Abstract
ABSTRACT Background: Causes, magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region. There is a scarcity of literature on profile of traumatic spinal cord injury to inform prevention and rehabilitation of this health condition in African rural settings, particularly Tanzania. Objective: To describe the incidence, etiology and clinical outcomes of traumatic spinal cord injury and issues related to retrospective study in underdeveloped setting. Methods: Records for patients with traumatic spinal cord injury for five consecutive years (2010–2014) were obtained retrospectively from the admission wards and health records archives of the Kilimanjaro Christian Medical Center. Sociodemographic, cause, complications and patients’ condition on discharge were recorded and analyzed descriptively. Results: The admission books in the wards registered 288 new traumatic spinal cord injury cases from January 2010 to December 2014. Of the 288 cases registered in the books, 224 were males and 64 females with mean age 39.1(39.1 ± 16.3) years and the majority of individuals 196(68.1%) were aged between 16 and 45 years. A search of the hospital archives provided 213 full patient records in which the leading cause of injury was falls 104(48.8%) followed by road traffic accidents 73(34.3%). Cervical 81(39.9%) and lumbar 71(34.74%) spinal levels were the most affected. The annual incidence for the Kilimanjaro region (population 1,640,087) was estimated at more than 26 persons per million population. The most documented complications were pressure ulcers 42(19.7%), respiratory complications 32(15.0%) and multiple complications 28(13.1%). The mean length of hospital stay was 64.2 ± 54.3 days and the mortality rate was 24.4%. Conclusion: Prevention of traumatic spinal cord injury in North-east Tanzania should consider falls (particularly from height) as the leading cause, targeting male teenagers and young adults. Pressure ulcers, respiratory complications, in-hospital mortality and availability of wheelchairs should be addressed.
Highlights
Causes, magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region
The aim of this study is to describe the situation of Traumatic spinal cord injury (TSCI) within a low income and resource constrained Kilimanjaro rural region in Tanzania as well as addressing issues related to clinical outcomes in such settings
We considered the whole population as at risk of TSCI regardless of age or sex due to the array of causes and calculation for incidence rate included the Kilimanjaro population for year 2012 which is the midpoint for 2010–2014
Summary
Magnitude and consequences of traumatic spinal cord injury depend largely on geography, infrastructure, socioeconomic and cultural activities of a given region. A person with spinal cord injury is at immediate risk of respiratory and cardiac failure which may lead to death in the acute phase [3]. Those who survive the acute phase, faces a lifelong risk of secondary complications such as pressure ulcers, urinary tract infections, deep venous thrombosis, contractures, chronic pain and spasms [1,4]. The World Health Organization informs that up to 90% of all spinal cord lesions are due to trauma and that the leading cause globally is RTA [1]. Falls are the second leading cause of TSCI in some parts of India, Nepal, South Asia, Estonia and Ireland it is reported the first leading cause [6]
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