Glasgow Outcome Scale score of severe head injury in Mbarara regional referral hospital: A retrospective study

“…According to different studies done in Uganda, TBI accounted for most of the neurosurgical admissions at 87.0% and mortality rate of 13.0% (5) while the prevalence of STBI was at 9.0% (6). In Tanzania, the prevalence of STBI was higher at 33.0% (7) and in Malawi and Burkina Faso, the prevalence of STBI was 33.0% and 14.0% respectively (8,9). In developed countries, the prevalence of STBI was at 44.0% (10).…”