A Psychosocial Assessment of Patients Receiving Orthopaedic Treatment in a Tertiary Hospital in Northern Tanzania

Background: Patients with musculoskeletal injuries in Sub-Saharan Africa often receive prolonged conservative inpatient treatment due to limited access to surgical care. Little is known regarding the psychosocial impact of prolonged conservative treatment for orthopaedic injuries, which may add to disability and preclude rehabilitation. Methods: A cross-sectional study was conducted to characterize the psychosocial health of orthopaedic inpatients at a tertiary hospital in Moshi, Tanzania. Three validated surveys assessing coping strategies, functional social support, and symptoms of depression were orally administered to all orthopaedic patients with a length of stay (LOS) ≥ 6 days. Results: Fifty-nine patient surveys were completed, and revealed 97% (57) of patients were more likely to utilize more mature than immature coping strategies. Patients with chest or spinal column injuries were more likely to use immature coping strategies (p=0·044). Patients with head injuries had more social support compared to others (p=0·009). Lack of insurance, limited education, and rural origins were associated with less functional social support, although this finding did not reach statistical significance. 23·7% (14) of patients had symptoms consistent with mild depression, 33·9% (20) with moderate depression, and 3·4% (2) with moderately severe depression. LOS was the only significant predictor for depression severity. Interpretation: In spite of the predominantly mature coping strategies utilized and some functional support, sixty-one percent of orthopaedic inpatients exhibited depressive symptoms. Psychosocial health in this population is sub-optimal. Access to timely surgical care would greatly decrease LOS, the most prominent predictor of symptom severity. Funding Statement: Center for Global Health, University of Pennsylvania; The Dr. Bipinchandra Barahia Fund Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: This study received local institutional review board approval and ethics committee approval from the Kilimanjaro Christian Medical College.