The burden of intentional injuries in Mwanza City, north-western Tanzania: a tertiary hospital survey

Abstract

Intentional injuries are an emerging silent epidemic in developing countries and contribute significantly to global injury burden. A descriptive prospective study was conducted to establish the prevalence, contributing factors, injury pattern and treatment outcome of intentional injuries at Bugando Medical Centre in North-western Tanzania. Data was collected using a pre-tested, coded questionnaire and analyzed using SPSS software version 17.0. A total of 1642 (23.7%) patients with intentional injuries were studied. Of these, 97.7% resulted from interpersonal violence (homicide) and 2.3% were self-inflicted (suicide). Males outnumbered females by a ratio of 2.2:1. Their median age was 24 years.  The majority of injuries (53.5%) occurred at home. Criminal violence was the most common reason for intentional injuries accounting for 52.1% of cases. In women, domestic violence was responsible for 64.6% of the admissions. Poverty, lack of education, unemployment and alcohol abuse were the most common contributing factors to intentional injuries. Blunt and sharp objects (48.6%) were the most common weapons used. Gunshot injuries were recorded in 11.6% of cases. The head/neck was commonly affected in 49.2%. Soft tissue injuries (87.3%) were the most frequent type of injuries. The majority (90.1%) of patients were treated surgically. Complication rate was 15.0%.The median hospital stay was 26 days (range 1 day to 114 days). Patients with long bone fractures and those who had complications stayed longer in the hospital (P < 0.001). Mortality rate was 13.3%. The mortality rate was significantly high in patients with severe injuries (Injury Severity Score > 15), severe head injuries and those who needed intensive care unit admissions and ventilatory support (P< 0.001). Intentional injuries are an emerging but neglected epidemic in Mwanza City and contribute significantly to high morbidity and mortality. Urgent preventive measures targeting at the root causes of violence such as poverty, unemployment, and alcohol abuse will reduce the incidence of these injuries in our setting.