title: A prospective registry evaluating the epidemiology and clinical care of traumatic brain injury patients presenting to a regional referral hospital in Moshi, Tanzania: challenges and the way forward.
abstract: Traumatic brain injury (TBI) is the most common cause of death and disability globally disproportionately affecting low- and middle-income countries where increasing injury rates are compounded by limited quality care. The objective of this study is to describe quality of care for TBI patients who presented to Kilimanjaro Christian Medical Center, Moshi, Tanzania. We evaluated a prospective quality improvement TBI registry that enrolled consecutive patients with acute TBI. Descriptive statistics and qualitative comparative analysis was performed. Overall, 893 TBI patients were enrolled during the study period, with a mean age of 32.1 years and who were mostly (80%) male. 12.9% suffered severe TBI (GCS < 9). Most injuries were road traffic (66%) especially motorcyclists (49%) and 26.8% were alcohol related. One intubation occurred, and 22.9% of hypoxic patients received oxygen. Severe TBI mortality was 47%. TBI affects men 15-45 years old in traffic crashes with high mortality for severe TBI (47%) patients. Care addressing secondary injury, hypoxemia, and hypotension is limited.
authors.affiliation: a Duke Division of Emergency Medicine , Duke University Medical Center , Durham , NC , USA.|b Duke Global Health Institute , Duke University , Durham , NC , USA.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Staton
authors.affiliation: c Kilimanjaro Christian Medical Center , Moshi , Tanzania.
authors.forename: Daniel
authors.initials: D
authors.lastname: Msilanga
authors.affiliation: c Kilimanjaro Christian Medical Center , Moshi , Tanzania.
authors.forename: George
authors.initials: G
authors.lastname: Kiwango
authors.affiliation: d Faculty of Medicine , Faculdade INGA , Maringá , Brazil.
authors.forename: Joao Ricardo
authors.initials: JR
authors.lastname: Vissoci
authors.affiliation: e State University of West of Parana/Unioeste , Foz do Iguaçu , Brazil.
authors.forename: Luciano
authors.initials: L
authors.lastname: de Andrade
authors.affiliation: f London School of Tropical Medicine and Hygiene , London , United Kingdom.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Lester
authors.affiliation: a Duke Division of Emergency Medicine , Duke University Medical Center , Durham , NC , USA.|b Duke Global Health Institute , Duke University , Durham , NC , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hocker
authors.affiliation: a Duke Division of Emergency Medicine , Duke University Medical Center , Durham , NC , USA.|b Duke Global Health Institute , Duke University , Durham , NC , USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Gerardo
authors.affiliation: c Kilimanjaro Christian Medical Center , Moshi , Tanzania.
authors.forename: Mark
authors.initials: M
authors.lastname: Mvungi
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012042:Registries; D013636:Tanzania / Q000453:epidemiology; D016896:Treatment Outcome; D055986:Vital Signs; D055815:Young Adult
keywords: Tanzania; epidemiology; quality of care; traumatic brain injury