Abstract
BackgroundTrauma is among the leading causes of morbidity and mortality among pediatric and adolescent populations worldwide, with over ninety percent of childhood injuries occurring in low-income and middle-income countries. Lack of region-specific data on pediatric injuries is among the major challenges limiting the ability of health systems to implement interventions to prevent injuries and improve outcomes. We aim to characterize the burden of pediatric health injuries, initial healthcare interventions and outcomes seen in thirteen diverse healthcare facilities in Tanzania.MethodsThis was a prospective cohort study of children aged up to 18 years presenting to emergency units (EUs) of thirteen multi-level health facilities in Tanzania from 1st October 2019 to 30th September 2020. We describe injury patterns, mechanisms and early interventions performed at the emergency units of these health facilities.ResultsAmong 18,553 trauma patients seen in all thirteen-health facilities, 4368 (23.5%) were children, of whom 2894 (66.7%) were male. The overall median age was 8 years (Interquartile range 4–12 years). Fall 1592 (36.5%) and road traffic crash (RTC) 840 (19.2%) were the top mechanisms of injury. Most patients 3748 (85.8%) arrived at EU directly from the injury site, using motorized (two or three) wheeled vehicles 2401 (55%). At EU, 651 (14.9%) were triaged as an emergency category. Multiple superficial injuries (14.4%), fracture of forearm (11.7%) and open wounds (11.1%) were the top EU diagnoses, while 223 (5.2%) had intracranial injuries. Children aged 0–4 years had the highest proportion (16.3%) of burn injuries. Being referred and being triaged as an emergency category were associated with high likelihood of serious injuries with adjusted odds ratio (AOR) 4.18 (95%CI 3.07–5.68) and 2.11 (95%CI 1.75–2.56), respectively. 1095 (25.1%) of patients were admitted to inpatient care, 14 (0.3%) taken to operation theatre, and 25 (0.6%) died in the EU.ConclusionsIn these multilevel health facilities in Tanzania, pediatric injuries accounted for nearly one-quarter of all injuries. Over half of injuries occurred at home. Fall from height was the leading mechanism of injury, followed by RTC. Most patients sustained fractures of extremities. Future studies of pediatric injuries should focus on evaluating various preventive strategies that can be instituted at home to reduce the incidence and associated impact of such injuries.
Highlights
Trauma is among the leading causes of morbidity and mortality among pediatric and adolescent populations worldwide, with over ninety percent of childhood injuries occurring in low-income and middle-income countries
While there have been efforts in reducing the burden of childhood mortality due to trauma in most high-income countries (HIC), in low and middle-income countries (LMICs), efforts have largely focused on addressing mortality resulting from communicable illnesses, leaving a surge in mortality resulting from injuries among the same age population (Adeloye et al 2018; Sethi et al 2017; Ademuyiwa et al 2012)
Patient characteristics Among 18,553 trauma patients seen in all thirteenhealth facilities during the study period, 4368 (23.5%) were children, of whom 2894 (66.7%) were male, and overall median age was 8 years (Interquartile range 4–12 years)
Summary
Trauma is among the leading causes of morbidity and mortality among pediatric and adolescent populations worldwide, with over ninety percent of childhood injuries occurring in low-income and middle-income countries. A recent study on global health estimates of child mortality due to injuries in World Health Organisation (WHO) Europe region found a general decline of injuries over a 15-year period; there was persistent inequality between the LMICs and HICs in the region, with a widening gap of injury mortality (Sethi et al 2017). This trend has been attributed to socio-economic transition in these countries, with more urban dwellers and increasing motor vehicle accidents, combined with a lack of injury prevention strategies (Jullien 2021)
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