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Pediatric trauma burden in Tanzania: analysis of prospective registry data from thirteen health facilities
Hendry R Sawe1,2, Sveta Milusheva3, Kevin Croke3,4
1Department of Emergency Medicine, Emergency Medicine Department, MUHAS, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania. hsawe@muhas.ac.tz.
Insights
Pediatric trauma in Tanzania is a significant issue, with falls and road traffic crashes being leading causes. Most injuries occur at home, highlighting the need for home-based prevention strategies.
Area of Science:
- Global Health
- Pediatric Trauma Care
- Injury Epidemiology
Background:
- Trauma is a leading cause of death and disability in children globally, disproportionately affecting low- and middle-income countries.
- Lack of region-specific data hinders effective injury prevention and outcome improvement in healthcare systems.
- This study characterizes pediatric injuries in Tanzania to inform targeted interventions.
Purpose of the Study:
- To determine the burden of pediatric injuries in Tanzania.
- To analyze initial healthcare interventions and outcomes for injured children.
- To identify injury patterns and mechanisms in a Tanzanian pediatric population.
Main Methods:
- Prospective cohort study of children (up to 18 years) presenting to emergency units.
- Data collected from 13 multi-level health facilities in Tanzania over one year (Oct 2019-Sep 2020).
- Analysis of injury patterns, mechanisms, and emergency interventions.
Main Results:
- Pediatric trauma constituted 23.5% of 18,553 trauma patients; 66.7% were male, median age 8 years.
- Falls (36.5%) and road traffic crashes (19.2%) were primary injury mechanisms; 85.8% arrived directly from the scene.
- Common diagnoses included superficial injuries (14.4%), fractures (11.7%), and open wounds (11.1%); 5.2% had intracranial injuries. Burns were highest in 0-4 year olds (16.3%).
- Referral and emergency triage were linked to serious injuries. 25.1% admitted, 0.3% to OR, 0.6% died in EU.
Conclusions:
- Pediatric injuries represent a substantial burden in Tanzanian healthcare facilities, with over half originating at home.
- Falls and road traffic crashes are the predominant injury mechanisms, with extremity fractures being common.
- Future research should prioritize home-based preventive strategies to mitigate pediatric injury incidence and impact.
Background:
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. 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.
Methods:
This 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.
Results:
Among 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.
Conclusions:
In 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.
