The Pattern of Neurosurgical Disorders in Rural Northern Tanzania: A Prospective Hospital-Based Study

Background:Africa has very few neurosurgeons. These are almost exclusively in urban centers. Consequently, people in rural areas, most of the African population, have poor or no access to neurosurgical care. We have recently pioneered rural neurosurgery in Nigeria.Objectives:This report details our initial experiences and the profile of neurosurgical admissions in our center.Methods:A prospective observational study of all neurosurgical patients managed at a rural tertiary health institution in Nigeria from December 2010 to May 2012 was done. Simple descriptive data analysis was performed.Results:A total of 249 males (75.2%) and 82 females (24.8%) were managed. The median age was 37 years (range: Day of birth – 94 years). Trauma was the leading cause of presentation with 225 (68.0%) and 35 (10.6%) having sustained head and spinal injuries, respectively. Operative intervention was performed in 54 (16.3%). Twenty-four (7.2%) patients discharged against medical advice, mostly for economic reasons. Most patients (208, 63.4%) had satisfactory outcome while 30 (9.1%) died.Conclusion:Trauma is the leading cause of rural neurosurgical presentations. There is an urgent need to improve access to adequate neurosurgical care in the rural communities.

show abstract

“…[162021] Our overall mortality rate of 9.1% is also similar to that reported from rural Tanzania. [21]…”

Section: Discussionsupporting

confidence: 80%

Neurosurgery in rural Nigeria: A prospective study

Rabiu

Komolafe

2016

Journal of Neurosciences in Rural Practice

View full text Add to dashboard Cite

show abstract

“…In our study, over 65% of TBIs were due to road traffic injury, and more than half of those injuries were motorcyclists; this is a concerning, but common finding for the region C. A. Staton et al (Casey et al, 2012;Maier et al, 2014;Winkler et al, 2010). This vulnerable road user preponderance can be partly explained by the increase in the number of commercial motorcycle taxis, limited driving education, limited safety regulation policies or enforcement, and limited visibility measures or road courtesy behaviours.…”

Section: Epidemiologymentioning

confidence: 52%

“…About 500 patients are admitted to the intensive care unit (ICU) annually, of which 68% are traumatic brain injured patients, and their overall mortality rate was estimated a priori to be about 30% (Mortality in the KCMC Intensive Care Unit, 2012). Regional data suggest that upwards of a third of patients in the ICUs suffer from TBI, and TBI is the most common neurosurgical process presenting to hospitals (Mortality in the KCMC Intensive Care Unit, 2012;Winkler, Tluway, Slottje, Schmutzhard, & Hartl, 2010).…”

Section: Introductionmentioning

confidence: 99%

A prospective registry evaluating the epidemiology and clinical care of traumatic brain injury patients presenting to a regional referral hospital in Moshi, Tanzania: challenges and the way forward

Staton

Msilanga

Kiwango

et al. 2015

International Journal of Injury Control and Safety Promotion

View full text Add to dashboard Cite

Traumatic brain injury (TBI) is the most common cause of death and disability globally disproportionately affecting low- and middle-income countries where increasing injury rates are compounded by limited quality care. The objective of this study is to describe quality of care for TBI patients who presented to Kilimanjaro Christian Medical Center, Moshi, Tanzania. We evaluated a prospective quality improvement TBI registry that enrolled consecutive patients with acute TBI. Descriptive statistics and qualitative comparative analysis was performed. Overall, 893 TBI patients were enrolled during the study period, with a mean age of 32.1 years and who were mostly (80%) male. 12.9% suffered severe TBI (GCS < 9). Most injuries were road traffic (66%) especially motorcyclists (49%) and 26.8% were alcohol related. One intubation occurred, and 22.9% of hypoxic patients received oxygen. Severe TBI mortality was 47%. TBI affects men 15-45 years old in traffic crashes with high mortality for severe TBI (47%) patients. Care addressing secondary injury, hypoxemia, and hypotension is limited.

show abstract

“…1, 2 Head injuries are amongst the most likely to result in death or disability. 3 Traumatic brain injury (TBI) is a rural as well as urban problem, 4–6 and patients from low and middle income countries have more than twice the odds of dying after severe TBI compared to patients in high income countries, with mortality reaching above 50% in some low and middle income countries (LMIC). 7, 8 The incidence of TBI in sub-Saharan Africa (SSA) may be as much as 3.5 times higher than the global incidence and is predicted to reach 14 million per year by 2050.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

Self Cite

View full text Add to dashboard Cite

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.

show abstract

The Pattern of Neurosurgical Disorders in Rural Northern Tanzania: A Prospective Hospital-Based Study

Cited by 32 publications

References 6 publications

Neurosurgery in rural Nigeria: A prospective study

Neurosurgery in rural Nigeria: A prospective study

A prospective registry evaluating the epidemiology and clinical care of traumatic brain injury patients presenting to a regional referral hospital in Moshi, Tanzania: challenges and the way forward

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

Contact Info

Product

Resources

About