Injury experience in Tanzania - Need for intervention

Objective: To determine distribution of injuries and factors associated with mortality in six hospitals of Tanzania mainland.Design: A Cross - Sectional hospital based study.Setting: Data were collected from casualty departments of Muhimbili Orthopaedic Institute, Morogoro, Mtwara, Kigoma, Musoma regional hospitals and Korogwe district hospital.Subjects: Patients who sustained injuries and attended in six involved hospitals between November 2011 and December 2012.Results: Of the 9316 injury patients seen, 71.7% were males. Majority (55%) were between 18 – 45 years age group. Traffic crashes were the leading cause of injuries and accounted for 47.5% of all injuries. Fractures accounted for 49.2%, and injuries were severe in 1.2% as determined by the Kampala trauma score II (KTS II). Majorities 66.7% were admitted and 2.4% died at the casualty. Factors associated with mortality were; being unemployed (P = 0.000), using ambulances to the hospital (P = 0.000), receiving medical attention within 2 to 10 hours after injury (P = 0.001), road traffic crashes (P = 0.000), 18 - 45 years age group (P = 0.003), low KTS II score (P = 0.000) and sustaining head injury (P = 0.000).Conclusion: Injuries in Tanzania are an important public health problem, predominantly in adult males, mostly due to traffic crashes. It is therefore important to reinforce preventive measures and pre-hospital emergency service is urgently needed

Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania

<p>Abstract</p> <p>Background</p> <p>Road traffic crash is of growing public health importance worldwide contributing significantly to the global disease burden. There is paucity of published data on road traffic crashes in our local environment. This study was carried out to describe the injury characteristics and outcome of road traffic crash victims in our local setting and provide baseline data for establishment of prevention strategies as well as treatment protocols.</p> <p>Methods</p> <p>This was a prospective hospital based study of road traffic crash victims carried out at Bugando Medical Centre in Northwestern Tanzania between March 2010 and February 2011. After informed consent to participate in the study, all patients were consecutively enrolled into the study. Data were collected using a pre-tested questionnaire and analyzed using SPSS computer software version 15.0.</p> <p>Results</p> <p>A total of 1678 road traffic crash victims were studied. Their male to female ratio was of 2.1:1. The patients ages ranged from 3 to 78 years with the mean and median of 29.45 (± 24.22) and 26.12 years respectively. The modal age group was 21-30 years, accounting for 52.1% patients. Students (58.8%) and businessmen (35.9%) were the majority of road traffic crash victims. Motorcycle (58.8%) was responsible for the majority of road traffic crashes. Musculoskeletal (60.5%) and the head (52.1%) were the most common body region injured. Open wounds (65.9%) and fractures (26.3%) were the most common type of injuries sustained. The majority of patients (80.3%) were treated surgically. Wound debridement was the most common procedure performed in 81.2% of the patients. The complication rate was 23.7%. The overall average length of hospital stay (LOS) was 23.5 ± 12.3 days. Mortality rate was 17.5%. According to multivariate logistic regression analysis, patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with long bone fractures stayed longer in the hospital and this was significant (P < 0.001) whereas the age of the patient, severe trauma (Kampala Trauma Score II ≤ 6), admission Systolic Blood Pressure < 90 mmHg and severe head injury (Glasgow Coma Score = 3-8) significantly influenced mortality (P < 0.001).</p> <p>Conclusion</p> <p>Road traffic crashes constitute a major public health problem in our setting and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic crashes is necessary to reduce the morbidity and mortality resulting from these injuries. Early recognition and prompt treatment of road traffic injuries is essential for optimal patient outcome.</p

Pattern and Outcome of Chest Injuries at Bugando Medical Centre in Northwestern Tanzania.

Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P < 0.001), whereas mortality was significantly associated with pre-morbid illness, associated injuries, trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P < 0.001). Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region

Fluid lavage in patients with open fracture wounds (FLOW): an international survey of 984 surgeons

<p>Abstract</p> <p>Background</p> <p>Although surgeons acknowledge the importance of irrigating open fracture wounds, the choice of irrigating fluid and delivery pressure remains controversial. Our objective was to clarify current opinion with regard to the irrigation of open fracture wounds.</p> <p>Methods</p> <p>We used a cross-sectional survey and a sample-to-redundancy strategy to examine surgeons' preferences in the initial management of open fracture wounds. We mailed this survey to members of the Canadian Orthopaedic Association and delivered it to attendees of an international fracture course (AO, Davos, Switzerland).</p> <p>Results</p> <p>Of the 1,764 surgeons who received the questionnaire, 984 (55.8%) responded. In the management of open wounds, the majority of surgeons surveyed, 676 (70.5%), favoured normal saline alone. Bacitracin solution was used routinely by only 161 surgeons (16.8%). The majority of surgeons, 695 (71%) used low pressures when delivering the irrigating solution to the wound. There was, however considerable variation in what pressures constituted high versus low pressure lavage. The overwhelming majority of surgeons, 889 (94.2%), reported they would change their practice if a large randomized controlled trial showed a clear benefit of an irrigating solution – especially if it was different from the solution they used.</p> <p>Conclusion</p> <p>The majority of surgeons favour both normal saline and low pressure lavage for the initial management of open fracture wounds. However, opinions varied as regards the comparative efficacy of different solutions, the use of additives and high versus low pressure. Surgeons have expressed considerable support for a trial evaluating both irrigating solutions and pressures.</p

Citywide Trauma Experience in Mwanza, Tanzania: A Need for Urgent Intervention.

Trauma remains a leading cause of morbidity and mortality in resource limited countries. There is paucity of published reports on trauma care in Tanzania, particularly the study area. This study was carried out to describe our experiences in trauma management outlining the etiological spectrum, injury characteristics and treatment outcome of trauma patients at our local setting and compare our results with those from other centers in the world. A descriptive prospective study of trauma patients was conducted at Bugando Medical Centre from April 2010 to March 2012. Statistical data analysis was done using SPSS software version 17.0. A total of 5672 trauma patients were enrolled in the study. The male to female ratio was 2.3: 1. The majority of patients were in the 2nd decade of life. Road traffic accident was the most common cause of trauma accounting for 60.7% of cases. The majority of patients (76.6%) sustained blunt injuries. Musculoskeletal (68.5%) and head/neck (52.6%) were the most frequent body region injured. Soft tissue injuries (open wounds) and fractures were the most common injuries accounting for 82.8% and 76.8% respectively. Majority of patients (74.4%) were treated surgically with wound debridement (94.0%) being the most frequently performed procedure. Postoperative complications were recorded in 31.5% of cases.The overall median duration of hospitalization was 26 days (range 1 day to 144 days). Mortality rate was 16.7%. Patients who had polytrauma, burn injuries and those who had tetanus and long bone fractures stayed longer in the hospital and this was statistically significant (P < 0.001), whereas the age > 65 years, severe trauma, admission Systolic Blood Pressure < 90 mmHg, presence of tetanus, severe head injury, the duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on CT scan of the brain significantly influenced mortality (P < 0.001). Trauma resulting from road traffic accidents remains a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of trauma in this region

Public/Private Mix: An Alternative Funding for Public Hospitals in Developing Countries: A 5-Years&apos; Experience at Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.

Background:The economic deterioration and structural adjustment policies of the 1970&apos;s and 80&apos;s had a particularly negative impact on social services especially health and education in most developing countries. In Tanzania at the height of this period the Government could meet only 10 - 20% of the recurrent budget needs of its hospitals. In 1996 the government of Tanzania passed the first Parliamentary act empowering a public health institution to attend private patients. Methods: A review of the source of funding at the Muhimbili Orthopaedic Institute over a 5-year period between 1997 and 2001 inclusive was done. Results: Muhirnbili Orthopaedic Institute experience showed that it is possible for public institution to practice private-public mix. Private patients constituting only 30% of outpatients and 5% of inpatients generated 77% of Institute&apos;s income, which was about 35% of the total income of the Institute. Conclusion: Private-public mix when carried out properly in hospitals offers enormous advantages in bridging the gap between actual budgets of Institutions and what governments in developing countries are able to give public hospitals

Childhood Burn Injuries in Children in Dar es Salaam: Patterns and Perceptions of Prevention

A study was conducted in the three city hospitals of Dar es Salaam and two national referral hospitals to describe the pattern of burn injuries and to determine victims\' and guardians\' perceptions of the causes and prevention of burns. The study included all injured children younger than 18 years attending Mwananyamala, Ilala and Temeke city hospitals, Muhimbili National Hospital and Muhimbili Orthopaedic Institute between May and November 1999. Data were obtained by filling in a prepared questionnaire. A total of 253 children attended the hospitals with burn injuries during the period of study. Children younger than five years of age constituted 63.6% of the group. Scalding from hot liquids accounted for 75.8% of the burns, followed by open flame burns (16.2%). Most burns (82.9%) occurred in low socio-economic groups, and 94.4% occurred at home. Over half of the parents (51.5%) thought that burns could not be prevented since ‘accidents\' are unpreventable and it is difficult to control children; 48.5% of the parents thought that burns could be prevented. There is a need to change parental and guardians\' attitudes and beliefs that burns are unpreventable, if burn prevention interventions are to be effective. African Safety Promotion Vol.1(1) 2002: 42-4

Road traffic accidents in Tanzania: a ten year epidemiological appraisal

A descriptive analysis of road traffic accidents data in Tanzania was done using routine police records. The trends, road users injured or killed and conservative factors were recorded. The results showed that between 1990 and 2000 the number of road traffic accidents rose by 44% from a total 10,107. At the same time the number of associated injuries increased by more than 44% and that of death by more than 64% during the same period. A total of 56% of the injured were passengers followed by pedestrian (25%) while the dead included passengers. Inappropriate road use behaviours by different road users were reported to be the major cause of accidents with driver's inappropriate behaviour contributing 52%. It is suggested that police data collection be strengthened and also be linked to health data. Such data will then provide information on the type of intervention necessary for various stages before and after injury has occurred and will also show the true burden of injuries in the country