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Background : Mild traumatic brain injury (mTBI) constitutes the majority of traumatic brain injuries worldwide and is associated with substantial healthcare utilization. Contemporary epidemiological data from low- and middle-income countries are limited. Wherefore this study provides evidence for planning and prevention of this public health burden. Methods : A descriptive cross-sectional study was conducted among adult patients presenting with mTBI at a tertiary trauma centre in Abuja, Nigeria. Demographic characteristics and mechanisms of injury were analysed. Results : A total of 103 patients were included. Young adult males predominated, and road traffic accidents were the leading mechanism of injury. Conclusion : mTBI in Nigeria disproportionately affects economically productive males and is largely attributable to preventable road traffic injuries.
Keywords: Road safety; mild traumatic brain injury; epidemiology; road traffic accident; Nigeria; trauma; low- and middle-income countries; Roadsafety,mildtraumaticbraininjury; roadtrafficaccident; low-andmiddle-incomecountries
Traumatic brain injury (TBI) represents a major and growingpublichealthproblemworldwide,contributingsubstantiallytomortality,disability,andsocioeconomicburden(1). Mildtraumaticbraininjury(mTBI) constitutesapproximately70–90%ofallTBIspresentingtoemergencydepartmentsglobally.[2]Despiteits classificationas“mild,”mTBIisassociatedwithsignificantshort-andlong-termmorbidity,healthcareutilization,andeconomicimpact.[3]Recentepidemiological datahighlightsubstantialregionalvariationinmTBI mechanismsandaffectedpopulations.Inhigh-income countries,fallsamongtheelderlyincreasinglypredominate,whereasinlow-andmiddle-incomecountries (LMICs),roadtrafficaccidents(RTAs)remaintheleadingcause.[4–6]Thereasonsarethatinhigh-income countries,sustainedinvestmentsinroadsafetylegislation,vehicledesign,andorganizedtraumacarehave resultedinagradualshiftintheepidemiologyofmTBI, therebyallowingfallsamongolderadultstoberepresentthedominantmechanismofinjuryinthesesettings,reflectingdemographictransitionsandpopulationageing.[7]Incontrast,LMICscontinuetoexperienceadisproportionateburdenofroadtraffic–related headinjuriesduetorapidurbanization,motorisation, inadequateroadinfrastructure,andweakenforcement oftrafficregulations.[8]Sub-SaharanAfricabearsadisproportionateburdenduetorapidurbanization,poor roadinfrastructure,limitedenforcementoftrafficregulations, and increasing motorcycle use.[9] Nigeria, themostpopulouscountryinAfrica,contributessignificantlytotheregionaltraumaburden. TheWorld Health Organization’s 2023 Global Status Report on RoadSafetyestimatesNigeria’sroadtrafficfatalityrate amongthehighestglobally.[8]Structuraldeficiencies inroaddesign,limitedpedestrianinfrastructure,poor vehicleroadworthiness,andinadequatepublictransportationsystemshaveresultedinwidespreadreliance oncommercialmotorcyclesandtricycles(“okada”and “keke”),whichareassociatedwithahighriskofheadinjury.However,hospital-basedepidemiologicaldataon mTBIremainsparse,fragmented,andoftenoutdated, particularlyforurbantraumacentresmanaginglarge volumesofmildheadinjurypatients.
Within West Africa, similar patterns have been reportedinGhana,SierraLeone,andCôted’Ivoire,where roadtrafficaccidentsremainthedominantcauseof TBIamongyoungadults.[10–12]Motorcycle-related crashes,inparticular,accountforagrowingproportion of head injuries in urban and peri-urban areas, ofteninvolvingridersandpassengerswhodonotuse protectivehelmets.Weakenforcementofhelmetlegislation,combinedwithsocioeconomicpressuresand limitedpublicawareness,continuestounderminepreventioneffortsacrossthesubregion.Beyondmortality,non-fatalmTBIimposesasubstantialbutunderappreciatedsocioeconomicburden.Individualswith mTBIfrequentlyexperiencepersistentpost-concussive symptomsthatinterferewithemployment,education, andsocialparticipation. Ineconomicallyproductive agegroups,evenmildbraininjuriescanresultinsignificantincomelossandlong-termeconomichardshipfor affectedhouseholds.[3,13]HealthsystemsinNigeria andmuchofWestAfricaareill-equippedtomanage thiscumulativeburden,givencompetinghealthpriorities,limiteddiagnosticresources,andshortagesof trainedpersonnel.
Understanding demographic patterns and mechanisms of mTBI is essential for targeted prevention strategies,resourceplanning,andpolicydevelopment. Contemporarytraumasystemsincreasinglyemphasise injurysurveillanceasacornerstoneofpublichealthintervention.[14]Despitethemagnitudeoftheproblem, contemporaryhospital-basedepidemiologicaldataon mTBIinNigeriaremainsparse.Manyexistingstudiesfocusprimarilyonmoderate-to-severeTBIoraggregate allheadinjuriesintoasinglecategory,limitingtheir usefulnessfortargetedpreventionandpolicydevelopment.[15,16]Robust,context-specificdataonmTBI arethereforeessentialtoinformevidence-basedinterventions,guidepolicydecisionsbyagenciessuchas theFederalRoadSafetyCorps(FRSC),andsupportthe developmentofeffectivetraumasurveillancesystems. Thisstudythereforeexaminesthedemographiccharacteristics and mechanisms of mild traumatic brain injuryinanurbanNigeriantertiarytraumacentre,providing updated epidemiological insights relevant to preventionandhealthcareplanningaswellasroad safety.
Thisdescriptivecross-sectionalstudywasconducted attheTraumaCentreoftheNationalHospitalAbujabetweenNovember2021andJuly2022.Allconsecutive adultpatientsaged16yearsandabovewhopresented within24hoursofbluntheadinjuryandhadaGlasgowComaScalescoreof13–15wereeligible.Patients withpenetratingheadinjuries,polytraumarequiring immediateoperativeintervention,orincompleteclinicalrecordswereexcluded. EthicalapprovalwasobtainedfromtheHealthResearchEthicsCommitteeof theNationalHospitalAbujaonthe7thDecember2020 (ApprovalNo:NHA/EC/108/2020).ThestudywasconductedinaccordancewiththeDeclarationofHelsinki, andallpatientdatawereanonymized.
MildTraumaticBrainInjury
Male 91 88.3 Female 12 11.7 Age21–40years 67 65.0
Demographicandinjury-relateddatawerecollectedusingastructuredproforma.Variablesrecordedincluded age,sex,occupation,andmechanismofinjury.Mechanismsofinjurywerecategorizedintoroadtrafficaccidents,assaults,falls,sports-relatedinjuries,anddomesticaccidents.DatawereanalysedusingIBMSPSS version25andsummarizedusingdescriptivestatistics.
Atotalof103patientswithmildtraumaticbraininjury wereanalysedandpresentedintablesandfigures.The meanageofpatientswas32.5±12.3years,withthe majority(65%)agedbetween21and40years.Males constituted91cases(88.3%),givingamale-to-female ratioof7.6:1.
Roadtrafficaccidentswerethemostcommonmechanismofinjury,accountingfor63.1%ofcases.Assaults andfallseachaccountedfor13.6%ofinjuries,while sports-relatedanddomesticaccidentsaccountedfor smaller proportions. Artisans (24.3%) and students (20.4%)werethemostaffectedoccupationalgroups.
Thisstudyprovidescontemporaryevidenceontheepidemiologyofmildtraumaticbraininjuryfromamajor urban tertiary trauma centre in Nigeria. Table 1 showsfindingsthatdemonstrateaclearpredominance ofyoungadultmaleswhileTable2andfigure1identify roadtrafficaccidentsastheprincipalmechanismof injury,accountingfornearlytwo-thirdsofcases.These observations are consistent with reports from NigeriaandotherWestAfricancountriesandunderscore thepersistentpublichealthchallengeposedbypreventableroadtrafficinjuries.[10–12,16]
Themarkedmalepredominanceobservedalignswith recentepidemiologicalstudiesacrossAfricaandAsia, wheremalesconstitute70–90%ofTBIpatients.[10,12] Thistrendreflectsgender-baseddifferencesinoccupationalexposure,drivingbehaviour,andrisk-taking activities.Theconcentrationofcasesinthe21–40-year agegroupunderscoresthesignificantsocioeconomic impactofmTBI,asthisdemographicrepresentsthe mTBI
Roadtrafficaccident 63.1 Assault 13.6 Fall 13.6 Sportsinjury 4.9 Domesticaccident 4.8
anismsandemphasisestheneedforcontext-specific preventionstrategies.
Roadtrafficaccidentswerethedominantmechanism ofinjury,consistentwithWHOestimatesandrecent Nigerianandsub-SaharanAfricantraumaseries.[7,11] Factorscontributingtothispatternincludepoorroad conditions,weakenforcementoftrafficlaws,lowhelmetandseatbeltcompliance, andhighcommercial motorcycleusage.Assaultsandfallsaccountedfora significantminorityofcases,reflectingurbaninterpersonalviolenceandoccupationalhazards.SimilardistributionshavebeenreportedinrecentNigerianand WestAfricanstudies,suggestingpersistentsocialand environmentaldeterminantsofinjury.[12,17]
Theepidemiologicalprofileobservedinthisstudyhas directimplicationsforinjuryprevention. Contemporarytraumaliteratureemphasisestheimportanceof evidence-basedinterventionssuchashelmetlegislation,speedcontrol,alcoholenforcement,andpublic education campaigns.18,19] Nigeria’s ongoing road safetychallengesindicateaneedforstrongermultisectoralcollaborationbetweenhealth,transport,and lawenforcementagenciesasroadsafetyincludesboth themethodsandmeasuresusedforpreventionofaccidents.[20]Fromahealthcareplanningperspective,the predominanceofmTBIunderscorestheimportance ofefficientemergencydepartmenttriageandimagingstewardship. Integrationofvalidatedclinicaldecisionrulescouldcomplementpreventionstrategies byoptimisingresourceusewhilemaintainingpatient safety.[13]
Recent hospital-based studies from Nigeria, Ghana, and Kenya report similar patterns of male predominanceandRTA-drivenmTBI,confirmingtheexternal validityofthepresentfindings.[11,12]However,variabilityinreportedmechanismshighlightstheneedfor standardizedtraumaregistriesandcontinuoussurveillancesystemsacrosstheregion.
This study is limited by its single-centre design and modestsamplesize.Additionally,prehospitalfatalities andpatientswithminorinjurieswhodidnotpresent tohospitalwerenotcaptured,potentiallyunderestimatingtruecommunityincidence. Nonetheless,the findingsprovidevaluablecontemporarydatafroma majorurbantraumacentre.
MildtraumaticbraininjuryinNigeriapredominantlyaffectsyoungadultmales,withroadtrafficaccidentsremainingtheprincipalmechanismofinjury.Thesefindingsunderscoretheurgentneedforstrengthenedroad safetypolicies,targetedinjurypreventionstrategies, andimprovedtraumasurveillance.Updatedepidemiologicaldatasuchastheseareessentialtoinformpublic healthinterventionsandhealthcaresystemplanningin low-andmiddle-incomecountries.Theseapproaches willhelpmitigatethelong-termsocioeconomicimpact ofbraininjuryinNigeriaandWestAfrica.