Epidemiology and Characteristics of Neurosurgical Conditions at Mbarara Regional Referral Hospital

World Neurosurg. 2017 Jun;102:526-532. doi: 10.1016/j.wneu.2017.03.019. Epub 2017 Mar 23.

Abstract

Background: The unmet surgical need, specifically neurosurgical need, in Uganda is significant, yet only 2 public hospitals currently perform neurosurgery in the country. This study examines the epidemiology and outcomes of neurosurgical conditions presenting to 1 of 12 regional referral hospitals in Uganda, in an effort to understand the neurosurgical needs of this population.

Methods: The study was conducted at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda. Demographics, clinical characteristics, and outcomes were retrospectively collected for all patients who presented to MRRH with a neurosurgical condition between January 2012 and September 2015.

Results: During the study period, 1854 patients presented to MRRH with a neurosurgical condition. More than half of the patients were between 19 and 40 years old, and the majority were males (76.1%). The overall median length of stay was 5 days (interquartile range: 2.5-10). The majority of admissions were due to trauma (87%), with almost 60% due to road traffic incidents. The overall mortality rate was 12.8%. A multivariable Cox proportional hazards model revealed that age, closed head injury, and admission Glasgow Coma Scale have a strong positive correlation with mortality while getting a diagnostic image and neurosurgical procedure were negatively correlated with mortality.

Conclusion: Traumatic brain injury represented the majority of neurosurgical admissions at MRRH, disproportionately affecting young males. Age, closed head injury, admission Glasgow Coma Scale, getting a diagnostic image, and neurosurgical procedure were all independent predictors of mortality. Resource appropriate interventions throughout the health system are needed to meet the demand and improve outcomes.

Keywords: Africa; Epidemiology; Global surgery; Neurosurgery; Uganda.

Publication types

  • Multicenter Study

MeSH terms

  • Accidents, Traffic / statistics & numerical data
  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Brain Injuries / epidemiology
  • Brain Injuries / surgery
  • Central Nervous System Diseases / mortality
  • Central Nervous System Diseases / surgery*
  • Child
  • Child, Preschool
  • Critical Care / statistics & numerical data
  • Female
  • Glasgow Outcome Scale
  • Humans
  • Infant
  • Infant, Newborn
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Neurosurgical Procedures / statistics & numerical data*
  • Retrospective Studies
  • Sex Distribution
  • Treatment Outcome
  • Uganda / epidemiology
  • Young Adult