The Burden of Acute Disease in Mahajanga, Madagascar and Dar Es Salaam, Tanzania: A Comparative Study

BACKGROUND: The burden of acute disease in sub-Saharan Africa is severely underdocumented. Efforts to target care within the region are limited by a lack of direction regarding the most appropriate disease patterns on which to focus both research and funding. This is a comparative study of disease prevalence between the countries of Madagascar and Tanzania, intended to accomplish two primary goals. The first is to present the most common diseases afflicting each region in order to reveal the most urgent needs. With this information the international emergency medicine community as well as policy-makers may begin to address the respective needs of each country from an informed perspective. The second goal is to compare this data to better understand the effects of varying geopolitical circumstances on disease patterns. I posit that the approach to the diseases presented here must be in a country-specific, and not region-specific manner (e.g. sub-Saharan). OBJECTIVE: To characterize, quantify, and compare the burden of acute disease in Madagascar and Tanzania. METHODS: Clinical patient charts were reviewed from major hospitals in both countries. Diagnoses were coded using international conventions and entered into computer databases. Analyses regarding the frequency of various diseases were performed. RESULTS: Trauma is the most common acute pathology overall and across all age groups in Madagascar. Similarly, trauma is overall the most common pathology in Tanzania, but infectious disease is more prevalent in patients less than 5 and less than 18 years of age. Given that trauma represents 48% of disease in Madagascar and 25% in Tanzania, it is likely that the disparity amongst pediatric patients is due to a higher risk of traumatic injury in Madagascar, and not a higher risk of pediatric infectious disease in Tanzania. CONCLUSION: Madagascar and Tanzania share many of the same patterns and frequencies of acute disease. Traumatic injury should be the main thrust of clinical and public health initiatives in both countries, as it represents the bulk of their acute disease burden. However, infectious disease should be the focus of pediatric emergency research in Tanzania, whereas trauma prevention should have the lion’s share of pediatric emergency effort in Madagascar.