title: Traumatic brain injury in a rural and an urban Tanzanian hospital--a comparative, retrospective analysis based on computed tomography.
abstract: BACKGROUND
  In a resource-poor environment such as rural East Africa, expensive medical devices such as computed tomographic (CT) scanners are rare. The CT scanner at the rural Haydom Lutheran Hospital (HLH) in Tanzania therefore offers a unique chance to observe possible differences with urban medical centers in the disease pattern of trauma-related cranial pathologies. The purpose of this study was to compare traumatic brain injuries (TBIs) between a rural and an urban area of Tanzania.
  
  
  METHODS
  HLH has 350 beds and one CT scanner. The urban Aga Khan Hospital is a private hospital with 80 beds and one CT scanner. This was a retrospective study. Data of 248 patients at HLH and of 432 patients at Aga Khan Hospital with TBI could be collected.
  
  
  RESULTS
  The prevalence of TBI was significantly higher in the rural area compared to the urban area (34.2% vs. 21.9%, P < 0.0001). TBI due to violence was noted to occur more frequently at HLH, whereas road traffic accidents were more frequent at the Aga Khan Hospital. The number of patients showing a normal CT result was significantly higher in the urban area (53.0% vs. 35.9%, P < 0.0001). Bone fractures (35.9% vs. 15.7%, P < 0.0001) and pneumocephalus (6.9% vs. 0.9%, P < 0.0001) were diagnosed significantly more frequently in the rural survey. Soft tissue swelling (11.6% vs. 1.2%, P < 0.0001) and frontal sinus injuries (7.4% vs. 0.4%, P < 0.0001) were observed significantly more often in the urban setting.
  
  
  CONCLUSIONS
  This study documents the burden of TBI and the differences in TBI-related CT diagnoses and their incidence between urban and rural areas in Eastern Africa. These results are important as they demonstrate that patients with severe TBI are not a primarily urban concern. Management of TBI should be included in the training curricula for health personnel alike irrespective of whether their workplace is primarily urban or rural.
authors: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors: Daniel
authors: D
authors: Maier
authors: Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Innocent
authors: I
authors: Njoku
authors: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors: Erich
authors: E
authors: Schmutzhard
authors: Department of Radiology, Aga Khan Hospital, Dar es Salaam, Tanzania.
authors: Jaffer
authors: J
authors: Dharsee
authors: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors: Magdalena
authors: M
authors: Doppler
authors: Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA. Electronic address: roh9005@med.cornell.edu.
authors: Roger
authors: R
authors: Härtl
authors: Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Germany.
authors: Andrea Sylvia
authors: AS
authors: Winkler
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000453:epidemiology; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011007:Pneumocephalus / Q000000981:diagnostic imaging / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Africa; Brain; Computed tomography; Epidemiology; Radiography; Rural population; Tanzania; Traumatic brain injury