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Burden, Characteristics and Process of Care Among the Pediatric and Adult Trauma Patients in Botswana’s Main Hospitals

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Abstract

Background

Botswana is notable among countries with high rates of Road Traffic Collisions (RTC); like many other lower–middle-income countries (LMICs), it lacks trauma systems. The World Health Organization recommends ‘Essential Trauma Care’ in countries with no formal trauma systems. The proportion of injuries in Emergency Departments and the care process were investigated to gain an overview for enabling the design of a relevant LMICs trauma system.

Method

Blunt and penetrating trauma patients were included from three major hospitals, examining the proportion of injuries, patient characteristics, the care process and comparing these between pediatrics and adults. Data are presented using descriptive statistics.

Results

The proportion of trauma ranged between 6 and 10% of Emergency Department cases. Pediatrics constituted 19%, and 59% of all patients were male. The median age was 28 years [IQR 17–39] and 8 years [IQR 4–11] for adults and pediatrics, respectively. The leading causes of injuries were: falls in pediatrics (55%) and interpersonal violence in the adults (34%), followed by RTC in both children (20%) and adults (30%). The public inter-hospital vehicles transported 77% of pediatrics and 69% of adults, while formal ambulance transported only 9% of pediatrics and 22% of adults. The median Emergency Department waiting time for pediatrics was 187 min [IQR 102–397] and for adults was 208 min [IQR 100–378]: Most were triaged as non-urgent (70% pediatrics and 72% adults), and the majority were discharged (84% pediatrics and 76% adults).

Conclusion

The Emergency Department workload of injuries is notably high, with differing mechanisms of injury and transport modes between pediatrics and adults: Waiting time is severely prolonged for urgent and critical patients. Diagnoses, triage categories and patients disposition were similar.

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Fig. 1

Source: modified from d-map.com (Red squares and green crystals—adult and pediatric trauma patients respectively; Yellow line—A1 road)

Fig. 2
Fig. 3

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Acknowledgements

The authors would like to thank the hospitals administrations of Princes Marina, Nyangabgwe, Mahalapye, Lenmed-Health Bokamoso and Life-Gaborone hospitals for giving access to their data. Thanks to the postgraduate office at UKZN for necessary support granted for this research.

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Authors and Affiliations

  1. Department Surgery, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

    Michael B. Mwandri & Timothy C. Hardcastle

  2. Department of Surgery, Kilimanjaro Christian Medical University College, P.O. Box 3010, Moshi, Tanzania

    Michael B. Mwandri

  3. Trauma Service and Trauma ICU, Inkosi Albert Luthuli Central Hospital, Durban, South Africa

    Timothy C. Hardcastle

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  1. Michael B. Mwandri
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Correspondence to Michael B. Mwandri.

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Mwandri, M.B., Hardcastle, T.C. Burden, Characteristics and Process of Care Among the Pediatric and Adult Trauma Patients in Botswana’s Main Hospitals. World J Surg 42, 2321–2328 (2018). https://doi.org/10.1007/s00268-018-4528-7

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