Incidence, Impact, and Healthcare-Seeking Behavior for Extremity Fractures in Resource-Limited Settings: A Household Survey in Rural Tanzania.

Abstract

Limited research exists on the burden of extremity fractures in Sub-Saharan Africa. Underreporting is likely, as patients often seek out traditional bonesetters (TBSs). This study aims to determine the annual incidence and impact of extremity fractures, alongside health-seeking behavior of patients in rural Tanzania. We conducted a cross-sectional household survey in Rorya district, Tanzania, enrolling 497 households with 2667 members, using spatial random sampling. We surveyed household heads regarding access to fracture care and fracture occurrence among household members. We then randomly selected up to three members per household to survey, using the 1448 responses to calculate extremity fracture incidence. Any (self-)reported fractures were questioned on healthcare-seeking behavior and assessed through radiological evaluation. Confirmed cases completed a survey on disability and financial impact. We radiologically confirmed 11 extremity fractures among 1448 randomly selected respondents, yielding an annual incidence of 0.76%. Five additional fractures were identified among nonrandomized individuals totaling 16 confirmed cases. TBS attendance among patients suspecting fracture was significantly higher than hospital attendance (95% vs. 32%, p < 0.0005). Primary reasons for choosing TBSs were lower cost (62%) and perceived faster healing (29%). Sixty-two percent of patients reported reduced work capacity or requiring help with transport and 50% experienced a decrease in income. The annual incidence of extremity fractures in this study was 0.76%. TBSs were largely preferred over hospitals due to lower cost and perceived faster healing. Over half of patients experienced reduced ability to work and income loss. Improved communication between TBSs and hospitals, along with better access to hospital care, could reduce complications.