The burden of orthopaedic disease presenting to a referral hospital in northern Tanzania

Premkumar, Ajay; Massawe, Honest; Mshabaha, David J.; R.Forans, Jared; Ying, Xiaohan; Sheth, Neil P.

doi:10.15761/gos.1000122

Cited by 12 publications

(21 citation statements)

References 5 publications

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“…Casey et al studied patients presenting with traumatic injury to Emergency Department and reported 44.1% had extremity fractures and an average length of stay (LOS) of 9.5 days [20]. Premkumar et al found that 71.3% of orthopedic in-patients had lower extremity fractures with an associated average LOS in the orthopedic ward of 13.5 days [13]. Neither study analyzed hospital costs or the duration of disability due to injury.…”

Section: Discussionmentioning

confidence: 99%

“…We prospectively collected data from all patients visiting KCMC's outpatient orthopedic clinic during the month of July 2016. The orthopedic clinic operates two days per week and treats an average of 532 patients per month [13].…”

Section: Methodsmentioning

confidence: 99%

“…The study was conducted at Kilimanjaro Christian Medical Center (KCMC), located in Moshi, Tanzania. KCMC is the third largest hospital in the country and is the only tertiary referral hospital serving a population of 11 million people living in the districts of Arusha, Kilimanjaro, Tanga, Singida, and Manyara [13]. IRB approval for the study was obtained from KCMC.…”

Section: Settingmentioning

confidence: 99%

See 2 more Smart Citations

The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania

Davey

Bulat

Massawe

et al. 2019

Annals of Global Health

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

See 1 more Smart Citation

The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania

Davey

Bulat

Massawe

et al. 2019

Annals of Global Health

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“…Granted that increased risk of infection with use of internal fixation as a first line treatment in open fractures may be one reason for this practice, the other major reason is unavailability of implants which are prohibitively expensive 39,40 ; even closed fractures requiring surgical fixation are commonly managed conservatively for this reason. 14,41 This study reveals that surgical debridement plus conservative treatment (US$1177) is in fact more costly than ORIF (US$618) as a result of this prolonged ward stay. Although the ORIF cost here excludes the cost of implants (about US$134 14 ), since they were not captured in the routine hospital cost records, it includes the costs of prolonged preoperative clinic visits.…”

Section: Discussionmentioning

confidence: 91%

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

Ifeanyichi¹,

Broekhuizen²,

Juma

et al. 2021

Int J Health Policy Manag

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Background: Access to surgical care is poor in Tanzania. The country is at the implementation stage of its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP; 2018-2025) aiming to scale up surgery. This study aimed to calculate the costs of providing surgical care at the district and regional hospitals. Methods: Two district hospitals (DHs) and the regional referral hospital (RH) in Arusha region were selected. All the staff, buildings, equipment, and medical and non-medical supplies deployed in running the hospitals over a 12 month period were identified and quantified from interviews and hospital records. Using a combination of step-down costing (SDC) and activity-based costing (ABC), all costs attributed to surgeries were established and then distributed over the individual types of surgeries. These costs were delineated into pre-operative, intra-operative, and post-operative components. Results: The total annual costs of running the clinical cost centres ranged from $567k at Oltrumet DH to $3453k at Mt Meru RH. The total costs of surgeries ranged from $79k to $813k; amounting to 12%-22% of the total costs of running the hospitals. At least 70% of the costs were salaries. Unit costs and relative shares of capital costs were generally higher at the DHs. Two-thirds of all the procedures incurred at least 60% of their costs in the theatre. Open reduction and internal fixation (ORIF) performed at the regional hospital was cheaper ($618) than surgical debridement (plus conservative treatment) due to prolonged post-operative inpatient care associated with the latter ($1177), but was performed infrequently due mostly to unavailability of implants. Conclusion: Lower unit costs and shares of capital costs at the RH reflect an advantage of economies of scale and scope at the RH, and a possible underutilization of capacity at the DHs. Greater efficiencies make a case for concentration and scale-up of surgical services at the RHs, but there is a stronger case for scaling up district-level surgeries, not only for equitable access to services, but also to drive down unit costs there, and free up RH resources for more complex cases such as ORIF.

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“…We prospectively collected data for all patients admitted to the orthopaedic ward at KCMC from June 2018 to July 2018 (4). We also retrospectively reviewed all available records for patients presenting to the KCMC emergency department (ED), orthopaedic outpatient clinic and orthopaedic ward (Table 1).…”

Section: Methodsmentioning

confidence: 99%

The Burden of Orthopaedic Disease in Sub-Saharan Africa: A Focus on Tanzania

Hardaker¹,

Jusabani²,

Massawe³

et al. 2021

Preprint

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Background As road traffic crashes (RTCs) continue to rise in the developing world, the current growth rate and true burden of orthopaedic injuries are unknown. In 2015, we characterized the orthopaedic burden at Kilimanjaro Christian Medical Center (KCMC) in Tanzania. In this study, we re-evaluated the burden and growth-rate over three years in the absence of any system level changes. Additionally, we calculated the percentage of orthopaedic patients that received definitive fixation for their orthopaedic injury when surgery was indicated.Methods We prospectively collected data for 190 patients admitted to the orthopaedic ward at KCMC during June/July 2018. We also retrospectively reviewed available records for patients presenting to the KCMC emergency department, orthopaedic outpatient clinic and orthopaedic ward.Results Prospective data: RTC (48.6%) was the most common etiology and femur fractures (31.0%) the most common type of injury. Almost 96% of admitted patients were indicated for surgical fixation, but only 44.5% received definitive fracture treatment. Retrospective data: KCMC treated an average of 15,117 orthopaedic patients per year, representing a 35.3% growth in the orthopaedic burden compared to 2015.Conclusion The burden of orthopaedic surgical disease at KCMC continues to grow. Throughout the developing world, multiple system level constraints preclude delivery of definitive treatment for most patients. Without innovative strategies to address this situation, the discrepancy between the need for orthopaedic care and surgical care capacity in the developing world will continue to grow.

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The burden of orthopaedic disease presenting to a referral hospital in northern Tanzania

Cited by 12 publications

References 5 publications

The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania

The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania

Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania

The Burden of Orthopaedic Disease in Sub-Saharan Africa: A Focus on Tanzania

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