Injury characteristics and their association with clinical complications among emergency care patients in Tanzania.

Abstract

Background

Over 5 million people annually die from injuries and millions more sustain non-fatal injuries requiring medical care. Ninety percent of injury deaths occur in low- and middle-income countries (LMICs). This study describes the characteristics, predictors and outcomes of adult acute injury patients presenting to a tertiary referral hospital in a low-income country in sub-Saharan Africa.

Methods

This secondary analysis uses an adult acute injury registry from Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. We describe this patient sample in terms of socio-demographics, clinical indicators, injury patterns, treatments, and outcomes at hospital discharge. Outcomes include mortality, length of hospital stay, and functional independence. Associations between patient characteristics and patient outcomes are quantified using Cox proportional hazards models, negative binomial regression, and multivariable logistic regression.

Results

Of all injury patients (n=1365), 39.0% were aged 30 to 49 years and 81.5% were men. Most patients had at least a primary school education (89.6%) and were employed (89.3%). A majority of injuries were road traffic (63.2%), fall (16.8%), or assault (14.0%) related. Self-reported comorbidities included hypertension (5.8%), HIV (3.1%), and diabetes (2.3%). Performed surgeries were classified as orthopedic (32.3%), general (4.1%), neurological (3.7%), or other (59.8%). Most patients reached the hospital at least four hours after injury occurred (53.9%). Mortality was 5.3%, median length of hospital stay was 6.1 days (IQR: 3.1, 15.0), self-care dependence was 54.2%, and locomotion dependence was 41.5%.

Conclusions

Our study sample included primarily young men suffering road traffic crashes with delayed hospital presentations and prolonged hospital stays. Being older, male, and requiring non-orthopedic surgeries or having HIV portends a worse prognosis. Prevention and treatment focused interventions to reduce the burden of injury mortality and morbidity at KCMC are needed to lower injury rates and improve injury outcomes.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.afjem.2022.08.001

Publication Info

Zimmerman, Armand, Loren K Barcenas, Msafiri Pesambili, Francis Sakita, Simon Mallya, Joao Ricardo Nickenig Vissoci, Lawrence Park, Blandina T Mmbaga, et al. (2022). Injury characteristics and their association with clinical complications among emergency care patients in Tanzania. African journal of emergency medicine : Revue africaine de la medecine d'urgence, 12(4). pp. 378–386. 10.1016/j.afjem.2022.08.001 Retrieved from https://hdl.handle.net/10161/25914.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Blandina Mmbaga

Adjunct Associate Professor of Global Health
Bettger

Janet Prvu Bettger

Adjunct Associate in the Department of Orthopaedic Surgery

Dr. Bettger’s research is dedicated to establishing real world evidence aimed to improve health care quality and policies that reduce the burden of disease and disability. As a health services researcher and implementation scientist, her research extends from observational studies to randomized and pragmatic trials. She was the Founding Director of Duke Roybal Center for Translational Research in the Behavioral and Social Sciences of Aging and the Founding Director of Undergraduate Initiatives for the Duke-Margolis Center for Health Policy. She has examined implementation of several integrated care models to improve the transition home from the hospital (VERITAS with virtual exercise therapy after knee replacement, COMPASS for stroke, RECOVER for stroke in rural China, and coordinated care for trauma patients in Tanzania). She also studies implementation of community-based models of care that can prevent functional decline. These include the CTSA-funded IMPAC RCT of integrating physical therapists into primary care as first line providers to address musculoskeletal pain, the VA-funded Gerofit program of structured and progressive in-person and virtual group exercise for older Veterans, MRC-funded SINEMA RCT of a village-based model supporting stroke recovery in China, and a NIDCD study comparing three primary care protocols for older adult hearing healthcare.

In addition to the evidence translation studies in China (RECOVER and SINEMA) and Tanzania, she has partnered with experts in Singapore on stroke systems research, and worked on large cluster randomized trials to improve evidence-based care in Brazil, Peru, Argentina (BRIDGE-Stroke) and China (CNSR and Golden Bridge). To address health locally, she was the faculty sponsor to launch Exercise is Medicine at Duke and Help Desk, a student volunteer community resource navigator model addressing social determinants of health.

Dr. Bettger received her BA from the University of Western Ontario, Canada and her MS from the University of Wisconsin–LaCrosse where she studied community reintegration for stroke and brain-injured patients transitioning from hospital to home. Her doctoral training in Rehabilitation Sciences, completed at Boston University, concluded with an investigation of patterns of functional recovery and factors affecting outcomes in patients transitioning home following acute rehabilitation. While working on her doctorate, she also worked in state government as the director of the Paul Coverdell National Acute Stroke Registry. Dr. Bettger completed post-doctoral training at the University of Pennsylvania with a NIH NRSA research fellowship in neurorehabilitation, a research fellowship at the NewCourtland Center for Transitions and Health, and a Switzer Fellowship funded by the National Institute on Disability and Rehabilitation Research to study the role of the environment on functional outcomes. She completed additional research training at Duke as a mentored scholar in comparative effectiveness research funded by AHRQ. As of July 2022, she is an Adjunct Associate Professor for Duke's Department of Orthopaedics and has transitioned out of her role as Co-Director of the Duke Clinical and Translational Institute (CTSA) Pilots Accelerator Core working with NCCU. She is affiliate faculty with Duke's Science and Society, Duke-Margolis Center for Health Policy, the Duke Clinical Research Institute (DCRI) and Duke Global Health Institute (DGHI), is a Senior Fellow of the Duke Center for the Study of Aging and Human Development, and is a Fellow of the American Heart Association. 

Staton

Catherine Ann Staton

Professor of Emergency Medicine

Catherine Staton MD MSc

Dr. Staton is a Professor in Emergency Medicine (EM), Neurosurgery & Global Health with tenure at Duke University. She is the Director of the GEMINI (Global EM Innovation & Implementation) Research Center and the EM Vice Chair of Research Strategy & Faculty Development. Her research integrates innovative implementation methods into health systems globally to improve access to acute care. In 2012, with an injury registry at Kilimanjaro Christian Medical Center, Tanzania Dr. Staton demonstrated 30% of injury patients had at risk alcohol use, providing preliminary data for a K01/Career Development Award. Her K01 award adapted a brief alcohol intervention to the KCMC ED and Swahili. This intervention has been proven to reduce 26 binge drinking events per year compared to usual care, and the team is now planning for regional implementation. Dr. Staton and her mentor and collaborator Dr. Mmbaga are co-PD of the “The TReCK Program: Trauma Research Capacity Building in Kilimanjaro” to train 12 masters and doctoral learners to conduct innovative implementation and data science projects to improve care for injury patients. Currently, Dr. Staton and GEMINI partners with over a dozen faculty from over 6 low- and middle-income countries to conduct research, has mentored over 150 learners from undergraduate to post-doctoral levels from high, middle and low- income settings and has over 160 manuscripts.


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