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Traumatic spinal cord injuries in rural Tanzania: occurrences, clinical outcomes and life situations of persons living in the Kilimanjaro region
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Traumatic spinal cord injury (TSCI) is one of the most troubling health condition as it leaves the inflicted individual with irreversible sensorimotor impairment. Rural areas of Tanzania and other low income countries are characterized by inadequate emergency, medical and rehabilitation services and are mostly inaccessible by wheelchair. The studies in this thesis aimed to create an understanding of the epidemiology, clinical outcomes of SCI, as well as living with the condition, in a typical rural area of a low-income country.

Methods: Four studies were conducted with two being hospital-based and two carried out in the community. A retrospective study assessed the magnitude, etiology and clinical outcomes for past five years (2010-2014) by using patients’ data from archives of the Kilimanjaro Christian Medical Centre (KCMC). In the same setting, another study assessed the same variables prospectively for one year (2017) with greater focus being placed on classifying severity of injury and health complications. In the community, a qualitative study was used to conceptualize coping resources for persons with SCI in one study, while in another, the WHOQoL-BREF questionnaire was used to assess the quality of life of these persons quantitatively.

Results: The retrospective study obtained 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million for this period. The most documented complications were pressure ulcers at 19.7%, respiratory complications at 15.0% and multiple complications at 13.1%. The in-hospital mortality rate was 24.4%. The prospective study involved 87 persons who sustained SCI in 2017, of whom 66.7% were due to falls (especially from a position of height), 28.7% to road traffic accidents and 4.6% from other causes. The annual incidence rate based on Kilimanjaro region (population 1,910, 555) was estimated at more than 38 new cases per million. The majority of the injuries occurred at the cervical 56.3% and lumbar 31% levels. Most of the injuries 59.8% were incomplete while 40.2% were complete. The questionnaire study reports that the majority of the participants rated their quality of lives as neither poor nor good 39(48.8%) and poor life 20(25%). The mean score for domains of QoL showed the highest score in social relations and psychological well-being, while the lowest scores were rated for physical health and environment. There was no significant mean difference in the score of domains based on sociodemographic characteristics, except for physical environment in which quadriplegia scored lower than paraplegia (p = 0.038). The qualitative interview study identified acceptance as the core category for identification and utilization of both internal and external coping resources for persons with TSCI in the community. Internal coping resources related to personal factors and external coping resources related to family and community were found to be important.

Conclusion: Most of the traumatic SCI in Kilimanjaro rural area are due to falls, followed by road traffic accidents. SCI-related complications are common and hospital mortality is still high. Persons with SCI faces various challenges pertaining to health and accessibility that affect them physically, socially and environmentally. Establishment of emergency and critical care services, trauma registries, community-based rehabilitation and population-based surveys would address major issues pertaining to TSCI in these areas.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2018. , p. 62
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1988
Keywords [en]
traumatic spinal cord injuries, rural, low income country, clinical outcomes, quality of life
National Category
Physiotherapy
Research subject
Rehabilitation Medicine
Identifiers
URN: urn:nbn:se:umu:diva-153378ISBN: 978-91-7601-956-6 (print)OAI: oai:DiVA.org:umu-153378DiVA, id: diva2:1263991
Public defence
2018-12-14, Aulan, Vårdvetarhuset, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2018-11-23 Created: 2018-11-19 Last updated: 2018-12-11Bibliographically approved
List of papers
1. Traumatic spinal cord injury in the north-east Tanzania: describing incidence, etiology and clinical outcomes retrospectively
Open this publication in new window or tab >>Traumatic spinal cord injury in the north-east Tanzania: describing incidence, etiology and clinical outcomes retrospectively
2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, no 1, article id 1355604Article in journal (Refereed) Published
Abstract [en]

Background: Causes, magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region. There is a scarcity of literature on profile of traumatic spinal cord injury to inform prevention and rehabilitation of this health condition in African rural settings, particularly Tanzania. Objective: To describe the incidence, etiology and clinical outcomes of traumatic spinal cord injury and issues related to retrospective study in underdeveloped setting.

Methods: Records for patients with traumatic spinal cord injury for five consecutive years (2010–2014) were obtained retrospectively from the admission wards and health records archives of the Kilimanjaro Christian Medical Center. Sociodemographic, cause, complications and patients’ condition on discharge were recorded and analyzed descriptively.

Results: The admission books in the wards registered 288 new traumatic spinal cord injury cases from January 2010 to December 2014. Of the 288 cases registered in the books, 224 were males and 64 females with mean age 39.1(39.1 ± 16.3) years and the majority of individuals 196(68.1%) were aged between 16 and 45 years. A search of the hospital archives provided 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). Cervical 81(39.9%) and lumbar 71(34.74%) spinal levels were the most affected. The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million population. The most docu- mented complications were pressure ulcers 42(19.7%), respiratory complications 32(15.0%) and multiple complications 28(13.1%). The mean length of hospital stay was 64.2 ± 54.3 days and the mortality rate was 24.4%.

Conclusion: Prevention of traumatic spinal cord injury in North-east Tanzania should consider falls (particularly from height) as the leading cause, targeting male teenagers and young adults. Pressure ulcers, respiratory complications, in-hospital mortality and availability of wheelchairs should be addressed. 

Keywords
Traumatic spinal cord injury, etiology, rural, Tanzania, Africa
National Category
Physiotherapy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-138838 (URN)10.1080/16549716.2017.1355604 (DOI)000408679400001 ()28856978 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2018-12-11Bibliographically approved
2. Incidence of traumatic spinal cord injury and prevalence of medical complications among hospitalized patients at Kilimanjaro: a one year prospective study
Open this publication in new window or tab >>Incidence of traumatic spinal cord injury and prevalence of medical complications among hospitalized patients at Kilimanjaro: a one year prospective study
(English)Manuscript (preprint) (Other academic)
Keywords
Traumatc spinal cord injury, rural, complications clinical outcomes low income countries
National Category
Physiotherapy
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-153375 (URN)
Projects
Traumatic spinal cord injuries in rural Tanzania
Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2018-12-11
3. Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community survey
Open this publication in new window or tab >>Quality of life of persons with traumatic spinal cord injury in rural Kilimanjaro, Tanzania: a community survey
(English)Manuscript (preprint) (Other academic)
National Category
Physiotherapy
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-153377 (URN)
Projects
Traumatic spinal cord injuries in rural Tanzania
Available from: 2018-11-19 Created: 2018-11-19 Last updated: 2018-12-11
4. Coping Resources for Persons With Traumatic Spinal Cord Injury in A Tanzania Rural Area
Open this publication in new window or tab >>Coping Resources for Persons With Traumatic Spinal Cord Injury in A Tanzania Rural Area
Show others...
2018 (English)In: Global Journal of Health Science, ISSN 1916-9736, E-ISSN 1916-9744, Vol. 10, no 5, p. 138-153Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Persons with traumatic spinal cord injury (TSCI) in Tanzanian rural settings face a variety of geographical and socioeconomic challenges that make life almost impossible for them. However, some have managed to live relatively long lives despite these difficult conditions. This study aimed at exploring secrets behind successful lives of persons with TSCI in typical resource-constrained rural Tanzanian settings.

METHODS: A modified constructivist grounded theory was employed for the analysis of data from 10 individuals who have lived between 7 and 28 years with TSCI in typical Tanzanian rural area. The 10 were purposively selected from 15 interviews that were conducted in 2011. The analysis followed the constructivist approach in which data was first open and axial coded, prior to categories being constructed. The categories were frequently reviewed in light of the available literature to determine the over-arching core category that described or connected the rest.

RESULTS: Nine categories (identified as internal and external coping resources) were constructed. The internal coping resources were: secured in God, increase in awareness on health risk, problem-solving skills and social skills. External coping resources were: having a reliable family, varying support from the community, a matter of possession and left without means for mobility. Acceptance was later identified as a core category that determines identification and utilization of the rest of the coping resources.

CONCLUSION: Persons with traumatic spinal cord injury can survive for a relatively long time despite the hostile environment. Coping with these environments requires the employment of various coping resources, acceptance being the most important.

Place, publisher, year, edition, pages
Canadian Center of Science and Education, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-147731 (URN)10.5539/gjhs.v10n5p138 (DOI)
Available from: 2018-05-16 Created: 2018-05-16 Last updated: 2018-12-11Bibliographically approved

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