Survey of Pain Management Practices in a Tanzanian Emergency Department
Injury is a leading cause of morbidity and mortality globally, accounting for 11% of global disability-adjusted life years (DALYs) and 6% of global years lived with disability (YDLs). The burden of injury is disproportionately high in low- and middle-income countries (LMICs), including Tanzania. Early and effective pain management for injury patients is essential to ensure proper physical, psychological, and emotional outcomes and recovery, yet few studies have examined emergency department analgesic strategies in Tanzania. This study aimed to analyze the sociodemographic and injury characteristics associated with severe pain of injury patients admitted to the Kilimanjaro Christian Medical Centre (KCMC) emergency department, and qualitatively describe analgesic practices and challenges in the KCMC ED.
Self-reported sociodemographic and pain data (score 0-100) data were collected from a prospective trauma registry of adult patients (n=1181) admitted to KCMC ED for acute injury. Injury severity data were determined by the Kampala Trauma Score (KTS). Descriptive statistics were performed and multivariable linear regressions assessed the association between sociodemographic and injury characteristics with severe pain. KCMC ED physicians and nurses (n=11) were recruited to participate in qualitative interviews aimed at understanding common analgesic practices and challenges in the ED setting.
Mean pain level decreased across all sociodemographic characteristics between ED admittance and ED discharge. Participants who were either separated or widowed were likely to experience higher reduction in pain level during ED treatments than those who reported living with a partner. Participants who were admitted to the KCMC ED for road traffic injury or fall were more likely to experience lower reduction in pan level than participants with assault injuries. Interviewed KCMC ED physicians and nurses described high usage of pharmacological analgesic methods for traumatic injury patients.
It is important to understand effective analgesic treatments that can be administered as early as possible post-injury. KCMC ED pain management modalities are generally effective at reducing pain of traumatic injury patients. Adjustments to strategies for road traffic accident and fall injury patients may be made so that higher levels of pain reduction are achieved.
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