Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management

Michael Mwandri; Timothy Craig Hardcastle; Hendry Sawe; Francis Sakita; Juma Mfinanga; Sarah Urassa; Alex Mremi; Lazaro Nelbert Mboma; Prosper Bashaka

doi:10.1016/j.afjem.2020.01.010

Trauma burden, patient demographics and care-process in major hospitals in Tanzania: A needs assessment for improving healthcare resource management

Afr J Emerg Med. 2020 Sep;10(3):111-117. doi: 10.1016/j.afjem.2020.01.010. Epub 2020 Mar 10.

Authors

Michael Mwandri¹, Timothy Craig Hardcastle^{1

2}, Hendry Sawe^{3

4}, Francis Sakita⁵, Juma Mfinanga³, Sarah Urassa⁵, Alex Mremi⁵, Lazaro Nelbert Mboma⁶, Prosper Bashaka⁶

Affiliations

¹ University of KwaZulu Natal, Department of Surgery, 719 Umbilo Road, Durban 4001, South Africa.
² Inkosi Albert Luthuli Central, 800 Vusi Mzimela Road, Mayville 4058, Durban 4091, South Africa.
³ Muhimbili National Hospital, P.O. Box 65000, Dar es Salaam, Tanzania.
⁴ Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
⁵ Kilimanjaro Christian Medical Center, P.O. Box 3021, Moshi, Tanzania.
⁶ Mbeya Zonal Referral Hospital, P.O. Box 419, Mbeya, Tanzania.

Abstract

Background: Appropriate referrals of injured patients could improve clinical outcomes and management of healthcare resources. To gain insights for system development, we interrogated the current situation by assessing burden, patient demography, causes of injury, trauma mortality and the care-process.

Methods: We used an observational, cross-sectional study design and convenience sampling to review patient charts from 3 major hospitals and the death registry in Tanzania.

Results: Injury constitutes 9-13% of the Emergency Centre census. Inpatient trauma-deaths were 8%; however, the trauma death registry figures exceeded the 'inpatient deaths' and recorded up to 16%. Most patients arrive through a hospital referral system (82%) and use a hospital transport network (76%). Only 8% of the trauma admissions possessed National Health Insurance. Road traffic collision (RTC) (69%), assault (20%) and falls (9%) were the leading causes of injury. The care process revealed a normal primary-survey rate of 73-90%. Deficiencies in recording were in the assessment of: Airway and breathing (67%), circulation (40%) and disability (80%). Most patients had non-operative management (42-57%) or surgery for wound care or skeletal injuries (43%). Laparotomies were performed in 26%, while craniotomy and chest drain-insertion were each performed in 10%.

Conclusion: The burden of trauma is high, and the leading causes are: RTC, assault, and falls. Deaths recorded in the death registries outweigh in-hospital deaths for up to twofold. There are challenges in the care process, funding and recording. We found a functional hospital referral-network, transport system, and death registry.

Keywords: Emergency; Global health; Injuries; Prehospital; Quality of care; Surgery.