# Social drivers and pediatric injury outcomes in Northern Tanzania: A prospective pediatric injury registry secondary analysis

## TL;DR

This study in Tanzania finds that social factors like lack of health insurance and food insecurity are linked to worse outcomes for children with injuries.

## Contribution

The study identifies specific social drivers of poor pediatric injury outcomes in a low-income setting in sub-Saharan Africa.

## Key findings

- Lack of health insurance and ambulance transfer were linked to higher mortality in injured children.
- Older age and food insecurity were associated with worse morbidity outcomes.
- Non-ambulance transfer was protective against poor outcomes.

## Abstract

Trauma remains a leading cause of preventable childhood mortality and disability worldwide, with over 95% of pediatric injury-related deaths occurring in low- and middle-income countries (LMICs). Social drivers of health (SDH) – including socioeconomic status, insurance coverage, and community infrastructure – strongly influence these outcomes but remain underexplored in sub-Saharan Africa. To examine the association between selected SDH factors and morbidity and mortality among injured children presenting to a tertiary referral hospital in Northern Tanzania. This secondary analysis utilized data from a prospective pediatric injury registry at Kilimanjaro Christian Medical Center (KCMC) from November 2020 to January 2024. Children under 18 years presenting with acute injuries were enrolled. SDH variables included residence type, payment method, insurance status, household composition, food security, and transfer status. Outcomes were in-hospital mortality and morbidity, defined using the Glasgow Outcome Scale – Extended Peds (GOS-E Peds). Multivariable logistic regression and modified Poisson regression models were used to identify independent predictors of mortality and morbidity. A total of 877 children were included (median age 7 years, 63% males). Mortality rate was 7.0%, while 38.8% experienced poor morbidity outcomes (GOS-E Peds ≥3). In multivariable analysis, lack of health insurance (adjusted OR=2.4, 95%CI 1.1—5.3) and transfer by ambulance to KCMC (adjusted OR=3.8, 95%CI 1.5—9.4) were associated with higher odds of mortality. Older age (adjusted PR = 1.05, 95%CI 1.02—1.09) predicted greater morbidity, while non-ambulance transfer was protective (adjusted PR = 0.74, 95%CI 0.56—0.97). Food insecurity remained an independent correlate of poor outcomes. Social and economic inequities, particularly inter-facility ambulance transfer, lower MUAC, and food security, were independently associated with adverse pediatric injury outcomes. Food insecurity and lack of insurance remained cross-cutting vulnerabilities. Integrating SDH surveillance into trauma care systems and addressing access barriers may reduce injury-related morbidity and mortality in LMICs.