Trauma burden, patient demographics and care-process in major hospitals in Tanzania: a needs assessment for improving healthcare resource management

Background:Appropriate referrals of injured patients could improve clinical outcomes and management ofhealthcare resources. To gain insights for system development, we interrogated the current situation by assessingburden, patient demography, causes of injury, trauma mortality and the care-process.Methods:We used an observational, cross-sectional study design and convenience sampling to review patientcharts from 3 major hospitals and the death registry in Tanzania.Results:Injury constitutes 9­13% of the Emergency Centre census. Inpatient trauma-deaths were 8%; however,the trauma death registryfigures exceeded the'inpatient deaths'and recorded up to 16%. Most patients arrivethrough a hospital referral system (82%) and use a hospital transport network (76%). Only 8% of the traumaadmissions possessed National Health Insurance. Road traffic collision (RTC) (69%), assault (20%) and falls (9%)were the leading causes of injury. The care process revealed a normal primary-survey rate of 73­90%.Deficiencies in recording were in the assessment of: Airway and breathing (67%), circulation (40%) and dis-ability (80%). Most patients had non-operative management (42­57%) or surgery for wound care or skeletalinjuries (43%). Laparotomies were performed in 26%, while craniotomy and chest drain-insertion were eachperformed in 10%.Conclusion:The burden of trauma is high, and the leading causes are: RTC, assault, and falls. Deaths recorded inthe death registries outweigh in-hospital deaths for up to twofold. There are challenges in the care process,funding and recording. We found a functional hospital referral-network, transport system, and death registry

The burden of acute coronary syndrome, heart failure, and stroke among emergency department admissions in Tanzania: A retrospective observational study

Introduction The prevalence of cardiovascular disease in sub-Saharan Africa is substantial and growing. Much remains to be learned about the relative burden of acute coronary syndrome (ACS), heart failure, and stroke on emergency departments and hospital admissions.Methods A retrospective chart review of admissions from September 2017 through March 2018 was conducted at the emergency department of a tertiary care center in northern Tanzania. Stroke admission volume was compared to previously published data from the same hospital and adjusted for population growth. Results Of 2418 adult admissions, heart failure and stroke were the two most common admission diagnoses, accounting for 294 (12.2%) and 204 (8.4%) admissions, respectively.ACS was uncommon, accounting for 9 (0.3%) admissions. Of patients admitted for heart failure, uncontrolled hypertension was the most commonly identified etiology of heart failure, cited in 124 (42.2%) cases. Ischemic heart disease was cited as the etiology in only 1 (0.3%) case. Adjusting for population growth, the annual volume of stroke admissions increased 70-fold in 43 years, from 2.9 admissions per 100,000 population in 1974 to 202.2 admissions per 100,000 in 2017.Conclusions :The burden of heart failure and stroke on hospital admissions in Tanzania is substantial, and the volume of stroke admissions is rising precipitously. ACS is a rare diagnosis, and the distribution of cardiovascular disease phenotypes in Tanzania differs from what has been observed outside of Africa. Further research is needed to ascertain the reasons for these differences