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Traumatic spinal cord injury in the north-east Tanzania: describing incidence, etiology and clinical outcomes retrospectively
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi. Faculty of Rehabilitation Medicine, Physiotherapy Department, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
2017 (Engelska)Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, nr 1, artikel-id 1355604Artikel i tidskrift (Refereegranskat) 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. 

Ort, förlag, år, upplaga, sidor
2017. Vol. 10, nr 1, artikel-id 1355604
Nyckelord [en]
Traumatic spinal cord injury, etiology, rural, Tanzania, Africa
Nationell ämneskategori
Sjukgymnastik Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Forskningsämne
sjukgymnastik
Identifikatorer
URN: urn:nbn:se:umu:diva-138838DOI: 10.1080/16549716.2017.1355604ISI: 000408679400001PubMedID: 28856978OAI: oai:DiVA.org:umu-138838DiVA, id: diva2:1137853
Tillgänglig från: 2017-09-01 Skapad: 2017-09-01 Senast uppdaterad: 2018-12-11Bibliografiskt granskad
Ingår i avhandling
1. Traumatic spinal cord injuries in rural Tanzania: occurrences, clinical outcomes and life situations of persons living in the Kilimanjaro region
Öppna denna publikation i ny flik eller fönster >>Traumatic spinal cord injuries in rural Tanzania: occurrences, clinical outcomes and life situations of persons living in the Kilimanjaro region
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2018. s. 62
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1988
Nyckelord
traumatic spinal cord injuries, rural, low income country, clinical outcomes, quality of life
Nationell ämneskategori
Sjukgymnastik
Forskningsämne
rehabiliteringsmedicin
Identifikatorer
urn:nbn:se:umu:diva-153378 (URN)978-91-7601-956-6 (ISBN)
Disputation
2018-12-14, Aulan, Vårdvetarhuset, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2018-11-23 Skapad: 2018-11-19 Senast uppdaterad: 2018-12-11Bibliografiskt granskad

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