Road traffic injury incidence and crash characteristics in Dar es Salaam: a population based study

Descriptive analysis of road traffic crashes encountered by Tanzanian motorcycle taxi drivers trained in first aid

Introduction

In Dar es Salaam, Tanzania, death from road traffic crashes (RTC) occurs at roughly double the global rate. In this study, we sought to understand the locations and types of vehicles involved in RTC in Dar es Salaam encountered by a cohort of motorcycle taxi drivers previously trained in first aid.

Methods

This was a quasi-non-randomized interventional study, cohort subtype, with three-month follow-up. Some 186 motorcycle taxi drivers were selected by convenience sampling from 16 heavily populated, central wards and trained in a basic hemorrhage control course. Participants reported the location and types of vehicles involved in RTCs they encountered and intervened upon through performing bleeding control interventions. Surveys were designed on KoboToolbox and administered via phone call at monthly intervals over a three-month period. The main outcome measures were the location of crash encounters and types of vehicles involved.

Results

In all 62 unique participants (33.3 %) encountered and provided bleeding control interventions to 83 injured individuals following 69 RTC in at least 31 distinct city wards, despite training only having occurred in 16 wards. Eight crash locations were not recorded. Crashes in distant wards typically contained major roads. Most commonly, crashes involved a motorcycle without the involvement of another vehicle (n=20), followed by motorcycle vs. car/three-wheeled vehicle (n=15), motorcycle vs. bus/van (n=10), motorcycle vs. motorcycle (n=9), motorcycle vs. pedestrian (n=7), pedestrian vs. bus/van (n=2), pedestrian vs. car/three-wheeled vehicle (n=1), motorcycle vs. bicycle (n=1), multi vehicle (n=1), and other (n=3).

Conclusions

Motorcycle taxi drivers trained in hemorrhage control frequently encounter and intervene upon RTC in wards where they are based as well as in distant locations, commonly in wards containing major roads. Expanding first aid training for motorcycle taxi drivers could improve timely access to emergency care for RTC victims. Since most crashes involved motorcycles, road safety training should be integrated into future courses.

Effectiveness of a Bleeding Control Course for Public Transit Drivers in Dar es Salaam, Tanzania

INTRODUCTION

In Dar es Salaam, mortality from road traffic injuries is roughly double the global rate. Most civilians are transported to hospitals by laypeople. We examined the impact of a bleeding control course among taxi drivers.

METHODS

Before-after study; participants were trained in hemorrhage control and equipped with a first aid kit. Primary outcomes were perceived bleeding control knowledge, perceived ability to apply bleeding control skills, and intention to intervene. Surveys were administered before, after, and 3 mo after training. Data were measured on a 1-5 Likert scale.

RESULTS

Among 186 participants, knowledge increased from 1.70 (95% confidence interval [CI] 1.55-1.85) before training to 4.67 (95% CI 4.55-4.78) after training and was sustained at 3 mo 4.69 (95% CI 4.61-4.77). Ability to apply skills increased from 2.12 (95% CI 1.96-2.27) before training to 4.68 (95% CI 4.59-4.78) after training and was sustained at 3 mo 4.67 (95% CI 4.57-4.76). Intention to intervene increased from 2.69 (95% CI 2.47-2.92) before training to 4.66 (95% CI 4.55-4.76) after training and was sustained at 3 mo 4.57 (95% CI 4.48-4.67). 83 interventions occurred. Transport to health-care facilities occurred 58 times. Care was transferred to a doctor or nurse 39 times.

CONCLUSIONS

This course increased participant's perceived bleeding control knowledge, ability to apply skills, and intention to intervene. Participants utilized skills in the field, transported the injured, and handed off care. This course should be evaluated globally in similar contexts.

Estimating the Burden of Disability From Road Traffic Injuries in 5 Low- and Middle-Income Countries: Protocol for a Prospective Observational Study

BACKGROUND

Road traffic injuries (RTIs) are a leading cause of death and unintentional injuries globally. They claim 1.35 million lives and produce up to 50 million injuries each year, causing a major drain on health systems. Despite this high burden, there is a lack of robust data on the long-term consequences of RTIs, specifically the level of disability experienced by many survivors and its impact on their everyday lives.

OBJECTIVE

This study aims to characterize RTIs, disability level, and related consequences affecting adult road traffic crash survivors in 5 low- and middle-income countries (LMICs). In addition, this study estimates the role of demographic and crash- and treatment-related factors in predicting adverse outcomes and disability as well as examining the disability level among patients with RTIs, likelihood of return to normal life, and the environmental factors that may influence these outcomes after discharge from the hospital.

METHODS

This prospective observational study was conducted at selected hospitals in Bangladesh, Cambodia, Ethiopia, Mexico, and Zambia. The study sample included all adult patients with RTIs admitted to the hospital for at least 24 hours. Consecutive sampling was performed until the minimum required sample size of 400 was reached for each participating country. Data were collected from patients or their caregivers using a hospital-based surveillance tool administered at the participating sites as well as a telephone-based follow-up instrument administered 1, 3, and 6 months after discharge. Descriptive analysis and multivariate models will be used to estimate the contribution of a range of factors in predicting adverse outcomes, disability, and return to normal life.

RESULTS

Enrollment began in June 2021 and was completed in April 2022. Follow-up data collection ended in September 2022. Data analysis is currently underway, with results expected for publication in mid-2023. Expected results include estimates of disability among patients with RTIs as well as identifying the predictors of adverse outcomes, disability, and the likelihood of return to normal life.

CONCLUSIONS

Research findings will help better understand the long-term burden of disability from RTIs in the 5 LMICs and the challenges facing survivors of road traffic crashes. They will be used to inform interventions aimed at improving the health care, social, physical, and policy conditions in LMICs that can facilitate recovery and rehabilitation for patients with RTIs, reduce the burden of disability, and enhance their participation in society.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40985.

Limb Injuries and Disability in the Southwest Region of Cameroon

INTRODUCTION

Extremity injuries are a leading cause of morbidity in low- and middle-income countries (LMICs), often resulting in marked short-term and long-term disabilities. Most of the existing knowledge on these injuries originates from hospital-based studies; however, poor access to health care in LMICs limits these data because of inherent selection bias. This subanalysis of a larger population-level cross-sectional study in the Southwest Region of Cameroon aims to determine patterns of limb injury, treatment-seeking behaviors, and predictors of disability.

METHODS

Households were surveyed in 2017 on injuries and subsequent disability sustained over the previous 12 months using a three-stage cluster sampling framework. Subgroups were compared using the chi square, Fisher exact, analysis of variance, Wald, and Wilcoxon rank-sum tests. Logarithmic models were used to identify predictors of disability.

RESULTS

Of 8,065 subjects, 335 persons (4.2%) sustained 363 isolated limb injuries. Over half of the isolated limb injuries (55.7%) were open wounds while 9.6% were fractures. Isolated limb injuries most commonly occurred in younger men and resulted from falls (24.3%) and road traffic injuries (23.5%). High rates of disability were reported, with 39% reporting difficulty with activities of daily living. Compared with individuals with other types of limb injuries, those with fractures were six times more likely to seek a traditional healer first for care (40% versus 6.7%), 5.3 times (95% CI, 1.21 to 23.42) more likely to have any level of disability after adjustment for injury mechanism, and 2.3 times more likely to have difficulty paying for food or rent (54.8% versus 23.7%).

DISCUSSION

Most traumatic injuries sustained in LMICs involve limb injuries and often result in high levels of disability that affect individuals during their most productive years. Improved access to care and injury control measures, such as road safety training and improvements to transportation and trauma response infrastructure, are needed to reduce these injuries.

Road traffic injuries in Tanzanian children and adolescents: A cross-sectional household survey

OBJECTIVE

To measure annual rates of road traffic injuries (RTI) and to describe the characteristics of road traffic crashes experienced by children and adolescents in Tanga, Tanzania.

METHODS

We conducted a cross-sectional household survey using geospatial population-weighted sampling in the city of Tanga in northern Tanzania. Data were collected in February and March of 2022. We report 12-month rates of road traffic crashes and RTI (reported by adult caregivers) among children and adolescents <18 years of age.

RESULTS

A total of 2,794 adult respondents reported data on 6563 children and adolescents, among whom, 180 were reported to have experienced road traffic crashes in the past 12 months (crash incidence: 27.4 per 1,000 children, 95%CI 23.5-31.4) and 158 sustained injuries (RTI incidence: 24.1 per 1000 children, 95%CI 20.4-27.8). Almost a quarter of RTI (23%) were reported to be major (resulting in ≥30 days of missed activities). RTI was higher among adolescents (13-17 years) than children <5 years (21.5 vs. 14.1 per 1,000, p=0.039). Few children always or sometimes wore helmets when riding on motorcycles/motorbikes (12.8%) or wore safety restraints/seat belts in cars or other vehicles (11.9%).

CONCLUSION

The high rate of road traffic crashes and RTI observed among children and adolescents in a medium-sized city in Tanzania underscores the urgent need to improve road safety and increase use of safety equipment in low resource settings.

Factors affecting bus accident severity in Thailand: A multinomial logit model

Bus accidents are a serious issue, with high rates of injury and fatality in Thailand. However, no studies have been conducted on the factors affecting bus accident severity in Thailand. A cross-sectional study was conducted by the Department of Highways, Thailand over the 2010–2019 period. A multinomial logit model was used to evaluate the factors associated with bus accident severity. This model divided accidents into three categories: non-injury, injury, and fatality. The risk factors consisted of three major categories: the bus driver, characteristics of the crash, and environmental characteristics. The results showed that characteristics of the bus driver, the crash, and the environment where the crash occurred all increased the probability of bus accidents causing injury. These three main factors included driving on sloped roads (relative risk ratio [RRR] 3.03, 95% confidence level [CI] 1.73 to 5.30), drowsy driving (RRR 2.60, 95% CI 1.71 to 3.96), and driving in the wrong direction (RRR 2.37, 95% CI 1.77 to 3.19). Moreover, the factors that increased the probability of the accidents causing fatality were drowsy driving (RRR 3.40, 95% CI 2.07 to 5.57) and drivers not obeying or following traffic rules (RRR 3.02, 95% CI 1.95 to 4.67), especially in the northern part of Thailand (RRR 3.01, 95% CI 1.98 to 4.62). The results can provide a valuable resource to help road authorities in development targeting road safety programs at sloped roads in the northern part of Thailand. Stakeholders should increase road safety efforts and implement campaigns, such as raising public awareness of the risks of not obeying or following traffic rules and drowsy driving which could possibly reduce the risk of both injury and fatality.

Overcoming challenges in crash prediction modeling using discretized duration approach: An investigation of sampling approaches

Until recently, statistical approaches used for real-time crash prediction modeling were limited to case-control design and "sampling of alternatives" approaches. A recent study has developed a duration-based real-time crash prediction model capable of incorporating dynamic (time-varying) covariates within its framework. The modeling approach discretizes the duration between crashes into equal time intervals which can be modeled as alternatives in a multinomial logit framework. The approach, however, requires a reformulation of the original crash dataset to fit its modeling framework which results in considerably large data making model estimation computationally demanding. Additionally, validation of the model in the original study is based on crash data from just one interstate, I-405, assuming homogenous highway segments each 5 miles in length. This study improves upon the original study by investigating sampling techniques that can be applied to the reformulated data to reduce computational load using 2019 crash data from two interstates, I-40 and I-55, in Memphis, Tennessee. Furthermore, discretization of inter-crash duration is undertaken following non-homogenous segmentation of the interstates that is based on highway geometry, terrain, and posted speed limit. To accomplish the study objectives, a relatively small future window of 1 h with 15-minute time intervals is used to discretize the inter-crash duration and obtain the reformulated data. Sampling of crashes for model estimation is then done at the crash, epoch, and segment levels to answer the question of which sampling technique (by crash, epoch, or segment) would result in reasonable accuracy when compared with the complete (100%) data. Results show that 25% of samples drawn at the epoch level can result in a considerable reduction of computational load while providing reasonably consistent estimates.

Characteristics and outcomes following motorized and non-motorized vehicular trauma in a resource-limited setting

INTRODUCTION

Despite the ubiquity of motorized vehicular transport, non-motorized transportation continues to be common in sub-Saharan Africa.

METHODS

We performed a retrospective analysis of trauma patients presenting to Kamuzu Central Hospital in Malawi from February 2008 to May 2018. Demographic and clinical variables including injury characteristics and outcomes were collected. We performed bivariate and multivariate logistic regression to determine predictors of mortality following non-motorized vehicular trauma.

RESULTS

This study included 36,412 patients involved in vehicular road injuries. Patients in the non-motorized group had a preponderance of men (84% versus 73%, p<0.01). The proportion of patients with Glasgow Coma Scale > 8 was slightly higher in the non-motorized group (99% versus 98%, p<0.01), though injury severity did not differ significantly between the two groups. A higher proportion in the motorized group had the most severe injury of contusions and abrasions (56% versus 50%, p<0.01). In contrast, the non-motorized group had a higher proportion of orthopedic injuries (24% versus 16%, p<0.01). The crude mortality rate was 4.51% and 2.15% in the motorized and non-motorized groups, respectively. After controlling for demographic factors and injury severity, the incidence rate ratio of mortality did not differ significantly between motorized and non-motorized trauma groups (IRR 0.91, p=0.35).

CONCLUSIONS

Non-motorized vehicular trauma remains a significant proportion of morbidity and mortality resulting from road traffic injuries. The injury severity and incidence rate ratio of mortality did not differ between motorized and non-motorized trauma groups. Health care providers should not underestimate the severity of injuries from non-motorized trauma.

Presentation of Pediatric Unintentional Injuries at Rural Hospitals in Rwanda: A Retrospective Study

Background:

Injuries are a leading cause of mortality among children globally, with children in low- and middle-income countries more likely to die if injured compared to children in high-income countries. Timely and high-quality care are essential to reduce injury-related morbidity and mortality.

Objectives:

This study describes patterns, management, and outcomes of children 0–15 years presenting with unintentional injuries at three district hospitals in rural Rwanda between January 1 and December 31, 2017.

Methods:

Using a retrospective cross-sectional study design, we assessed the demographic and clinical characteristics, care provided, and outcomes of the children using data extracted from patient medical charts. We describe the patient population using frequencies and proportions as well as median and interquartile ranges.

Findings:

Of the 449 injured children who sought care at the three rural district hospitals, 66.2% (n = 297) were boys. The main causes of injury were falls (n = 261, 58.1%), burns (n = 101, 22.5%), and road traffic injuries (n = 67, 14.9%). Burns were the most common injury among children aged 0–5 years while falls were the leading injury type among the 5–15 years age group. Vital signs were inconsistently completed ranging between 23.8–89.1% of vital sign items. Of the injured children, 37.0% (n = 166) received surgery at the district hospital, general practitioners performed 80.9% (n = 114) of surgeries, 87.4% (n = 145) of operated patients received no anesthesia, and 69.3% (n = 311) were admitted to the district hospital, while 2.7% (n = 12) were transferred to tertiary facilities for higher-level care.

Conclusions:

The presentation of child injuries—namely falls, burns, and road traffic accidents—is similar to what has been reported in other sub-Saharan African countries. However, more needs to be done to improve the completion and documentation of vital signs and increase availability of surgical specialists. Finally, targeted strategies to prevent burns and motorcycle-related injuries are recommended prevention interventions for this rural population.

Injury patients' perceptions of drink-driving: A qualitative assessment of drink-driving behavior in Moshi, Tanzania

BACKGROUND

Globally, about 2.3 billion people are current alcohol drinkers, and 283 million have an alcohol use disorder. Alcohol use while driving is a major contributor to road traffic injuries (RTI). We need to understand the culture and perception of drink-driving in this setting to understand why people continue to drink drive and allow policymakers to develop more effective ways to address drink-driving behavior. This study aims to qualitatively determine what injury patients, their families, and community advisory board members in Tanzania believe about drink-driving to help inform policies to address this problem.

METHODS

The semi-structured focus group was designed based on the grounded theory and assessed using thematic analysis. Focus groups participants were a convenience sample of injury patients, their families, and community advisory board (CAB) members. Analysis was iterative throughout the study. All transcripts were coded using a thematic narrative approach. Representative quotes for each theme were then selected based on comparative analysis of coding with input from research team members.

RESULTS

A total of ten focus groups were conducted (4 patient, 4 family, and 2 CAB) with a total of 104 participants (37 females and 67 males). The normalization of drinking among drivers has allowed this behavior to become ingrained in the culture. Participants expressed notions that passengers are responsible for their own safety, rather than drivers being responsible for their passengers. Most participants believe it is a citizen's duty to inform the police of suspected drink-driving, however there were differing opinions about how effective informed police officers can be in practice. Focus group discussions between all three population types highlighted major themes of 'drinking is ingrained in boda boda driver culture', 'individuals have a personal responsibility to address drink-driving', and a 'police enforcement on drink-driving is necessary'.

CONCLUSIONS

Normalization of drink-driving in commercial driver culture creates a dangerous environment for passengers which can be mitigated by education and health promotion. As most passengers already take personal responsibility for their own road traffic safety, they may be likely to make use of safe ride options, if available. While legislation is in place against drink-driving, police officers need to be empowered with appropriate training and funding to enforce them.

Early treatment of open diaphyseal tibia fracture with intramedullary nail versus external fixator in Tanzania: Cost effectiveness analysis using preliminary data from Muhimbili Orthopaedic Institute

INTRODUCTION

Open tibia fractures are some of the most common types of Orthopedics injuries in low- and middle-income countries (LMICs). In Tanzania, open tibia fractures are treated either conservatively by prolonged cast or surgically by external fixation (EF) or intramedullary nail (IMN) when available. The cost of treatment and amount of time patients spend away from work are major economic concerns with prolonged casting and EF. The goal of this study was to determine the cost effectiveness of IMN versus EF in the treatment of open diaphyseal tibia fractures at Muhimbili Orthopaedic Institute (Dar es Salaam, Tanzania).

METHODS

This is a prospective randomized control study conducted of patients with a closeable AO/OTA 42 open diaphyseal tibia fracture. The patients underwent surgical fixation with either IMN or EF at Muhimbili Orthopaedic Institute (MOI), and were followed up at 2, 6, and 12 weeks postoperatively. A micro-costing method was used to estimate the fixed and variable costs of IMN and EF of the open diaphyseal tibial fracture.

RESULTS

The mean total cost per patient was lower for the IMN group ($425.8 ± 38.4) compared to the EF group ($559.6 ± 70.5, p < 0.001), with savings of $133.80 per patient for the IMN group. The mean hospital stay was 2.72 ± 1.40 days for the IMN group and 2.44 ± 1.47 days for the EF group (p = 0.5). Quality-adjusted life years (QALYs) were 0.26 per patient for the IMN group and 0.24 in the EF group at 12 weeks (p = 0.8). Ninety-two percent of patients in the IMN group achieved fracture union versus 60% in the EF group at three months postoperatively (p = 0.03).

CONCLUSION

IM nailing of a closeable open diaphyseal tibial fracture is more cost effective than EF. In addition, IM nailing has better union rates at three months compared to EF.

The Economic Burden of Non-fatal Musculoskeletal Injuries in Northeastern Tanzania

Background:

Although musculoskeletal injuries have increased in sub-Saharan Africa, data on the economic burden of non-fatal musculoskeletal injuries in this region are scarce.

Objective:

Socioeconomic costs of orthopedic injuries were estimated by examining both the direct hospital cost of orthopedic care as well as indirect costs of orthopedic trauma using disability days and loss of work as proxies.

Methods:

This study surveyed 200 patients seen in the outpatient orthopedic ward of the Kilimanjaro Christian Medical Center, a tertiary hospital in Northeastern Tanzania, during the month of July 2016.

Findings:

Of the patients surveyed, 88.8% earn a monthly income of less than $250 and the majority of patients (73.7%) reported that the healthcare costs of their musculoskeletal injuries were a catastrophic burden to them and their family with 75.0% of patients reporting their medical costs exceeded their monthly income. The majority (75.3%) of patients lost more than 30 days of activities of daily living due to their injury, with a median (IQR) functional day loss of 90 (30). Post-injury disability led to 40.6% of patients losing their job and 86.7% of disabled patients reported a wage decrease post-injury. There were significant associations between disability and post-injury unemployment (p < .0001) as well as lower post-injury wages (p = .022).

Conclusion:

This exploratory study demonstrates that in this region of the world, access to definitive treatment post-musculoskeletal injury is limited and patients often suffer prolonged disabilities resulting in decreased employment and income.

Magnitude of road traffic accident related injuries and fatalities in Ethiopia

Background

In many developing countries there is paucity of evidence regarding the epidemiology of road traffic accidents (RTAs). The study determines the rates of injuries and fatalities associated with RTAs in Ethiopia based on the data of a recent national survey.

Methods

The study is based on the secondary data of the Ethiopian Demographic and Health Survey conducted in 2016. The survey collected information about occurrence injuries and accidents including RTAs in the past 12 months among 75,271 members of 16,650 households. Households were selected from nine regions and two city administrations of Ethiopia using stratified cluster sampling procedure.

Results

Of the 75,271 household members enumerated, 123 encountered RTAs in the reference period and rate of RTA-related injury was 163 (95% confidence interval (CI): 136–195) per 100,000 population. Of the 123 causalities, 28 were fatal, making the fatality rate 37 (95% CI: 25–54) per 100,000 population. The RTA-related injuries and fatalities per 100,000 motor vehicles were estimated as 21,681 (95% CI: 18,090–25,938) and 4,922 (95% CI: 3325–7183), respectively. Next to accidental falls, RTAs were the second most common form of accidents and injuries accounting for 22.8% of all such incidents. RTAs contributed to 43.8% of all fatalities secondary to accidents and injuries. Among RTA causalities, 21.9% were drivers, 35.0% were passenger vehicle occupants and 36.0% were vulnerable road users including: motorcyclists (21.0%), pedestrians (12.1%) and cyclists (2.9%). Approximately half (47.1%) of the causalities were between 15–29 years of age and 15.3% were either minors younger than 15 years or seniors older than 64 years of age. Nearly two-thirds (65.0%) of the victims were males.

Conclusion

RTA-related causalities are extremely high in Ethiopia. Male young adults and vulnerable road users are at increased risk of RTAs. There is a urgent need for bringing road safety to the country's public health agenda.

Morbidity and mortality from road traffic crashes in children in Metro West, City of Cape Town - 2014

The road traffic crash injury burden significantly impacts the lives of South African children. This study aimed to assess the fatal and non-fatal pattern of road traffic crash injury of children under 13 years old from Metro West, City of Cape Town, from 1 January until 31 December 2014. The data were stratified by age, sex and mechanism of road traffic crash. The overall mortality rate was 8.7 per 100 000 population and pedestrians contributed the most to this burden (72.5%). There were more male children involved in a road traffic crash (p = 0.0001). The greatest proportion of fatal and non-fatal road traffic crash injuries was observed in children aged 5-9 years. Fractures contributed to the greatest rate of years lived with disability (3.0 years of life lived with disability per 100 000). Our study found that the burden of road traffic crashes primarily affects male pedestrians aged 5-9 years old.

School Area Road Safety Assessment and Improvements (SARSAI) programme reduces road traffic injuries among children in Tanzania

PURPOSE

To determine the impact of a paediatric road traffic injury (RTI) prevention programme in urban Sub-Saharan Africa.

SETTING

Dares Salaam, Republic of Tanzania.

METHODS

Household surveys were conducted in catchment areas around 18 primary schools in Dar es Salaam, Republic of Tanzania; the catchment areas were divided into control and intervention groups. Collected data included basic demographic information on all school-aged household members and whether or not they had been involved in an RTI in the previous 12 months, and, if so, what the characteristics of that RTI were. Based on these findings, a separate road safety engineering site analysis and consultation with the communities and other stakeholders, an injury-prevention programme was developed and implemented, consisting of infrastructure enhancements and a site-specific educational programme. The programme was initially implemented at the intervention schools. After 1 year, data were collected in the same manner. The control group received the same intervention after follow-up data were collected.

RESULTS

Data were collected on 12 957 school-aged children in the baseline period and 13 555 school-aged children in the post-intervention period, in both the control and intervention communities. There was a statistically significant reduction in RTIs in the intervention group and a non-significant increase in RTI in the control group. The greatest reduction was in motorcycle-pedestrian RTI, private vehicle-pedestrian RTI and morning RTI.

CONCLUSION

The programme demonstrated a significant reduction in paediatric RTI after its implementation, in very specific ways. This study demonstrates that for a reasonable investment, scientifically driven injury-prevention programmes are feasible in resource-limited settings with high paediatric RTI rates.

Pattern of road traffic injuries in Yemen: a hospital-based study

Introduction

Road traffic injuries (RTIs) are the eighth leading cause of death globally and the leading cause of death for young people. This study aimed to present time-limited trial surveillance in two referral hospitals to describe the pattern of RTIs in Sana'a, Yemen and determine road traffic crashes (RTCs) associated factors.

Methods

All RTIs presented to Emergency Departments (ED) of the two Sanaa city hospitals between August and October, 2015 were studied and described. Data were collected everyday by trained data collectors. A pretested questionnaire modified from WHO injury surveillance form was used for data collection.

Results

A total of 156 casualties from 128 RTCs had attended the two study hospitals during the study period. About 73% of victims were less than 30 years old. Only 13% of casualties were transported by ambulance. None of the victims wore the seat belt in case of 4-wheeled vehicles' users nor the helmet in case of 2-wheeled vehicles' users. Poor driving skills were involved in 133 (85%) casualties. Factors related to the vehicles contributed to 12% of RTCs. Of the 156 casualties, 17% had severe injuries and needed ICU admission. After 48 hours of the accident, 38% of patients ended with disability due to fractured limbs, 29% were not improving and their conditions were deteriorating, 18% had recovered and 5% died.

Conclusion

Several personal, behavioral, environmental and vehicles related factors had contributed to RTIs in Yemen. The burden of RTIs in Yemen in terms of disability and mortality is high.

The epidemiology of pre-hospital potential spinal cord injuries in Victoria, Australia: a six year retrospective cohort study

BACKGROUND

Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI.

METHODS

This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI. Data was extracted from the AV data warehouse, including demographic details, trauma aetiology, paramedic assessment, management and other event characteristics.

RESULTS

A total of 106,059cases were included in the study, representing 2.3 % of all emergency transports by AV. Subjects had a median age of 51 years (interquartile range; 29-78) and 52.4 % were males (95 % CI 52-52.7). Males were significantly younger than females (M: 43 years [26-65] vs. F: 64 years [36-84], p =0.001). Falls and traffic accidents were the leading causes of injuries, comprising 46.9 and 39.4 % of cases, respectively. Other causes included accidents due to sport, animals, industrial work and diving, as well as violence and hanging. 29.9 % of patients were transported to a Major Trauma Service (MTS). A proportion of 48.8 % of the study population met the Pre-hospital Major Trauma criteria.

CONCLUSION

This is the first study to describe the epidemiology of potential TSCI in Australia and is based on a large, state-wide sample. It provides background knowledge and a baseline for future research, as well as a reference point for future in policy. Falling and traffic related injuries were the leading causes of potential SCI. Future research is required to identify the proportion of confirmed TSCI among the potentials and factors associated with TSCI in prehospital settings.

Rwanda's Model Prehospital Emergency Care Service: A Two-year Review of Patient Demographics and Injury Patterns in Kigali

Introduction Injury is responsible for nearly five million annual deaths worldwide, and nearly 90% of these deaths occur in low- and middle-income countries (LMICs). Reliable clinical data detailing the epidemiology of injury are necessary for improved care delivery, but they are lacking in these regions.

METHODS

A retrospective review of the Service d'Aide Medicale Urgente (SAMU; Kigali, Rwanda) prehospital database for patients with traumatic injury-related conditions from December 2012 through November 2014 was conducted. Chi-squared analysis, binomial probability test, and student's t-test were used, where appropriate, to describe patient demographics, injury patterns, and temporal and geographic trends of injuries.

RESULTS

In the two-year period, 3,357 patients were managed by SAMU for traumatic injuries. Males were 76.5% of the study population, and the median age of all injured patients was 29 years (IQR=23-35). The most common causes of injury were road traffic crashes (RTCs; 73.4%), stabbings/cuts (11.1%), and falls (9.4%), and the most common anatomic regions injured were the head (55.7%), lower (45.0%) extremities, and upper (27.0%) extremities. Almost one-fourth of injured patients suffered a fracture (24.9%). The most common mechanism of injury for adults was motorcycle-related RTCs (61.4%), whereas children were more commonly injured as pedestrians (59.8%). Centrally located sectors within Kigali represented common areas for RTCs.

CONCLUSIONS

These data support the call for focused injury prevention strategies, some of which already are underway in Rwanda. Further research on care processes and clinical outcomes for injured patients may help identify avenues for improved care delivery. Enumah S , Scott JW , Maine R , Uwitonze E , Nyinawankusi JD , Riviello R , Byiringiro JC , Kabagema I , Jayaraman S . Rwanda's model prehospital emergency care service: a two-year review of patient demographics and injury patterns in Kigali. Prehosp Disaster Med. 2016;31(6):614-620.

The burden of road traffic crashes, injuries and deaths in Africa: a systematic review and meta-analysis

Objective

To estimate the burden of road traffic injuries and deaths for all road users and among different road user groups in Africa.

Methods

We searched MEDLINE, EMBASE, Global Health, Google Scholar, websites of African road safety agencies and organizations for registry- and population-based studies and reports on road traffic injury and death estimates in Africa, published between 1980 and 2015. Available data for all road users and by road user group were extracted and analysed. We conducted a random-effects meta-analysis and estimated pooled rates of road traffic injuries and deaths.

Findings

We identified 39 studies from 15 African countries. The estimated pooled rate for road traffic injury was 65.2 per 100 000 population (95% confidence interval, CI: 60.8–69.5) and the death rate was 16.6 per 100 000 population (95% CI: 15.2–18.0). Road traffic injury rates increased from 40.7 per 100 000 population in the 1990s to 92.9 per 100 000 population between 2010 and 2015, while death rates decreased from 19.9 per 100 000 population in the 1990s to 9.3 per 100 000 population between 2010 and 2015. The highest road traffic death rate was among motorized four-wheeler occupants at 5.9 per 100 000 population (95% CI: 4.4–7.4), closely followed by pedestrians at 3.4 per 100 000 population (95% CI: 2.5–4.2).

Conclusion

The burden of road traffic injury and death is high in Africa. Since registry-based reports underestimate the burden, a systematic collation of road traffic injury and death data is needed to determine the true burden.

Prevalence of injury and associated factors among patients visiting the Emergency Departments of Amhara Regional State Referral Hospitals, Ethiopia: a cross-sectional study

Background

Injury significantly affecting the health and well-being of the society.

The prevalence tends to be higher in low income countries. The aim of this study was to assess the prevalence of injury and associated factors among patients visiting emergency departments of Amhara Regional State referral hospitals.

Methods

Institution based cross sectional study was conducted from March to April 2014. The systematic random sampling technique was employed to select the study participants. The data were collected using an interviewer administered questionnaire. Bivariate and multivariate logistic regressions were performed to identify factors associated with injury. Odds ratios with 95 % confidence interval were computed to determine the level of significance.

Result

The prevalence of injury was 55.6 %. Being male (AOR = 2.8; 95 % CI, 1.79-4.47), monthly income less than 34.2 USD (AOR = 1.89; 95 % CI, 1.03–3.46), being age between 20 to 44 years (AOR = 2.25; 95 % CI, 1.06–4.81), being a daily laborer (AOR = 6.27; 95 % CI, 2.38-16.47), being a farmer (AOR = 2.9; 95 % CI, 1.31-6.41) and being a substance user (AOR = 2. 16; 95 % CI, 1.18-3.96) were significantly associated with injury.

Conclusion

The prevalence of injury was high. Being male, age 20 to 44 years, income < 34.2 USD, being a daily laborer, being a farmer and alcohol use were factors associated with injury. Hence, appropriate injury prevention strategy should be designed in order to lessen the magnitude of injury.

Incidence and costs of bicycle-related traumatic brain injuries in the Netherlands

The main cause of death and serious disability in bicycle accidents is traumatic brain injury (TBI). The aim of this population-based study was to assess the incidence and costs of bicycle-related TBI across various age groups, and in comparison to all bicycle-related injuries, to identify main risk groups for the development of preventive strategies. Data from the National Injury Surveillance System and National Medical Registration were used for all patients with bicycle-related injuries and TBI who visited a Dutch emergency department (ED) between 1998 and 2012. Demographics and national, weighted estimates of injury mechanism, injury severity and costs were analysed per age group. Direct healthcare costs and indirect costs were determined using the incidence-based Dutch Burden of Injury Model. Between 1998 and 2012, the incidence of ED treatments due to bicycle-related TBI strongly increased with 54%, to 43 per 100,000 persons in 2012. However, the incidence of all bicycle-related injuries remained stable, from 444 in 1998 to 456/100,000 in 2012. Incidence of hospital admission increased in both TBI (92%) and all injuries from cycling (71%). Highest increase in incidence of both ED treatments and hospital admissions was seen in adults aged 55+. The injury rate of TBI per kilometre travelled increased (44%) except in children, but decreased (-4%) for all injuries, showing a strong decrease in children (-36%) but an increase in men aged 25+, and women aged 15+. Total costs of bicycle-related TBI were €74.5 million annually. Although bicycle-related TBI accounted for 9% of the incidence of all ED treatments due to cycling, it accounted for 18% of the total costs due to all bicycle-related injuries (€410.7 million). Children and adolescents (aged 0-24) had highest incidence of ED treatments due to bicycle-related injuries. Men in the working population (aged 15-64) had highest indirect costs following injuries from cycling, including TBI. Older cyclists (aged 55+) were identified as main risk group for TBI, as they had highest ED attendance, injury rate, injury severity, admission to hospital or intensive care unit, and costs. Incidence of ED treatments due to cycling are high and often involve TBI, imposing a high burden on individuals and society. Older cyclists aged 55+ were identified as main risk group for TBI to be targeted in preventive strategies, due to their high risk for (serious) injuries and ever-increasing share of ED visits and hospital admissions.

Global trauma: the great divide

Road trauma is an emergent global issue. There is huge disparity between the population affected by road trauma and the resource allocation. If the current trend continues, a predicted extra 5 million lives will be lost in this decade. This article aims to create an awareness of the scale of the problem of road trauma and the inequality in the resources available to address this problem. It also describes the responses from the international organisations and the orthopaedic community in dealing with this issue. The International Orthopaedic community has a unique opportunity and moral obligation to play a part in changing this trend of global trauma.

Serious road injuries in The Netherlands dissected

OBJECTIVE

This article discusses the characteristics and injury patterns of serious road injuries (Maximum Abbreviated Injury Scale [MAIS] 2+ inpatients) in The Netherlands.

METHODS

In The Netherlands, the actual number of serious injuries is estimated by linking police data to hospital data. The distribution of serious road injuries over (1) travel mode and gender and (2) crash type and age are compared for the years 2000 and 2011. Moreover, the distribution of the injuries over the body regions is illustrated using colored injury body profiles.

RESULTS

The number of serious injuries is higher for men than for women and increased from 16,500 in 2000 to 19,700 in 2011. In 2011, about half (51%) of the serious road injuries were due to a bicycle crash not involving a motor vehicle. The share of casualties aged 60 years and older is relatively high (43% in 2011) in these crashes. The injury body profiles show that head injuries (31%) and injuries to the lower extremities (37%) are most prevalent. Compared to other travel modes, pedestrians and riders of powered 2-wheelers relatively often sustain lower-leg injuries compared to other travel modes. Head injuries are most prevalent in cyclists who are injured in a crash with a motorized vehicle. Cyclists who are injured in a crash not involving a motor vehicle and casualties of 60 years and older relatively often include hip or upper-leg injuries.

CONCLUSION

The characteristics of serious road injuries differ from those of fatalities and the distribution of injuries over the body differs by travel mode, gender, and age.

Household survey in Sierra Leone reveals high prevalence of surgical conditions in children

BACKGROUND

Although great efforts are being undertaken to reduce child morbidity and mortality globally, there is limited knowledge about the need for pediatric surgical care. Some data on surgical need is available from hospital registries, but it is difficult to interpret for countries with limited surgical capacity.

METHODS

A cross-sectional two-stage cluster-based sample survey was undertaken in Sierra Leone, using the Surgeons OverSeas Assessment of Surgical Need tool. Data were collected and analyzed on numbers of children needing surgical care and pediatric deaths that may have been averted if surgical care had been available.

RESULTS

A total of 1,583 children out of 3,645 individuals (43.3 %) were interviewed. Most (64.0 %, n = 1,013) participants lived in rural areas. At the time of interview, 279 (17.6; 95 % confidence interval (95 % CI): 15.7-19.5 %) had a possible surgical condition in need of a consultation. Children in the northern and eastern provinces of Sierra Leone were much more likely to report a surgical problem than those in the urban-west.

CONCLUSIONS

There is a high need for surgical care in the pediatric population of Sierra Leone. While additional resources should be allocated to address that need, more research is needed. Ideally, questions on surgically treatable conditions should be added to the frequently performed health care surveys on the pediatric population.

Socioeconomic and disability consequences of injuries in the Sudan: a community-based survey in Khartoum State

BACKGROUND

Fatal and non-fatal injuries are of increasing public health concern globally, particularly in low and middle-income countries. Injuries sustained by individuals also impact society, creating a loss of productivity with serious economic consequences. In Sudan, there is no documentation of the burden of injuries on individuals and society.

METHODS

A community-based survey was performed in Khartoum State, using a stratified two-stage cluster sampling technique. Households were selected in each cluster by systematic random sampling. Face-to-face interviews during October and November 2010 were conducted. Fatal injuries occurring during 5 years preceding the survey and non-fatal injuries occurring during 12 months preceding interviews were included.

RESULTS

The total number of individuals included was 5661, residing in 973 households. There were 28 deaths due to injuries out of a total of 129 reported deaths over 5 years. A total of 441 cases of non-fatal injuries occurred during the 12 months preceding the survey. The number of disability days differed significantly between mechanisms of injury. Road traffic crashes and falls caused the longest duration of disability. Men had a higher probability than women of losing a job due to an injury.

CONCLUSIONS

This study demonstrates the importance of prioritising prevention of road traffic crashes and falls. The loss of productivity in lower socioeconomic strata highlights the need for social security policies. Further research is needed for estimating the economic cost of injuries in Sudan.

Impact of road traffic injuries on disability rates and long-term care costs in Spain

Road traffic injuries are one of the leading causes of increasing disability-adjusted life expectancy. We analyze long-term care needs associated with motor vehicle crash-related disability in Spain and conclude that needs attributable traffic injuries are most prevalent during victims' mid-life years, they create a significant burden for both families and society as a whole given that public welfare programmes supporting these victims need to be maintained over a long time frame. High socio-economic costs of road traffic accidents (in Spain 0.04% of the GDP in 2008) are clearly indicative of the need for governments and policymakers to strengthen road accident preventive measures.

Traumatic injuries in developing countries: report from a nationwide cross-sectional survey of Sierra Leone

OBJECTIVE

To use a nationwide household survey tool to provide an estimate of injury prevalence, mechanisms of traumatic injuries, and number of injury-related deaths in a low-income country.

DESIGN

A randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool was conducted in 2012.

SETTING

Sierra Leone, Africa.

PARTICIPANTS

Three thousand seven hundred fifty randomly selected participants throughout Sierra Leone.

MAIN OUTCOME MEASURES

Mechanisms of injury based on age, sex, anatomic location, cause, and sociodemographic factors as well as mechanisms of injury-related deaths in the previous year were the primary outcome measures.

RESULTS

Data were collected and analyzed from 1843 households and 3645 respondents (98% response rate). Four hundred fifty-two respondents (12%) reported at least 1 traumatic injury in the preceding year. Falls were the most common cause of nonfatal injuries (40%). The extremities were the most common injury site regardless of age or sex. Traffic injuries were the leading cause of injury-related deaths (32% of fatal injuries).

CONCLUSIONS

This study provides baseline data on the mechanisms of traumatic injuries as well as the sociodemographic factors affecting injury prevalence in one of the world's poorest nations. It is anticipated that these data will provide an impetus for further studies to determine injury severity, associated disability, and barriers to accessing care in these resource-poor areas.

Road traffic crashes with fatal and non-fatal injuries in Arkhangelsk, Russia in 2005-2010

The study investigated trends in traffic crashes with fatal and non-fatal injuries in Arkhangelsk, Russia in 2005-2010. Data were obtained from the road police. Negative binomial regression with time regressor was used to investigate trends in monthly incidence rates (IRs) of crashes, fatalities, and non-fatal injuries. During the six-year period, the police registered 4955 crashes with fatal and non-fatal injuries, which resulted in 217 fatalities and 5964 non-fatal injury cases. The IR of crashes with fatal and non-fatal injuries per total population showed no evident change, while the IR per increasing total number of motor vehicles decreased on average by 0.6% per month. Pedestrian crashes constituted 51.8% of studied crashes, and pedestrians constituted 54.6% of fatalities and 44.5% of non-fatal injuries. The IRs of pedestrian crashes and non-fatal pedestrian injuries per total population decreased on average by 0.3% per month, and these were the major trends in the data.