Epidemiology and Characteristics of Neurosurgical Conditions at Mbarara Regional Referral Hospital.
BACKGROUND
The unmet surgical need, specifically neurosurgical need, in Uganda is significant, yet only 2 public hospitals currently perform neurosurgery in the country. This study examines the epidemiology and outcomes of neurosurgical conditions presenting to 1 of 12 regional referral hospitals in Uganda, in an effort to understand the neurosurgical needs of this population.


METHODS
The study was conducted at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda. Demographics, clinical characteristics, and outcomes were retrospectively collected for all patients who presented to MRRH with a neurosurgical condition between January 2012 and September 2015.


RESULTS
During the study period, 1854 patients presented to MRRH with a neurosurgical condition. More than half of the patients were between 19 and 40 years old, and the majority were males (76.1%). The overall median length of stay was 5 days (interquartile range: 2.5-10). The majority of admissions were due to trauma (87%), with almost 60% due to road traffic incidents. The overall mortality rate was 12.8%. A multivariable Cox proportional hazards model revealed that age, closed head injury, and admission Glasgow Coma Scale have a strong positive correlation with mortality while getting a diagnostic image and neurosurgical procedure were negatively correlated with mortality.


CONCLUSIONS
Traumatic brain injury represented the majority of neurosurgical admissions at MRRH, disproportionately affecting young males. Age, closed head injury, admission Glasgow Coma Scale, getting a diagnostic image, and neurosurgical procedure were all independent predictors of mortality. Resource appropriate interventions throughout the health system are needed to meet the demand and improve outcomes.
Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA.
Jihad
J
Abdelgadir
Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA. Electronic address: emily.smith1@duke.edu.
Emily R
ER
Smith
Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; David Geffen School of Medicine at University of California, Los Angeles, California, USA.
Maria
M
Punchak
Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Emergency Medicine, Duke University, Durham, North Carolina, USA.
Joao Ricardo
JR
Vissoci
Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Emergency Medicine, Duke University, Durham, North Carolina, USA.
Catherine
C
Staton
Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda.
Alex
A
Muhindo
Department of Neurosurgery, Mbarara Regional Referral Hospital, Mbarara, Uganda.
David
D
Kitya
Global Health Institute, Duke University, Durham, North Carolina, USA; Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina, USA.
Lawrence P
LP
Park
Division of Global Neurosurgery and Neurology, Duke University, Durham, North Carolina, USA; Global Health Institute, Duke University, Durham, North Carolina, USA; Department of Neurosurgery, Duke University, Durham, North Carolina, USA.
Michael M
MM
Haglund
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001930:Brain Injuries / Q000453:epidemiology / Q000601:surgery; D002493:Central Nervous System Diseases / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
Africa; Epidemiology; Global surgery; Neurosurgery; Uganda