Epidemiology and Functional Outcome of Head Injury in Rural Kenya

Abstract

Background: Head injury is a major cause of disability, morbidity, and mortality and is responsible for a significant proportion of all traumatic deaths. The aim of this study was to document the epidemiology and factors influencing functional recovery in patients treated for head injury in a rural institution in Kenya.

 Methods: A retrospective analysis of 209 patients admitted to the surgical unit at Consolata Hospital and diagnosed with head injury between January 2009 and December 2012. Outcome was assessed according to the Glasgow Outcome Scale (GOS) score at the time of discharge from hospital.

Results: There were 180 men (86.1%) and 29 women (13.9%). The median age was 30 years. Road traffic accidents (56.7%), assault (23.9%), and falls (15.4%) were the leading causes of head injury. The distribution of head injury severity was mild in 72.5%, moderate in 9%, and severe in 18.5%. Good functional recovery was achieved by 139(66.5%) of the patients in our series, whereas moderate and severe disability accounted for 18.2% and 5.3% while mortality accounted for 10%. Increasing age (p=0.006), a lower GCS score at admission, pupillary abnormalities, a history of loss of consciousness and admission into our Intensive Care Unit were all associated with poorer outcomes (p<0.000).

Conclusion: Outcome depended on age, initial GCS score, pupillary abnormalities, history of loss of consciousness and admission into our Intensive Care Unit. These findings can be used to improve the  management criteria in rural hospitals but we recommend establishment of a standardized surveillance system for head injuries to aid in development of new, more effective, targeted prevention strategies.

Key Words: Head injury, Outcome, Epidemiology, Incidence