Spatial Analysis of the Determinants, Management and Outcomes of Traumatic Brain Injury in Rwanda, 2024

Background Traumatic brain injury (TBI) is a global health priority due to its preventability and its related expensive medical care. This research assessed the determinants, management and outcomes of TBI in Rwanda. Methods A multicentre cross-sectional study combined with a community-based telephone survey was implemented on a sample of 84 patients selected through a multi stage sampling technique. The data were collected in two reference hospitals through a standardized pre-tested questionnaire developed by the researcher who who included all the items of GOSE to determine the functional outcomes of TBI patients. Data collected were characteristics of the study participants, type of TBI, mode, mechanism, time and venue of the injury, mode of referencing from injury site to emergency department, clinical presentation and investigations on admission, treatment administrated, and outcomes of the management. The data were managed in SPSS23 and geo-referenced in Google Earth Pro. Descriptive statistics was implemented followed by determining association through Chi-square tests, correlation analysis and ANOVA. A multinomial regression established the relationship between determinants, management and outcomes of TBI. A spatial analysis through the kriging method of ArcGIS delineated TBI risk areas. A significance level of p  < 0.05 was set for all the statistical tests. Results More than half (51.2%) of the TBI cases were aged 25–49 years; TBI affected predominantly male gender (77.4%). The identified types of TBI were mild (50.0%), moderate (39.7%) and severe (10.3%). The GOSE scores revealed that 69.0% of the TBI patients had good outcomes. The statistically significant determinants of TBI were conscious status in moderate (OR = 51.2,95%[CI:6.6-397.2], p  = 0.000) and severe TBIs (OR = 48.8, 95%[CI: 1.8–1297.0], p  = 0.020) and the length of stay in hospital in severe TBI (OR = 1.142. 95%[CI:1.013–1.287], p  = 0.030). Three TBI risk areas were delineated in Rwanda through the kriging method; a high TBI risk area, an intermediate TBI risk area and low TBI risk area. Conclusion Traumatic brain injury is a country-wide public health concern in Rwanda. Its control and ultimately elimination indicate a public-private partnership between the affected communities, the public and private sectors, the armed forces, the Ministries of Transport, Education, and Health, the international organizations and non- governmental organizations.