The burden of orthopaedic disease presenting to a tertiary referral center in Moshi, Tanzania: a cross-sectional study.

Introduction: 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: 231 patients were admitted to the orthopaedic ward. Forty-one (17.7%) isolated spine patients were excluded, leaving 190 patients in the final study cohort. RTC (89, 46.8%) represented the most common mechanism of injury requiring orthopaedic ward admission, followed by falls (60, 31.6%) and infections (14, 7.4%). Femur fractures were the most common injury (62, 31.0%), followed by tibia fractures (27, 13.5%), isolated fibula fractures (23, 11.5%), and foot fractures (23, 11.5%). 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 is increasing. Without innovative strategies to address this situation, the discrepancy between the need for orthopaedic care and surgical care capacity at KCMC and in similar settings will continue to grow.

Comparing the drivers of medical student emigration intention across two African nations.

BACKGROUND: Sub-Saharan Africa faces the highest relative need for health care workers in the world and the emigration of physicians significantly contributes to this deficit. Few studies have explored development of these patterns during medical education. This study investigates career aspirations of medical students in two African nations with similar Human Development Indices, but distinct differences in training structure to better inform retention strategies. METHODS: A cross-sectional survey was administered in 2018 to medical students in Madagascar (University of Antananarivo, University of Mahajanga) and Tanzania (Kilimanjaro Christian Medical College, KCMC). Outcomes included emigration/career intentions, and factors influencing these decisions. Analysis utilised chi-square and Fisher's exact tests (α < 0.05, two-tailed) for statistical differences, logistic regression and qualitative content analysis of free text data. RESULTS: A total of 439 students responded to the survey with a response rate of 12.9% from Antananarivo (n = 142/1097), 11.6% from Mahajanga (n = 43/370), and 60.0% from KCMC (n = 254/423). Significantly more Malagasy (49.7%, n = 90/181) than Tanzanian (25.2%, n = 54/214) students expressed emigration intent (P < .001). Malagasy students indicating research, possibility of working abroad, or work intensity as influencing career choice more frequently expressed a desire to emigrate. Satisfaction with computer/internet access was inversely correlated with a desire to work abroad. In comparison, Tanzanian students reporting income potential as influential in their career choice or attending a private high school were more likely to express a desire to work abroad. Qualitative content analysis of free text data demonstrated deficits in faculty availability, diversity of training locations and a particular emphasis on infrastructure challenges within Madagascar. INTERPRETATION: A significant number of students desire to work abroad. Emigration interests are influenced by access to postgraduate training, infrastructure and opportunities in academia, which differ across countries. Efforts to retain physicians should consider these country and institution-specific factors that influence medical student desire to emigrate.