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Prevalence of Traumatic Brain Injury Among Trauma Patients in Ethiopia: Systematic Review and Meta-Analysis

Semagn Mekonnen Abate1, Bedru Jemal Abafita1, Tesfanew Bekele2

1Department of Anesthesiology, College of Health Sciences and Medicine, Dilla University, Dilla Ethiopia

2Department of Surgery, College of Health Sciences and Medicine, Dilla University, Dilla Ethiopia

Correspondence to: Dr. Semagn Mekonnen Abate, Email: semmek17@gmail.com

Received: 06 December 2019; Revised: 29 February 2020; Accepted: 25 April 2020; Available online: 21 June 2020

Abstract

Background: Traumatic brain injury (TBI) is a common cause of mortality and disability in young age populations, particularly in children and adolescents. The objective of this systematic review and meta-analysis was to assess the prevalence of TBI among trauma patients in Ethiopia. Methods: A three-stage search strategy was conducted on PubMed/Medline, Science Direct and African Journals Online, and a grey literature search was conducted on Google Scholar. Data were analyzed with R version 3.6.1. Results: The pooled prevalence of TBI in Ethiopia was 20% (95% confidence interval (CI), 11–32). Subgroup analysis revealed that road traffic accident was the commonest mechanism of injury in Ethiopia at 21% (95% IC, 15–30), next was assault at 18% (95% CI, 5–48). Conclusion: This review shows a high prevalence of TBI among trauma patients in Ethiopia when compared with continental and global reports. Policymakers and stakeholders should work on regulatory laws on transportation; pre-hospital emergency medical care system is also in high demand.

Protocol registration: This review was registered in Prospero international prospective register of systematic reviews (CRD42020146643).

Keywords: Head injury, Road traffic accident, Assault, Ethiopia

Ann Afr Surg. 2021;18(1):10–17

DOI: http://dx.doi.org/10.4314/aas.v18i1.3

Conflicts of Interest: None

Funding: None

© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction

Head injury is defined as any trauma to the head resulting from external mechanical force, such as rapid acceleration or deceleration, impact or penetration (1). The Centers for Disease Control and Prevention defines traumatic brain injury (TBI) as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or a penetrating head injury (2). Head injury is a common cause of mortality and disability in the young age population, particularly in children and adolescents (1). Among all trauma-related injuries, head injury is considered the greatest contributor to death and disability globally (3). In addition, besides the impact on the individual, TBI can negatively affect families, communities, and the economy of the country through loss of productive age groups and treatment costs (4).

It is estimated that in the USA about 5.3 million people are living with a TBI-related disability (5), and 7.7 million people in the European Union who have experienced TBI have disabilities (6). The World Health Organization (WHO) estimates that each year more than 10 million people in the world sustain TBI, resulting in death or severe disability (7).

The report on the Global burden of disease study shows there were 27.08 million new cases of TBI in 2016.  The report also revealed that TBI caused 8.1 million years of life lived with disability. Sub-Saharan Africa had 2.9 million new cases of TBI, equivalent to 360 per 100,000 population. The report also showed that Ethiopia accounted for 659 (624–703) TBI cases per 100,000 population, roughly representing 10.8% of Sub-Saharan Africa and 28% of eastern Sub-Saharan Africa TBI cases (3).

The incidence of TBI globally is rising, owing mainly to injuries associated with increases in population density and increased use of motor vehicles, particularly in middle- and low-income countries (8). Globally, road traffic accidents are responsible for more than 50 million injuries every year, with about 1.2 million ending in death (3,9,10). Indeed, many TBIs are the result of motor-related accidents, but the pattern of injury varies across regions: in high-income countries, individuals with TBI are generally motor vehicle occupants, whereas in middle- and low-income countries patients with TBI are often vulnerable road-traffic users such as pedestrians, cyclists, and motorcyclists. Increased motorization combined with inadequate traffic education and slow implementation of traffic safety regulations are the main causes of the increasing incidence of TBI in low- and middle-income countries (11).