Doing More With LessEpidemiology and Pattern of Traumatic Brain Injuries at Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
Introduction
Traumatic brain injury (TBI) is an acquired form of brain injury and is defined as “an alteration of brain function or other evidence of pathology, caused by an external force.”1 TBI constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally.2 When compared with the general population, TBIs are associated with increased mortality and decreased life expectancy.3,4
It is estimated that more than 69 million people each year have a TBI, and approximately half the world’s population are likely to have 1 or more TBIs over the course of their lifetime.5 The World Health Organization estimates that 90% of the deaths due to TBI occur in low-to middle-income countries (LMIC), which is where 85% of the population live.6 Globally, the incidence of TBI in LMICs is increasing sharply.7 Despite this, there remains a lack of research into its epidemiology. This is particularly true for Nepal, where studies on TBI are scarce.
In Nepal, TBI represents one of the leading causes of death and disability, where it is estimated the incidence is 382 per 100,000, compared with a global average of 369 per 100,000.8 However, its incidence is likely an underestimate due to lack of motorable roads, difficult geographic location, and unavailability of nearby trained personnel, meaning many patients fail to present to a hospital.
The majority of our knowledge on the epidemiology of TBI in Nepal comes from descriptive case series or cross-sectional single-center studies. Among these injuries, RTAs and falls represent the leading cause of TBI. In recent years there has been a gradual increase in RTA-related TBI due to the surge in motorization and urbanization in the country.9 According to a hospital-based study, among the 1056 patients admitted over a 1-year period with a history of TBI in eastern Nepal, 76% were due to RTA.10
In recent years, the government has addressed road safety in an attempt to reduce the burden of RTAs. They have focused on improving the road infrastructure, implementing stricter traffic rules and regulations, and introducing laws enforcing the use of helmets and prohibiting drunk driving. Although these measures have reduced the number and impact of RTAs, there are at present, a lack of policies and appropriate interventions to specifically curtail and prevent TBI.
Given the lack of data in the literature and the growing incidence of TBI, this study aims to analyze the epidemiology of TBI by examining a prospectively populated database of all patients presenting to 1 of the main neurosurgical hospitals in Kathmandu, Annapurna Neurological Institute & Allied Sciences (ANIAS). The results from this study will also help in guiding the implementation of appropriate interventions and in developing policy to reduce the incidence of TBI in Nepal.
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Setting
This study was conducted at ANIAS, Kathmandu, Nepal. ANIAS, which was established in 2009, is a 55-bed multispecialty private hospital and 1 of the major neurosurgical centers in Kathmandu. The neurosurgery department consists of 8 consultant neurosurgeons, 6 residents, and several nurses and medical officers. The hospital itself has advanced neuroimaging services including computed tomography (CT), magnetic resonance imaging, digital subtraction angiography (DSA), and ultrasound scanning.
Results
The age of patients ranged from 8 months to 92 years. The mean age of patients was 32.1 years (SD ± 21.32). The most common age groups sustaining a TBI was younger than 15 years old (22%, n = 36) and 15–25 years old (22%, n = 38) (Figure 1). There was a clear difference in the patient gender, where 73% (n = 122) were male and 27% (n = 45) were female.
RTAs were the commonest mechanism of injury (59%, n = 99), followed by falls (32%, n = 53) and physical assault (9%, n = 15) (Figure 2). Of the
Discussion
Understanding the epidemiology of TBI is fundamental toward shaping public health policy and implementing preventative strategies. Studies describing the epidemiology in Nepal are limited. We conducted a cross-sectional study of all patients presenting to ANIAS, Kathmandu, Nepal, with a history of TBI. Our principal objective was to describe the epidemiology and clinical characteristics of TBI at our hospital and make suggestions of specific strategies to reduce its incidence.
In our study, we
Conclusion
Our study provides insight into the epidemiology and pattern of TBI in ANIAS. It highlights that TBIs, particularly as a result of motorcycle accidents and fall injuries, are a public health concern in Nepal. The high incidence of TBI in both the young (15–25 years) and pediatric (<15 years) population should be highlighted. TBI has the potential to result in long-term disability, affecting cognition, behavior, and motor control. As the economically active population is largely affected, this
CRediT authorship contribution statement
Nicola Newall: Writing - original draft, Writing - review & editing, Conceptualization, Data curation. Sharad Gajuryal: Methodology, Data curation, Writing - review & editing, Supervision. Sangita Bidari: Data curation. Ashmita Karki: Data curation. Prashmita Karki: Data curation. Peter Bodkin: Conceptualization, Supervision. Basant Pant: Supervision.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.