Abstract
Background Road traffic injuries (RTIs) pose a severe public health crisis in Sub-Saharan Africa (SSA) and specifically in Tanzania, where the mortality due to RTIs is nearly double the global rate. There is a paucity of RTI data in Tanzania to inform evidence-based interventions to reduce the incidence and improve care outcomes. A trauma registry was implemented at 13 health facilities of diverse administrative levels in Tanzania. In this study, we characterize the burden of RTIs seen at these health facilities. Methods This was a one-year prospective descriptive study utilizing trauma registry data from 13 multilevel health facilities in Tanzania from 1 October 2019 to 30 September 2020. We provide descriptive statistics on patient demographics; location; share of injury; nature, type, and circumstances of RTI; injury severity; disposition; and outcomes. Results Among 18,553 trauma patients seen in 13 health facilities, 7,416 (40%) had RTIs. The overall median age was 28 years (IQR 22–38 years), and 79.3% were male. Most road traffic crashes (RTC) occurred in urban settings (68.7%), involving motorcycles (68.3%). Motorcyclists (32.9%) were the most affected road users; only 37% of motorcyclists wore helmets at the time of the crash. The majority (88.2%) of patients arrived directly from the site, and 49.0% used motorized (two- or three-) wheelers to travel to the health facility. Patients were more likely to be admitted to the ward, taken to operating theatre, died at emergency unit (EU), or referred versus being discharged if they had intracranial injuries (27.8% vs. 3.7%; p < 0.0001), fracture of the lower leg (18.9% vs. 6.4%; p < 0.0001), or femur fracture (12.9% vs. 0.4%; p < 0.0001). Overall, 36.1% of patients were admitted, 10.6% transferred to other facilities, and mortality was 2%. Conclusions RTCs are the main cause of trauma in this setting, affecting mostly working-age males. These RTCs result in severe injuries requiring hospital admission or referral for almost half of the victims. Motorcyclists are the most affected group, in alignment with prior studies. These findings demonstrate the burden of RTCs as a public health concern in Tanzania and the need for targeted interventions with a focus on motorcyclists.
Highlights
Road traffic injuries (RTIs) pose a severe public health crisis in Sub-Saharan Africa (SSA) and in Tanzania, where the mortality due to RTIs is nearly double the global rate. ere is a paucity of RTI data in Tanzania to inform evidencebased interventions to reduce the incidence and improve care outcomes
In an effort to mitigate the burden of RTIs, the Government of Tanzania, supported by the World Bank, planned a pilot implementation of emergency medical services (EMS) along the A7 highway that connects the north and south of Tanzania. is pilot EMS implementation included the creation of an ambulance dispatch center, activation of an emergency access telephone number, training community first responders, paramedics, fire safety personnel and drivers, procuring and equipping ambulances, and renovation of emergency units (EUs) in 6 health facilities located within 2 km of the A7 highway that included 2 regional hospitals (Tumbi and Morogoro), 3 health centers (Kimara, Chalinze, and Mikumi), and 1 dispensary (Fulwe)
In order to understand the impact of this pilot EMS implementation, we set up a trauma registry to enroll all injured patients at EUs of 13 public health facilities (Figure 1) that include all 6 health facilities involved in the pilot EMS implementation and 7 additional not part of the EMS implementation. e 7 additional facilities included 2 regional hospitals (Dodoma and Mawenzi), 3 district hospitals (Same, Korogwe, and Mvomero), and 2 health centers (Mkata and Gairo), all of which were located on a different though comparable highway
Summary
Road traffic injuries (RTIs) pose a severe public health crisis in Sub-Saharan Africa (SSA) and in Tanzania, where the mortality due to RTIs is nearly double the global rate. ere is a paucity of RTI data in Tanzania to inform evidencebased interventions to reduce the incidence and improve care outcomes. In order to understand the health impacts of this pilot EMS in Tanzania, we implemented a multisite prospective trauma registry (TR) data collection at emergency units (EUs) of 13 multilevel health facilities that include the diverse scale of the administrative structure of Tanzania’s public health infrastructure. In this manuscript, we characterize the burden of RTIs in these facilities, as a crucial step of setting a baseline for the future impact evaluation of EMS implementation in Tanzania and other similar settings in LMICs
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