Abstract:
Background: Skin disease is an important yet under-recognised contributor to global morbidity and mortality, particularly in Sub-Saharan Africa where epidemiological data remains sparse. Data from the Global burden of disease initiative shows upwards trajectory of skin disease through 2046 in Eastern Africa, with high global age standardised incidence and disability adjusted life year rates for skin disease. Despite this, access to dermatological care remains severely limited with most countries reporting fewer than one dermatologist per million people. Within Tanzania, many dermatological services are concentrated in urban centres leaving many rural populations with limited access to specialist care. As a supranational referral, training and research centre serving East Africa, the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania serves a unique lens to evaluate patterns of dermatological disease and geographic inequities in access to specialist care.
Methods: We conducted a retrospective review of routinely collected electronic health records from patients attending the RDTC between April 2017 and December 2020. De-identified demographic and diagnostic data were extracted and handwritten diagnoses were retrospectively categorised using ICD-11 codes. Only first patient visits and primary diagnoses were included. Geographic distance from patients’ region of residence to the RDTC was estimated using straight-line distance from the centroid of each administrative region. Descriptive statistical analyses was performed using STATA 15.1
Results: Of 45,821 recorded visits, 14,710 met the inclusion criteria. Median patient age was 26 years and 56.5% were female. Atopic dermatitis (AD) was the single most frequent diagnosis with (22.6%). Infectious dermatoses accounted for 24.0% of presentations, predominantly fungal infections (12.3%), followed by viral infections (4.5%) and ectoparasitic infections including scabies (3.8%). Acne and follicular disorders represented 6.5% and (1.7%) and whilst skin malignancies were scarce, Kaposi sarcoma accounted for 0.7%, squamous cell carcinoma 0.2% and melanoma 0.1% of diagnoses.
Geographically, among patients with available address data, 77.03% patients originated from within the Kilimanjaro region, where the RDTC is located. 103 patients travelled over 1000km, and 21 people travelled from outside Tanzania from Kenya and Somalia.
Conclusions: The disproportionately high frequency of AD mirrors existing regional epidemiological data, however it also reflects the gaps in primary care dermatological expertise. Although follow-up visits were excluded from the analytic cohort, they represented a substantial proportion of all recorded visits, consistent with the chronic and recurrent nature of many dermatological conditions. These findings suggest the need for primary care facilities to increase capacity to adequately manage chronic relapsing conditions, such as AD, to reduce delayed presentation to tertiary centres.
The substantial travel distances highlight geographic inequities in access to specialist care and support decentralisation, task-sharing, and teledermatology to expand access. The young median age emphasises the burden of chronic skin disease amongst the economically productive population, further stressing the need for sustainable healthcare infrastructure for continuity of care.
These findings underscore the value of routine clinical data in shaping dermatological global and public health policies, training to improve healthcare inequities and system levels reform across the region
Biography:
Lakshaajeni Thevapalan is a resident doctor working at the James Paget University Hospital. She graduated from UCL medical school, where she completed an intercalated BSc in clinical sciences. She has a strong interest in global health, having carried out an elective in Tanzania focusing on tropical disease and chronic skin conditions.
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