Incidence and Etiology of Traumatic Spinal Cord Injury in Rwanda: A Prospective Population-Based Study

Abstract

Abstract Study Design: A prospective, open-ended, cohort study design. Objectives: To determine the incidence, etiology and injury characteristics of traumatic spinal cord injury (TSCI) in Rwanda. Setting: All referral hospitals within the Republic of Rwanda. Methods: All survivors of acute TSCI who met the inclusion criteria were prospectively recruited for a one-year period. The International Spinal Cord Injury Core Data Set was used to collect the minimum set of variables to facilitate worldwide comparison of epidemiological data, while the International Standards for the Neurological Classification was used to categorise TSCI according to the American Spinal Injury Association Impairment Scale (ASIA). Data were collected by trained physiotherapists. Results: Overall, 122 adult individuals sustained a TSCI between 10 October 2019 until 9 October 2020 and all consented to take part in the study. The male-to-female ratio was 3.9:1, and the mean age was 42.5 (SD = ± 14.8) years. The crude incidence rate of TSCI was 22.2 per million people (95% CI:18.4–26.5) with significant differences in sex-adjusted rates for all age groups while men 46 years of age and older presented with the highest incidence. The leading causes of TSCI were falls (73.8%), followed by road traffic accidents (18.9%). Moreover, SCI lesions of the cervical region (n = 69) were the most common, followed by the lumbosacral region (n = 27). Fifty-one (41.8%) participants were diagnosed as complete injury, i.e., ASIA A, while incomplete injury category C constituted 35 (28.7%). Conclusion: The incidence and aetiology of TSCI in Rwanda are comparable to worldwide estimates and figures. Largely, the aetiology of TSCI are preventable as it is caused due to falls and road traffic accidents. Regardless of strict measures in place to prevent road traffic accidents in Rwanda, for example heavy penalties for drunk driving, speed limit governors, speed limit camera and many others, there is need to consider preventive strategies and policies on activities that predispose people to falls. Policies should focus largely on occupational health and safety in both formal and informal sectors or work.