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Moshi H1,2, Sundelin G1, Sahlen K-G3, Sorlin A1
1Umeå University, Community Medicine and Rehabilitation, Umea, Sweden, 2Kilimanjaro Christian Medical University College, Rehabilitation Medicine (Physiotherapy), Kilimanjaro, Moshi, Tanzania, 3Umeå University, Nursing, Umea, Sweden
Background: Traumatic spinal cord injury (TSCI) results from excessive forces damaging the vertebral column and the spinal cord within. Although road traffic accidents are the leading cause of TSCI globally, this is not the same in all settings. Other causes such as falls, assaults and sports-related trauma predominate in some areas, dependent on the dominant risky socioeconomic and cultural activities. Clinical outcomes are such as varying degrees of paralysis, SCI-related complications and in a worst case scenario, death. Little is known about predominating cause of TSCI and clinical outcomes in rural settings of the low-income countries, particularly Tanzania. This makes it difficult to plan for prevention and improvement of care.
Purpose: This study aimed at describing the occurrence and clinical outcomes of traumatic spinal cord injuries in Kilimanjaro -Tanzania, with focus on rural settings.
Methods: Data were collected prospectively from each person with traumatic SCI admitted at the Kilimanjaro Christian Medical Center for one year (January to December 2017). A table based on the international spinal cord injury core data set was used for data collection. This table was used to gather information personal details, the cause of injury, radiological diagnosis and health complications (including death). The American Spinal cord Injury Association neurological assessment scale (AIS) was used to assess sensorimotor function and completeness of the injury
Results: A total of 84 persons who sustained SCI in 2017 were admitted in the hospital of whom the majority were males 67(79/8%) at the age of between 12 and 74 years (mean= 40.92 ± 15.00). Of the causes, 54(64.2%) were due to fall (especially from trees), 26 (31%) road traffic accidents and 4 (4.8%) other causes. The majority of the injuries occurred at the cervical 44 (52.4%) and lumbar 29 (34.5%) levels respectively. Most of the injuries 53 (63/1%) were incomplete (AIS “BCDE”) while 31 (36.9%) were complete (AIS “A”). The most prevalent SCI-related health complications were pressure ulcers 34(40.5%) and urinary tract infections 33 (39.3%) and the in-hospital mortality rate was 21.4%. Based on the Kilimanjaro population, the annual incidence rate was 38 new cases per million inhabitants
Conclusion(s): Fall from trees is the leading cause of TSCI in the rural area of Kilimanjaro in Tanzania. The in-hospital mortality and prevalence of SCI-relate health complications are still high in this region
Implications: Physiotherapists are commonly involved in the acute and late rehabilitation of TSCI. It is important that they actively reconsider their role in the prevention of occurrence of SCI incidents and the related health complications. As for rural areas, leading causes (other than road traffic accidents) should be considered.
Keywords: Spinal cord injury, rural Kilimanjaro, trauma
Funding acknowledgements: Resources and Services Administration (HRSA) Award [grant number T84HA21123-02] through MRTP at KCMUCo.
Purpose: This study aimed at describing the occurrence and clinical outcomes of traumatic spinal cord injuries in Kilimanjaro -Tanzania, with focus on rural settings.
Methods: Data were collected prospectively from each person with traumatic SCI admitted at the Kilimanjaro Christian Medical Center for one year (January to December 2017). A table based on the international spinal cord injury core data set was used for data collection. This table was used to gather information personal details, the cause of injury, radiological diagnosis and health complications (including death). The American Spinal cord Injury Association neurological assessment scale (AIS) was used to assess sensorimotor function and completeness of the injury
Results: A total of 84 persons who sustained SCI in 2017 were admitted in the hospital of whom the majority were males 67(79/8%) at the age of between 12 and 74 years (mean= 40.92 ± 15.00). Of the causes, 54(64.2%) were due to fall (especially from trees), 26 (31%) road traffic accidents and 4 (4.8%) other causes. The majority of the injuries occurred at the cervical 44 (52.4%) and lumbar 29 (34.5%) levels respectively. Most of the injuries 53 (63/1%) were incomplete (AIS “BCDE”) while 31 (36.9%) were complete (AIS “A”). The most prevalent SCI-related health complications were pressure ulcers 34(40.5%) and urinary tract infections 33 (39.3%) and the in-hospital mortality rate was 21.4%. Based on the Kilimanjaro population, the annual incidence rate was 38 new cases per million inhabitants
Conclusion(s): Fall from trees is the leading cause of TSCI in the rural area of Kilimanjaro in Tanzania. The in-hospital mortality and prevalence of SCI-relate health complications are still high in this region
Implications: Physiotherapists are commonly involved in the acute and late rehabilitation of TSCI. It is important that they actively reconsider their role in the prevention of occurrence of SCI incidents and the related health complications. As for rural areas, leading causes (other than road traffic accidents) should be considered.
Keywords: Spinal cord injury, rural Kilimanjaro, trauma
Funding acknowledgements: Resources and Services Administration (HRSA) Award [grant number T84HA21123-02] through MRTP at KCMUCo.
Topic: Neurology: spinal cord injury; Disability & rehabilitation; Neurology
Ethics approval required: Yes
Institution: Kilimanjaro Christian Medical University College
Ethics committee: Research Ethics Review Committee
Ethics number: 620
All authors, affiliations and abstracts have been published as submitted.
