Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, +255 754 885 658, Tanzania.
Department of Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
BMC Emerg Med. 2023 Apr 10;23(1):42. doi: 10.1186/s12873-023-00805-x.
Low-and middle-income countries account for over 80% of fall-related fatalities globally. However there is little emphasis on the issue and limited high quality data to understand the burden, and to inform preventive and management strategies. We characterise the burden of fall injuries in Malawi and Tanzania.
This multi-centre prospective descriptive study utilized trauma registry data from 10 hospitals in Malawi and 13 hospitals in Tanzania. The study included twelve months of data in Tanzania (October 2019 to September 2020), and eighteen months of data from Malawi (September 2018 to March 2020). We describe patient demographics, the causes, location, and nature of injuries, timing of arrival to hospital, and final disposition. Regression analyses were performed to determine risk factors for serious injuries.
There were 93,178 trauma patients in the registries of both countries, of which 44,609 (47.9%) had fall related complaints. Fall injuries accounted for 55.3% and 17.4% of all trauma cases in Malawi and Tanzania respectively. Overall the median age was 16 years (Interquartile range (IQR) 8-31 years), and 62.8% were male. Most fall injuries (69.9%) occurred at home, were unintentional (98.1%), and were due to a ground level fall (74.9%). Nearly half of patients (47.9%) arrived at a facility using public transport, with median arrival time of 10 h (IQR 8-13 h) from initial injury. Extremities (87.0%) were the most commonly injured region, followed by head and neck (4.4%). Overall 3275 (7.4%) patients had potentially serious injuries. Age > 60 years was associated with two times odds of having serious injuries than those < 5 years, and those sustaining injury at work (adjusted Odds Ratio (aOR) 1.95 95% CI; 1.56-2.43) or recreational areas (aOR 3.47 95% CI; 2.93-4.10) had higher odds of serious injuries compared to those injured at home.
In these facilities in Sub-Saharan Africa, fall injuries accounted for a substantial fraction of all injuries. While most common in younger males, those aged 5-13 and over 60 years were more likely to have serious injuries. Most falls occurred at home, but serious injuries were more likely to occur at recreational and work areas. Future efforts should focus on preventive strategies to mitigate these injuries.
中低收入国家占全球跌倒相关死亡人数的 80%以上。然而，对于这个问题，关注较少，高质量数据也有限，难以了解其负担，也无法为预防和管理策略提供信息。我们对马拉维和坦桑尼亚的跌倒伤害负担进行了描述。
这项多中心前瞻性描述性研究利用了马拉维和坦桑尼亚 10 家医院和 13 家医院的创伤登记数据。该研究包括坦桑尼亚的 12 个月数据（2019 年 10 月至 2020 年 9 月）和马拉维的 18 个月数据（2018 年 9 月至 2020 年 3 月）。我们描述了患者的人口统计学特征、病因、受伤部位和性质、到达医院的时间以及最终去向。进行回归分析以确定严重伤害的危险因素。
两国的登记处共有 93178 名创伤患者，其中 44609 名（47.9%）有跌倒相关投诉。跌倒伤害分别占马拉维和坦桑尼亚所有创伤病例的 55.3%和 17.4%。总体而言，中位年龄为 16 岁（四分位距（IQR）8-31 岁），62.8%为男性。大多数跌倒伤害（69.9%）发生在家庭中，是意外（98.1%），且是由于地面水平跌倒（74.9%）所致。近一半的患者（47.9%）使用公共交通工具到达医疗机构，从最初受伤到到达医疗机构的中位时间为 10 小时（IQR 8-13 小时）。四肢（87.0%）是最常见的受伤部位，其次是头颈部（4.4%）。总体而言，3275 名（7.4%）患者有潜在的严重伤害。年龄>60 岁与年龄<5 岁的患者相比，发生严重伤害的几率是其两倍，而在工作场所（调整后的优势比（aOR）1.95，95%CI；1.56-2.43）或娱乐场所（aOR 3.47，95%CI；2.93-4.10）受伤的患者发生严重伤害的几率更高与在家中受伤的患者相比。
在这些撒哈拉以南非洲的医疗机构中，跌倒伤害占所有伤害的很大一部分。虽然最常见于年轻男性，但 5-13 岁和 60 岁以上的人群更有可能发生严重伤害。大多数跌倒发生在家庭，但严重伤害更可能发生在娱乐和工作场所。未来的工作应重点关注预防策略，以减轻这些伤害。
