Outcomes after acute traumatic spinal cord injury in Botswana: from admission to discharge.

STUDY DESIGN: Prospective follow-up study. OBJECTIVES: To increase the knowledge regarding clinical and functional outcomes after traumatic spinal cord injuries (TSCI) in a resource-constrained setting. A special focus was placed on secondary complications such as pressure ulcers. SETTING: The national referral hospital in Gaborone, Botswana. METHODS: The study included all patients admitted with an acute TSCI during a 2-year period (n=39). Data collection was conducted at the time of discharge, and clinical characteristics, length of stay and pressure ulcers were analysed using descriptive and inferential statistics. RESULTS: Completeness of injury and presence of pressure ulcers were the factors found to significantly prolong hospitalization, which was 5 months (median). One patient died before discharge and one was discharged to rehabilitation in South Africa; all other patients were living with close or distant family members after discharge. Patients were supplied with electrical or manual active wheelchairs. Self-catheterization or suprapubic catheters were the main methods for bladder management, and ano-rectal stimulation to manage the bowel. Pressure ulcers, urinary tract infections and pain were the most frequent complications during in-patient care. CONCLUSIONS: Rehabilitation of patients with TSCI in Botswana has been going through big changes, and new rehabilitation objectives, such as techniques used for the management of bladder and bowel dysfunctions and the provision of technical aids, have been implemented, which likely can contribute to an overall improvement in the outcomes. However, basic care at the general wards is still lagging behind, causing high rates of pressure ulcers that significantly extend hospitalization periods.

Outcomes 2 years after traumatic spinal cord injury in Botswana: a follow-up study.

STUDY DESIGN: Prospective follow-up study. OBJECTIVES: To identify indicators leading to compliance with yearly controls (YCs) and to describe the clinical and functional outcomes 2 years after traumatic spinal cord injury (SCI). SETTING: The national SCI rehabilitation centre in Botswana. METHODS: Included in the study were all people who were admitted with a traumatic SCI during a 2-year period and survived to be discharged (n=38). Data were collected at the YCs and included demographic characteristics and clinical and functional outcomes. Comparisons were made between those who did or did not attend YCs and between those who did or did not develop pressure ulcers (PUs). RESULTS: The follow-up rate was 71% (27/38) with higher attendance among those with complete injuries and those with secondary complications, especially pain. Age, gender, distance to the centre and education did not affect the follow-up rate. Self-catheterisation and suprapubic catheter were the preferred methods to manage neurogenic bladder dysfunction. Despite high rates of PUs (48%) and urinary tract infections (UTIs; 41%), no death had occurred during the follow-up period. Furthermore, one-third had resumed work. CONCLUSION: Despite high rates of UTIs and PUs developed in the home environment, this study showed a high survival rate 2 years after traumatic SCI, which might be explained by the establishment of a specialised SCI unit and the high follow-up rate. In addition, the continuing contact with the SCI staff might have facilitated the relatively high return-to-work rate. Long-term follow-up seems possible even in resource-constrained settings with clearly stated objectives, transport, dedicated staff and well-educated patients and families.

Traumatic spinal cord injury in Botswana: characteristics, aetiology and mortality.

STUDY DESIGN: Descriptive study with a cross-sectional design. OBJECTIVES: To describe the epidemiology of traumatic spinal cord injuries (TSCIs) in Botswana, with a specific focus on road traffic crashes (RTC). SETTING: Main public referral hospital, Gaborone, Botswana. METHOD: Two samples were included. Sample one described the epidemiology and included patients admitted during a 2-year period with acute TSCI. Sample two included only patients with TSCI due to RTC. RESULTS: Annual incidence was 13 per million population. Epidemiology of TSCI: 49 patients were included, 71% male, age ranging from 4 to 81 years, 80% ⩽ 45 years. Tetraplegia was more common than paraplegia (59/41%), and 39% had C1-C4 level of injury. The main cause of TSCI was RTC (68%), followed by assault (16%) and falls (10%). Mortality was 20%, where all, but one, had tetraplegia (18%). Median time from injury to spinal surgery was 12 days, with longer time for women, 16 days compared with 8 for men. Burst tire was the primary cause of RTC resulting in a TSCI, followed by hitting animals on the road. The majority had been passengers and 72% were involved in single crashes. CONCLUSION: The most common cause for TSCI was RTC, followed by assault. In-hospital mortality was high and the waiting period from the time of accident to spinal surgery was long, especially for women. The aetiology and high mortality of TSCI in Botswana indicate that improvements in roadway safety and medical care may decrease the TSCI incidence and mortality.