The effects of time and distance to definitive care on morbidity and mortality in pediatric injury patients in Northern Tanzania

Injury is the leading cause of death for youth aged 5-24 years with the majority of deaths occurring in low- and middle-income countries (LMICs). Interventions directed at reaching appropriate care faster have the potential to improve pediatric injury-related outcomes in LMICs. Using a pediatric injury registry, we examined the rates of morbidity and mortality of pediatric injury patients in Northern Tanzania based on referral status, location, distance, and time to definitive care. We included 849 patients aged <18 years. Patients treated at a health care facility prior to KCMC had higher morbidity that those who presented direct to KCMC. There was no significant association between distance of first care site to KCMC and mortality or morbidity, however there was a statistically significant increase in mortality with longer time to definitive care at KCMC. We found that pediatric injury patients treated at first care sites prior to KCMC had higher morbidity. Additionally, the chance of mortality was statistically higher in pediatric injury patients who took longer than 48 hours to reach definitive care at KCMC. This study identifies facilities with longer median times and allows for future targeted interventions to improve pediatric readiness and raising awareness of the importance of timely pediatric specific injury care.