{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T04:08:02Z","timestamp":1788754082256,"version":"build-2803163510"},"reference-count":50,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T00:00:00Z","timestamp":1693180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objective: About 14 million people will likely suffer a traumatic brain injury (TBI) per year by 2050 in sub-Saharan Africa. Studying TBI characteristics and their relation to outcomes can identify initiatives to improve TBI prevention and care. The objective of this study was to define the features and outcomes of TBI patients seen over a 1-year period in a level-I trauma centre in Cameroon. Materials and Methods: Data on demographics, causes, clinical aspects, and discharge status were collected over a period of 12 months. The Glasgow Outcome Scale-Extended (GOSE) and the Quality-of-Life Questionnaire after Brain Injury (QoLIBRI) were used to evaluate outcomes six months after TBI. Comparisons between two categorical variables were done using Pearson\u2019s chi-square test. Results: A total of 160 TBI patients participated in the study. The age group 15\u201345 years was most represented (78%). Males were more affected (90%). A low educational level was seen in 122 (76%) cases. Road traffic incidents (RTI) (85%), assaults (7.5%), and falls (2.5%) were the main causes of TBI, with professional bike riders being frequently involved (27%). Only 15 patients were transported to the hospital by ambulance, and 14 of these were from a referring hospital. CT-imaging was performed in 78% of cases, and intracranial traumatic abnormalities were identified in 64% of cases. Financial constraints (93%) was the main reason for not performing a CT scan. Forty-six (33%) patients were discharged against medical advice (DAMA) due to financial constraints. Mortality was 14% (22\/160) and high in patients with severe TBI (46%). DAMA had poor outcomes with QoLIBRI. Only four patients received post-injury physical therapy services. Conclusions: TBI in Cameroon mainly results from RTIs and commonly affects young adult males. Lack of pre-hospital care, financial constraints limiting both CT scanning and medical care, and a lack of acute physiotherapy services likely influenced care and outcomes adversely.<\/jats:p>","DOI":"10.3390\/medicina59091558","type":"journal-article","created":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T03:45:42Z","timestamp":1693194342000},"page":"1558","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Traumatic Brain Injury in Cameroon: A Prospective Observational Study in a Level I Trauma Centre"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1495-5855","authenticated-orcid":false,"given":"Franklin Chu","family":"Buh","sequence":"first","affiliation":[{"name":"Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene Ule Ngole","family":"Sumbele","sequence":"additional","affiliation":[{"name":"Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1612-1264","authenticated-orcid":false,"given":"Andrew I. R.","family":"Maas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, 2000 Edegem, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Motah","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala P.O. Box 2701, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jogi V.","family":"Pattisapu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL 32827, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0441-1934","authenticated-orcid":false,"given":"Eric","family":"Youm","sequence":"additional","affiliation":[{"name":"Holo Healthcare, Nairobi 00400, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil Kum","family":"Meh","sequence":"additional","affiliation":[{"name":"Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5008-6944","authenticated-orcid":false,"given":"Firas H.","family":"Kobeissy","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Riad El-Solh, Beirut P.O. Box 11-0236, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9343-6473","authenticated-orcid":false,"given":"Kevin W.","family":"Wang","sequence":"additional","affiliation":[{"name":"Center for Neurotrauma, Multiomics & Biomarkers (CNMB), Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, 720 Westview Dr SW, Atlanta, GA 30310-1458, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J. A.","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Cambridge CB2 0QQ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7771-0268","authenticated-orcid":false,"given":"Germain Sotoing","family":"Taiwe","sequence":"additional","affiliation":[{"name":"Department of Animal Biology and Conservation, Faculty of Science, University of Buea, Buea P.O. Box 63, Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.3171\/2017.10.JNS17352","article-title":"Estimating the global incidence of traumatic brain injury","volume":"130","author":"Dewan","year":"2019","journal-title":"J. Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1136\/injuryprev-2019-043466","article-title":"IMPACT and CRASH prognostic models for traumatic brain injury: External validation in a South-American cohort","volume":"26","author":"Wongchareon","year":"2020","journal-title":"INJ Prev."},{"key":"ref_3","unstructured":"GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators (2019). Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990\u20132016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol., 18, 56\u201387."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1159\/000501911","article-title":"For the NESS-China investigators. Prevalence and Altered Causes of Traumatic Brain Injury in China: A Nationwide Survey in 2013","volume":"54","author":"Sun","year":"2020","journal-title":"Neuroepidemiology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1089\/neu.2015.4126","article-title":"Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review","volume":"38","author":"Brazinova","year":"2021","journal-title":"J. Neurotrauma"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"140","DOI":"10.11604\/pamj.2017.26.140.10345","article-title":"Management and outcome of traumatic brain injury patients at Muhimbili Orthopaedic Institute Dar es Salaam, Tanzania","volume":"26","author":"Boniface","year":"2017","journal-title":"Pan Afr. Med. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e192","DOI":"10.1016\/j.wneu.2021.09.021","article-title":"The Burden of Traumatic Brain Injury in Sub-Saharan Africa: A Scoping Review","volume":"156","author":"Adegboyega","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_8","unstructured":"Toth, A. (2017). Advanced Imaging in Traumatic Brain Injury 2017. [Ph.D. Thesis, Universitas Quinqueecclesiennsis]."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.jns.2016.10.016","article-title":"Mortality of head injuries in Sub-Saharan African countries: The case of the university teaching hospitals of Cameroon","volume":"371","author":"Djientcheu","year":"2016","journal-title":"J. Neurol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1139\/bcb-2016-0160","article-title":"Traumatic brain injury: Classification, models, and markers","volume":"96","author":"Najem","year":"2018","journal-title":"Biochem. Cell Biol."},{"key":"ref_11","unstructured":"National Institute of Neurological Disorders (2023, August 02). Traumatic Brain Injury: Hope through Research, Available online: https:\/\/catalog.ninds.nih.gov\/sites\/default\/files\/publications\/traumatic-brain-injury-hope-through-research_1.pdf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2989","DOI":"10.2147\/NDT.S125620","article-title":"Biomarkers in traumatic brain injury (TBI): A review","volume":"14","author":"Dadas","year":"2018","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ashley, M.J., and Hovda, M.J. (2018). Traumatic Brain Injury Rehabilitation, Treatment, and Case Management, CRC Press\/Taylor & Francis. [4th ed.].","DOI":"10.1201\/9781315371351"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4236\/ojmn.2018.81010","article-title":"Epidemiological Analysis of 135 Cases of Severe Traumatic Brain Injury Managed at a Surgical Intensive Care Unit","volume":"8","author":"Ndoumbe","year":"2018","journal-title":"Open J. Mod. Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"101346","DOI":"10.1016\/j.inat.2021.101346","article-title":"Traumatic intracranial haemorrhage in Cameroon: Clinical features, treatment options and outcome","volume":"26","author":"Motah","year":"2021","journal-title":"Interdiscip. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/j.wneu.2017.09.084","article-title":"Epidemiology, Management, and Functional Outcomes of Traumatic Brain Injury in Sub-Saharan Africa","volume":"108","author":"Eaton","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_17","unstructured":"World Population Review (2023, June 20). Douala Population 2023. Available online: https:\/\/worldpopulationreview.com\/world-cities\/doualapopulation."},{"key":"ref_18","unstructured":"National Heart, Lung and Blood Institute (2023, August 02). Low Blood Pressure, Available online: https:\/\/www.nih.gov\/about-nih\/what-we-do\/nih-almanac\/national-heart-lung-blood-institute-nhlbi."},{"key":"ref_19","first-page":"118","article-title":"Disability rating scale for severe head trauma: Coma to community","volume":"63","author":"Rappaport","year":"1982","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e000253","DOI":"10.1136\/tsaco-2018-000253","article-title":"Determinants of emergency department disposition of patients with traumatic brain injury in Uganda: Results from a registry","volume":"3","author":"Mehmood","year":"2018","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.wneu.2017.07.070","article-title":"Incidence, Demographics, and Outcome of Traumatic Brain Injury in The Middle East: A Systematic Review","volume":"107","author":"Mekkodathil","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_22","first-page":"281","article-title":"Educational level and age as contributing factors to road traffic accidents","volume":"16","author":"Sami","year":"2013","journal-title":"Chin. J. Traumatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"15594","DOI":"10.3390\/ijerph121215009","article-title":"Socio Economic Status and Traumatic Brain Injury amongst Pediatric Populations: A Spatial Analysis in Greater Vancouver","volume":"12","author":"Amram","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1089\/neur.2022.0053","article-title":"Demographics, Causes, and Outcome of Traumatic Brain Injury among Trauma Cases in Cameroon: A Multi-Center Five Year\u2019s Retrospective Study","volume":"3","author":"Buh","year":"2022","journal-title":"Neurotrauma Rep."},{"key":"ref_25","unstructured":"Kouagheu, J. (2020). Au Cameroun, dans la jungle des motos-taxisA Douala, sept accidents de la circulation sur dix sont caus\u00e9s par les bend-skinneurs, ces jeunes chauffeurs sans le sou et, souvent, sans permis de conduire. Monde Afr, Available online: https:\/\/www.lemonde.fr\/afrique\/article\/2020\/02\/03\/au-cameroun-dans-la-jungle-des-motos-taxis_6028276_3212.html."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1017\/cjn.2015.320","article-title":"Health & Economic Burden of Traumatic Brain Injury in the Emergency Department","volume":"43","author":"Fu","year":"2016","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/S1474-4422(19)30232-7","article-title":"CENTER-TBI Participants and Investigators. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: A European prospective, multicentre, longitudinal, cohort study","volume":"18","author":"Steyerberg","year":"2019","journal-title":"Lancet Neurol."},{"key":"ref_28","unstructured":"Isah, M. (2023, August 02). Multisectorial Approach in Reducing Road Traffic Accidents in Cameroon. Nfafu Policy Institute. Available online: https:\/\/nkafu.org\/multi-sectorial-approach-in-reducing-road-traffic-accidents-in-cameroon\/."},{"key":"ref_29","unstructured":"Bezabeh, G.B., Souare, M., and Oumarou, A. (2013). Road Safety in Africa Assessment of Progresses and Challenges in Road Safety Management System 2013, African Development Bank Group."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kongnyuy, E.J., and Wiysonge, C.S. (2007). Alcohol use and extramarital sex among men in Cameroon. BMC Int. Health Hum. Rights, 7.","DOI":"10.1186\/1472-698X-7-6"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Wakabayashi, M., McKetin, R., Banwell, C., Yiengprugsawan, V., Kelly, M., Seubsman, S.-A., Iso, H., Sleigh, A., and Thai Cohort Study Team (2015). Alcohol consumption patterns in Thailand and their relationship with non-communicable disease. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-2662-9"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Paw\u0142owski, W., Lasota, D., Goniewicz, M., Rzo\u0144ca, P., Goniewicz, K., and Krajewski, P. (2019). The Effect of Ethyl Alcohol upon Pedestrian Trauma Sustained in Traffic Crashes. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16081471"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.afjem.2017.04.001","article-title":"Epidemiology, clinical characteristics and outcomes of head injured patients in an Ethiopian emergency centre","volume":"7","author":"Landes","year":"2017","journal-title":"Afr. J. Emerg. Med."},{"key":"ref_34","unstructured":"Tesfay, M. (2020). Clinical Profile and Outcome of Traumatic Brain Injury Patients at the Emergency Department of AaBET Hospital. [Master\u2019s Thesis, College of Health Science, Addis Ababa University]."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1016\/S0277-9536(02)00236-8","article-title":"Referral to rehabilitation following traumatic brain injury: A model for understanding inequities in access","volume":"56","author":"Foster","year":"2003","journal-title":"Soc. Sci. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1080\/02699050801998250","article-title":"Physiotherapy after traumatic brain injury: A systematic review of the literature","volume":"22","author":"Hellweg","year":"2008","journal-title":"Brain Inj."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2048","DOI":"10.1589\/jpts.28.2048","article-title":"The impact of physical therapy in patients with severe traumatic brain injury during acute and post-acute rehabilitation according to coma duration","volume":"28","author":"Savickas","year":"2016","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_38","unstructured":"John Hopkins Medicine (2023, August 02). Rehabilitation after Traumatic Brain Injury. Available online: https:\/\/www.hopkinsmedicine.org\/health\/treatment-tests-and-therapies\/rehabilitation-after-traumatic-brain-injury."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.jen.2010.04.017","article-title":"The Impact of Time from ED Arrival to Surgery on Mortality and Hospital Length of Stay in Patients with Traumatic Brain Injury","volume":"37","author":"Kim","year":"2011","journal-title":"J. Emerg. Nurs."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.3109\/02699052.2014.916820","article-title":"Characteristics of patients with acute traumatic brain injury discharged against medical advice in a Level 1 urban trauma centre","volume":"28","author":"LeBlanc","year":"2014","journal-title":"Brain Inj."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1017\/cjn.2016.241","article-title":"Discharge against Medical Advice in Traumatic Brain Injury: Follow-Up and Readmission Rate","volume":"44","author":"Marcoux","year":"2017","journal-title":"Can. J. Neurol. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Kalogriopoulos, N.A., Baran, J., Nimunkar, A.J., and Webstar, J.G. (2009, January 3\u20136). Electronic Medical Record Systems for Developing Countries: Review. Proceedings of the 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, Minneapolis, MN, USA. Available online: https:\/\/ewh.slc.engr.wisc.edu\/publications\/conferences\/2009\/IEEEEMBC\/KalogriopoulosNWMedRSIEEEMBC2009.pdf.","DOI":"10.1109\/IEMBS.2009.5333561"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"580","DOI":"10.4103\/ijccm.IJCCM_101_18","article-title":"What Happens to Patients Discharged Against Medical Advice?","volume":"22","author":"Ramakrishnan","year":"2018","journal-title":"Indian J. Crit. Care Med."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Albayati, A., Douedi, S., Alshami, A., Hossain, M.A., Sen, S., Buccellato, V., Cutroneo, A., Beelitz, J., and Asif, A. (2021). Why Do Patients Leave against Medical Advice? Reasons, Consequences, Prevention, and Interventions. Healthcare, 9.","DOI":"10.3390\/healthcare9020111"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"P\u00e9lieu, I., Kull, C., and Walder, B. (2019). Prehospital and Emergency Care in Adult Patients with Acute Traumatic Brain Injury. Med. Sci., 7.","DOI":"10.3390\/medsci7010012"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/S1474-4422(20)30182-4","article-title":"Clinical characteristics and outcomes in patients with traumatic brain injury in China: A prospective, multicentre, longitudinal, observational study","volume":"19","author":"Gao","year":"2020","journal-title":"Lancet Neurol."},{"key":"ref_47","first-page":"281","article-title":"Impact and Abic Study Group. Mortality from traumatic brain injury","volume":"95","author":"Lu","year":"2005","journal-title":"Acta Neurochir."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1186\/s12916-023-03009-z","article-title":"Early neuro-rehabilitation in traumatic brain injury: The need for an African perspective","volume":"21","author":"Buh","year":"2023","journal-title":"BMC Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"120","DOI":"10.3389\/fneur.2019.00120","article-title":"A Detailed Overview of Long-Term Outcomes in Severe Traumatic Brain Injury Eight Years Post-injury","volume":"10","author":"Ruet","year":"2019","journal-title":"Front. Neurol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1186\/s12955-018-0966-z","article-title":"Prospective evaluation of the Quality of Life after Brain Injury (QOLIBRI) score: Minor differences in patients with major versus no or mild traumatic brain injury at one-year follow up","volume":"16","author":"Born","year":"2018","journal-title":"Heal. Qual. Life Outcomes"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/9\/1558\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:40:38Z","timestamp":1760128838000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/9\/1558"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,28]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["medicina59091558"],"URL":"https:\/\/doi.org\/10.3390\/medicina59091558","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,28]]}}}