Exploring the relationship between social determinants of health and pediatric injury outcomes at a Northern Tanzania tertiary referral hospital

BackgroundTrauma is a leading cause of death and disability in children globally, with social determinants of health (SDH) affecting health outcomes. Limited data is available on the influence of SDH on outcomes in injured children in low- and middle-income countries (LMICs). ObjectiveTo explore the relationship of SDH factors with morbidity and mortality in pediatric trauma patients at a referral hospital in an LMIC. MethodsThis cross-sectional study utilized a prospective pediatric trauma registry at a tertiary hospital in northern Tanzania. It enrolled children under the age of 18 who presented with acute injuries. SDH factors included community type, payment method, insurance status, household composition, daily nutrition, and transfer status. Morbidity was assessed using the Glasgow Outcome Scale Extended Peds (GOS-E Peds). The primary outcomes were mortality and morbidity. Chi-square analysis, logistic regression, and modified Poisson regression modeling were employed to analyze associations between SDH burden and patient-specific outcomes. ResultsFrom November 2020 to January 2024, 877 patients were enrolled, resulting in a mortality rate of 7.0% and 38.8% experiencing poor morbidity outcomes (GOS-E Peds [≥]3). Older patients, uninsured patients, those living outside of Moshi Urban, those transferred by ambulance to KCMC, and those sustaining burn injuries had higher odds of mortality in univariable analysis. In adjusted Poisson regression, older patients demonstrated higher odds of morbidity, while those transferred without an ambulance to KCMC showed lower odds of morbidity. Food insecurity emerged as a significant factor influencing survival and poor outcomes, as illustrated in a Sankey diagram (Figure 1) that depicts the pathways to good (GOS-E Peds [≤]2) and poor (GOS-E Peds [≥]3) outcomes. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=105 SRC="FIGDIR/small/25335474v1_fig1.gif" ALT="Figure 1"> View larger version (23K): org.highwire.dtl.DTLVardef@20b88eorg.highwire.dtl.DTLVardef@349072org.highwire.dtl.DTLVardef@f74a38org.highwire.dtl.DTLVardef@129cc0f_HPS_FORMAT_FIGEXP M_FIG O_FLOATNOFigure 1.C_FLOATNO Interconnectedness of Food Insecurity and Insurance Status on Morbidity Description: Sankey Diagram showing the distribution of individuals based on dietary habits (Food secure vs. Food insecure), insurance status (Insured vs. Not Insured), and their corresponding health outcomes (Good vs. Poor). Flow thickness represents the proportion of individuals in each category, highlighting differences in outcome distributions across groups. C_FIG ConclusionsSeveral SDH factors, including insurance status and food insecurity, were associated with increased mortality and morbidity. These findings underscore the need for SDH monitoring and targeted interventions to address disparities in pediatric trauma outcomes in LMICs.