The burden of orthopaedic disease presenting to a tertiary referral center in Moshi, Tanzania: a cross-sectional study

Hardaker, William T.; Jusabani, Mubashir; Massawe, Honest; Pallangyo, Anthony; Temu, Rogers; Masenga, Gileard; Fessehaie, Nathaniel; Numfor, Anchi; Winterton, Matthew; Premkumar, Ajay; Sheth, Neil P.

doi:10.11604/pamj.2022.42.96.30004

Cited by 13 publications

(12 citation statements)

References 8 publications

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“…However, it contrasted with studies done on orthopedic admissions in Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania showed the three most common occupations were farmers, businessman, professional drivers, students (11,12). This is could be because KCMC is a private facility as opposed to KNH which is a public health facility.…”

Section: Discussionmentioning

confidence: 83%

Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review

Omondi

Mwangi

Sitati

et al. 2022

Preprint

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Tertiary hospitals in resource-limited countries treat patients referred but in most cases are the first level of care for the vast majority of patients. As a result, the tertiary facility effectively functions as a primary health care facility. The urban phenomenon of widespread self-referral is associated with low rates of formal referral from peripheral health facilities. Study Objective: To determine the patterns of orthopaedic and trauma admissions to Kenyatta National Hospital. Methodology: This was descriptive study design. Sample size was 905 patient charts for 2021 Findings The mean age was 33.8 years (SD 16.5) with range of 1 - 93 years. Majority 66.3% were between 25 – 64 years with those above 65 years being 40 (4.4%). Children 0-14 years comprised 10.9% of the admissions. Of the 905 admissions, 80.7% were accident and trauma-related admissions while 17.1% were non-trauma related admissions. About 50.1% were facility referrals while 49.9% were walk-ins. Majority of admissions were through Accident and Emergency Department 78.1%, Corporate Outpatient Care 14.9% and Clinic 7.0%. About 78.7% were emergency admissions while 20.8% were elective admissions. Approximately admissions 48.5% were due to Road Traffic Accidents, 20.9% due to falls and non-trauma related conditions represented 17.1%. Close to 44.8% were casual workers and 20.2% unemployed. Education level was also reviewed with 34.0% having primary education and 35.0% having secondary education. A significant proportion of female admissions (33.2%) were due to non-trauma conditions as compared to male admissions (12.8%) (p<0.001). Aadmissions for those aged 25 – 64 years were 3.5 more likely to have emergency admission as compared to those aged 0 – 14 years. Male were 65.1% less likely to have elective admissions compared to female (p<0.001). Those unemployed were 3.9 more likely to have emergency admission compared to businessmen/women. Vast majority (89.2%) of admissions were within Nairobi Metropolitan region

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Section: Discussionmentioning

confidence: 83%

Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review

Omondi

Mwangi

Sitati

et al. 2022

Preprint

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“…This compares favourably with study done in Taiwan that revealed orthopaedic fractures were associated with patients of low socio-economic status [ 23 ]. However, it contrasted with studies done on orthopedic admissions in Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania showed the three most common occupations were farmers, businessman, professional drivers [ 24 , 25 ]. This could be because KCMC is a private health facility as opposed to KNH which is a public health facility.…”

Section: Discussionmentioning

confidence: 94%

Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review

Omondi

Mwangi

Sitati

et al. 2023

PLOS Glob Public Health

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Tertiary hospitals in resource-limited countries should treat referred patients but in reality, are the first level of care for the vast majority of patients. As a result, the tertiary facility effectively functions as a primary health care facility. The urban phenomenon of widespread self-referral is associated with low rates of formal referral from peripheral health facilities. The study objective was to determine the patterns of orthopaedic and trauma admissions to Kenyatta National Hospital. This was descriptive study design. 905 patient charts were reviewed in 2021. The mean age was 33.8 years (SD 16.5) with range of 1–93 years. Majority 66.3% were between 25–64 years with those above 65 years being 40 (4.4%). Children 0–14 years comprised 10.9% of the admissions. Of the 905 admissions, 80.7% were accident and trauma-related admissions while 17.1% were non-trauma related admissions. About 50.1% were facility referrals while 49.9% were walk-ins. Majority of admissions were through Accident and Emergency Department 78.1%, Corporate Outpatient Care 14.9% and orthopedic Clinic 7.0%. About 78.7% were emergency admissions while 20.8% were elective admissions. Approximately 48.5% were due to Road Traffic Accidents and 20.9% due to falls. Close to 44.8% were casual workers and 20.2% unemployed. About 34.0% attained primary education and 35.0% secondary education. About 33.2% of female admissions were due to non-trauma conditions as compared to male admissions (12.8%) (p<0.001). Admissions for those aged 25–64 years were 3.5 more likely to have emergency admission as compared to those aged 0–14 years. Male were 65.1% less likely to have elective admissions compared to female (p<0.001). Whereas lower limb injuries and non-trauma related conditions were the most commonly admitted conditions, Lower limb injury and spine cases were mostly facility referred while non-trauma conditions were walk-in patients. Vast majority (89.2%) of admissions were from Nairobi Metropolitan region.

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“…To mitigate these systems‐based issues, American and Tanzanian surgeons have established a partnership through Global Orthopedics, the Tanzanian Ministry of Health, and Kilimanjaro Christian Medical University College (KCMUC), the only existing tertiary care referral center and the largest teaching hospital in northern Tanzania [9, 10]. KCMUC has experienced a growing musculoskeletal disease burden, with the number of patients increasing by 35.3% between 2015 and 2018 [6, 10]. However, despite being the major regional hospital in the northern corridor, KCMUC's orthopedic ward can only accommodate 59 patients, there is only one dedicated orthopedic operating theater, and the infection rate is as high as 37% [9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…The volunteerism paradigm is especially ineffective in orthopedics, as local surgeons are left with clinical complications that cannot be addressed without specific technical expertise and specialized equipment. Deficits in musculoskeletal care capacity are especially acute in Tanzania with only one orthopedic surgeon per 1.1 million people; in the northern corridor, only 10% of Tanzanians can access orthopedic surgical services [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the Social Impact of a Proposed Orthopedic Center of Excellence in Northern Tanzania: A Novel Use of the Impact Multiple of Money Methodology

et al. 2023

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Background Musculoskeletal injuries-often a result of Road Traffic Accidents (RTAs)-represent a significant burden in sub-Saharan Africa. RTA victims are faced with lifelong disability and diminished employment. Northern Tanzania in particular lacks the orthopedic surgical capacity needed to provide patients with definitive surgical fixation. While there is great potential in establishing an Orthopedic Center of Excellence (OCE), the precise social impact of such an initiative is currently unknown. Methods To demonstrate the social value of an orthopedic OCE in Northern Tanzania, this paper proposes a methodology for calculating social impact. This methodology draws upon RTA-related Disability Adjusted Life Years (DALYs), current and projected surgical complication rates, anticipated changes in surgical volume, and average per capita income to quantify how much social value can be gained by mitigating the impact of RTAs. These parameters can be utilized to calculate an impact multiplier of money (IMM), stating the social returns on each dollar invested.Results Modeling exercises demonstrate that improvements in the complication rate and surgical volume over the current baseline results in significant social impact. In the best-case scenario, the COE is expected to yield over $131 million over 10 years, with an IMM of 13.19. Conclusions Investments in orthopedic care will yield significant dividends, as demonstrated by our novel methodology. The cost-effectiveness of the OCE is comparable to, if not greater, than many other global health initiatives. More broadly, the IMM methodology can be used to quantify the impact of other projects aimed at reducing long-term injury.

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The burden of orthopaedic disease presenting to a tertiary referral center in Moshi, Tanzania: a cross-sectional study

Cited by 13 publications

References 8 publications

Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review

Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review

Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review

Evaluating the Social Impact of a Proposed Orthopedic Center of Excellence in Northern Tanzania: A Novel Use of the Impact Multiple of Money Methodology

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