Traumatic brain injury in African urban centers: The role of road traffic accidents, outcomes, and health-system factors: a systematic review

Abstract

Abstract Background Traumatic brain injury (TBI) is a major cause of death and disability in low- and middle-income countries, particularly in rapidly urbanizing regions of Sub-Saharan Africa. Road traffic accidents (RTAs), especially motorcycle-related crashes, represent a leading mechanism of injury in many African urban settings. Limited access to neurosurgical care, neuroimaging, critical care services, and organized trauma systems may adversely affect patient outcomes. This systematic review synthesized evidence on outcomes and health-system factors among TBI cohorts in African urban centres where RTAs constitute a major mechanism of injury. Methods PubMed and Google Scholar were systematically searched for studies published between January 2010 and May 2025. Eligible studies included observational studies, clinical audits, and hospital-based registries reporting outcomes among TBI patients treated in African urban centres. Primary outcomes were mortality and functional outcomes, including Glasgow Outcome Scale (GOS) or Glasgow Outcome Scale–Extended (GOSE) measures. Secondary outcomes included morbidity, length of hospital stay, and factors influencing access to neurosurgical care. Risk of bias was assessed using the Newcastle–Ottawa Scale tool. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively without meta-analysis. Results Thirteen studies from eight Sub-Saharan African countries were included. Study populations were predominantly composed of young adult males (mean or median age 28–34.5 years; 67–90% male), and RTAs were reported as the leading mechanism of injury in most settings. Severe TBI (Glasgow Coma Scale ≤ 8) was consistently associated with poor outcomes, with reported mortality ranging from approximately 25.8% to 47% among severe-injury cohorts. Predictors of adverse outcomes included low admission Glasgow Coma Scale score, hypotension, hypoxia, polytrauma, and delayed presentation to definitive care. Access to computed tomography (CT), intensive care unit (ICU) services, and neurosurgical intervention varied substantially across centres. Financial barriers frequently contributed to discharge against medical advice (DAMA), potentially compromising outcomes. Long-term functional and neuropsychological outcomes were infrequently reported. Most studies were judged to be at moderate risk of bias, with common limitations including retrospective study designs, single-centre recruitment, limited adjustment for confounding, and incomplete long-term follow-up. Conclusions TBI remains a major cause of mortality and disability in African urban centres, with RTAs representing a dominant mechanism of injury in most included cohorts. Poor outcomes were associated with severe injury, delayed access to care, limited neuroimaging and critical care capacity, and financial barriers to treatment. The available evidence is constrained by heterogeneous outcome reporting and predominantly observational study designs. Future multicentre prospective studies with standardized outcome measures and longer-term follow-up are needed to better characterize outcomes and guide improvements in trauma and neurocritical care systems across Sub-Saharan Africa.