Abstract:
Background: Traumatic head injury (THI) is one of the leading causes of death and
disability. In Developed countries, the designation of clear pathways and trauma centres
has improved care and outcomes of THI patients unlike in developed countries the
burden is still high and little is known about how well patients are managed.
Aim of the study: To determine factors that are associated with appropriate management
among patients with THI seen in regional and district hospitals in Tanzania.
Materials and methods: This was a prospective cohort study of THI patients seen in
regional and district hospitals of Tanzania from October to November 2020 and
included 162 hospitals. Patients were enrolled consecutively for over a 24hour period at
each site. A structured case report form (CRF) incorporated into online data capture
software was used to document patients’ demographics, clinical presentation,
management, disposition and 24 hours’ outcome. Appropriateness of management was
assessed using the WHO essential trauma care guidelines. Resource availability was
determined using the WHO emergency unit assessment tool. Data was analyzed using
SPSS and summarized into counts, proportions, medians and interquartile range (IQR),
95% confidence interval (CI) and P-value determined statistical significance. Logistic
regression analysis was used to determine predictors of appropriate management in THI
patients. Results: A total of 1056 trauma patients were seen in 162 hospitals around Tanzania
during the data collection periods. Of these, 218 (20.6%) patients with THI were
enrolled in this study. The median age was 29 years [IQR 20-38 years] and 73.4% were
males. Road Traffic Crash (RTC) was the most common mechanism of injury,
112(51.4%). Among all THI, 130 (59.6%) received appropriate management.
Availability of equipment at the facilities -adjusted odds ratio-(aOR 4.74 (95% CI 1.04-
21.52) was associated with appropriate management, with moderate (aOR 0.013 (95%
CI 0.002-0.11) or severe head injury (aOR 0.017 (95% CI 0.002-0.17) were
significantly less likely to receive appropriate management.
Conclusion: In this study, head injury severity and lack of equipment at the hospital
were found to be independent predictors of appropriate management of traumatic head
injury patients. There is an exigency to develop, implement and study systems that can
sustenance the improvement of THI appropriate management and optimize outcomes of
such patients.
