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Oladeji EO, Ezeme C, Baiyewu LA, Okunola MO, Ogunlade SO. The catastrophic cost of motorcycle road traffic injuries: Experience from a major reference centre in a lower-middle income country. Injury 2024; 55:111314. [PMID: 38233327 DOI: 10.1016/j.injury.2024.111314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Motorcycle crashes are an increasing public health problem in low- and middle-income countries (LMICs). An accurate estimation of the economic burden of these crashes could be complex owing to a prevalent system of out-of-pocket (OOP) payment for health care services in these countries. Our study aims to objectively evaluate the cost implication of motorcycle Road Traffic Injuries (RTIs) among road crash victims managed at a major trauma reference hospital in Nigeria. Two economic evaluation methods were used to accurately reflect the cost-of-care (C-o-C) of each victim as well as for cross-validation. METHOD This is a prospective cohort study conducted between August 2020 and May 2021. All patients involved in motorcycle road traffic crashes presenting to the Emergency Department of the University College Hospital, Ibadan, Nigeria, were included in the study. For each patient, all medical expenses from the time of injury (T0) to 30 days after injury (T30) or Time to death (TD) - whichever occurred first, were valued in costs, and added (Activity-based costing or ABC), while also estimating overall cost-of-care (C-o-C) at T30 or TD, using the willingness-to-pay (WTP) method. Following the WHO definition, catastrophic expenditure was defined as expenditure > 25% of the patient's estimated annual household income. RESULTS Of the 150 consecutively managed motorcycle crashes victims during the study period, 112 had complete data. The median monthly household income for the cohort was $121 with 75% of them earning less than $180. The median cost-of-care (C-o-C), by ABC, was $242 ($143 - 828). For individual care items, expenditure on surgical intervention(s) was the highest followed by prosthesis and implant procurement, and radiological investigations. On the other hand, the estimated medical cost was $2356 (IQR $938 - 6475) by WTP. Only 14% had health insurance coverage. The overall expenditure was catastrophic for 46% of the patients. Monthly household income of < $180 (AOR=9.2; 95% CI=2.6-32.8; p < 0.001), absence of health insurance coverage (AOR=10.7; 95% CI=1.1-101.6; p = 0.040), and prolonged hospital stay above 14 days (AOR=25.1; 95% CI=5.5 -115.1; p = 0.001) were predictors of catastrophic expenditure. There was a weak positive correlation between actual cost-of-care using the ABC method and WTP (r = 0.247; p = 0.102). CONCLUSION The aggregate cost of motorcycle RTIs is catastrophic for nearly half of the victims attending the University College Hospital, Ibadan. The willingness-to-pay method, though less tedious is often less reliable in these settings owing to a prevalent OOP payment system. This study identified the need to implement effective financial protection mechanisms against the high OOP expenditure faced by motorcycle crash victims in LMICs.
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Affiliation(s)
- E O Oladeji
- Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Trauma and Orthopaedics, St. Richard's Hospital Chichester, UK
| | - C Ezeme
- Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, South Yorkshire, England, UK.
| | - L A Baiyewu
- Department of Surgery, University College Hospital Ibadan, Nigeria; Division of Cardiothoracic Surgery, Department of Surgery, University College Hospital Ibadan, Nigeria; Department of Surgery, College of Medicine, University of Ibadan, Nigeria
| | - M O Okunola
- Department of Orthopaedics and Trauma, University College Hospital Ibadan, Nigeria
| | - S O Ogunlade
- Department of Orthopaedics and Trauma, University College Hospital Ibadan, Nigeria; Department of Surgery, College of Medicine, University of Ibadan, Nigeria
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Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
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Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
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Ardsby M, Shayo F, Sakita FM, Wilhelms D, Moshi B, Frankiewicz P, Silva LL, Staton CA, Mmbaga B, Joiner A. Emergency unit capacity in Northern Tanzania: a cross-sectional survey. BMJ Open 2023; 13:e068484. [PMID: 36813501 PMCID: PMC9950971 DOI: 10.1136/bmjopen-2022-068484] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Emergency medicine (EM) is a growing field in Sub-Saharan Africa. Characterising the current capacity of hospitals to provide emergency care is important in identifying gaps and future directions of growth. This study aimed to characterise the ability of emergency units (EU) to provide emergency care in the Kilimanjaro region in Northern Tanzania. METHODS This was a cross-sectional study conducted at 11 hospitals with emergency care capacity in three districts in the Kilimanjaro region of Northern Tanzania assessed in May 2021. An exhaustive sampling approach was used, whereby all hospitals within the three-district area were surveyed. Hospital representatives were surveyed by two EM physicians using the Hospital Emergency Assessment tool developed by the WHO; data were analysed in Excel and STATA. RESULTS All hospitals provided emergency services 24 hours a day. Nine had a designated area for emergency care, four had a core of fixed providers assigned to the EU, two lacked a protocol for systematic triage. For Airway and Breathing interventions, oxygen administration was adequate in 10 hospitals, yet manual airway manoeuvres were only adequate in six and needle decompression in two. For Circulation interventions, fluid administration was adequate in all facilities, yet intraosseous access and external defibrillation were each only available in two. Only one facility had an ECG readily available in the EU and none was able to administer thrombolytic therapy. For trauma interventions, all facilities could immobilise fractures, yet lacked interventions such as cervical spinal immobilisation and pelvic binding. These deficiencies were primarily due to lack of training and resources. CONCLUSION Most facilities perform systematic triage of emergency patients, though major gaps were found in the diagnosis and treatment of acute coronary syndrome and initial stabilisation manoeuvres of patients with trauma. Resource limitations were primarily due to equipment and training deficiencies. We recommend the development of future interventions in all levels of facilities to improve the level of training.
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Affiliation(s)
- Malin Ardsby
- Emergency Medicine, Linkopings universitet, Linkoping, Sweden
| | - Frida Shayo
- Emegency Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Francis M Sakita
- Emergency Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Daniel Wilhelms
- Emergency Medicine, Linkopings universitet, Linkoping, Sweden
| | - Baraka Moshi
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | | | | | - Catherine A Staton
- Duke Global Health Institute, Durham, North Carolina, USA
- Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Blandina Mmbaga
- Department of Pediatrics, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Anjni Joiner
- Duke Global Health Institute, Durham, North Carolina, USA
- Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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Road traffic injuries in Tanzanian children and adolescents: A cross-sectional household survey. Injury 2023; 54:160-167. [PMID: 36496266 DOI: 10.1016/j.injury.2022.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/09/2022] [Accepted: 11/23/2022] [Indexed: 11/26/2022]
Abstract
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.
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Daddah D, Hounkpe Dos Santos B, Glèlè Ahanhanzo Y. Contribution of a Geographic Information System to the Prevention of Crashes Among Vulnerable Road Users in the City of Cotonou: Exploratory Study. Risk Manag Healthc Policy 2022; 15:1271-1282. [PMID: 35784658 PMCID: PMC9242089 DOI: 10.2147/rmhp.s362167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Donatien Daddah
- Epidemiology and Biostatistics Department, Regional Institute of Public Health, Ouidah, Benin
- Center for Research in Epidemiology, Biostatistics and Clinical Research, Public Health School (Université Libre de Bruxelles), Brussels, Belgium
- Correspondence: Donatien Daddah, Tel +229 97167245, Email
| | - Bella Hounkpe Dos Santos
- Epidemiology and Biostatistics Department, Regional Institute of Public Health, Ouidah, Benin
- Center for Research in Epidemiology, Biostatistics and Clinical Research, Public Health School (Université Libre de Bruxelles), Brussels, Belgium
| | - Yolaine Glèlè Ahanhanzo
- Epidemiology and Biostatistics Department, Regional Institute of Public Health, Ouidah, Benin
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Konlan KD, Hayford L. Factors associated with motorcycle-related road traffic crashes in Africa, a Scoping review from 2016 to 2022. BMC Public Health 2022; 22:649. [PMID: 35382791 PMCID: PMC8981755 DOI: 10.1186/s12889-022-13075-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The toll associated with road traffic crashes (RTC) is high, and the burden of injury is disproportionately borne by pedestrians and motor riders, particularly in developing countries. This study synthesized the factors associated with motorcycle-related RTC in Africa. Methods The PICO framework and the PRISMA guidelines for conducting reviews were incorporated in searching, screening, and reporting the findings. Advanced search in five electronic databases (Google Scholar, PubMed Central, Scopus, CINAHL, and Embase) yielded 2552 titles and 22 from manual search, filtered for 2016 to 2022 (to generate 1699) and then further for primary studies (854). Through the title, abstract and full-text screening, 22 were appropriate for this review. Data extraction was done by the two researchers independently, and the results were compared. Convergent synthesis was adopted to integrate results, transformed into a narrative, and analyzed using thematic synthesis. Results The four main themes identified were the rider-related, non-rider-related factors, prevalence and severity of injuries from RTC, and the measures to reduce RTC. The behavioral factors associated with RTC were alcohol use, smoking, use of illicit drugs, tiredness of rider, poor knowledge on traffic regulations, more than one pillow rider, lack of rider license, non-observance of traffic regulations, and non-use of personal protective equipment. Road traffic crashes were common among younger age and male gender. Other factors identified included poor road network, unplanned stoppage by police, unlawful vehicular packing, increased urbanization, and slippery floors. Conclusion There is the need to institute multi-sectoral measures that target riders’ behavior change. Coordinated efforts should target governments, enforcement authorities, and regulatory bodies to enforce enactment that ensures safe use of roads.
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Affiliation(s)
- Kennedy Diema Konlan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta region, Ghana. .,College of Nursing, Yonsei University, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
| | - Linda Hayford
- Department of Medicine, St Anthony Hospital, Dzordze, Volta Region, Ghana
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Sundet M, Mulima G, Kajombo C, Gjerde H, Christophersen AS, Madsen JE, Young S. Geographical mapping of road traffic injuries in Lilongwe, Malawi. Injury 2021; 52:806-813. [PMID: 33712299 DOI: 10.1016/j.injury.2021.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Road traffic injuries are a leading cause of death and disability, especially in low- and middle-income countries. Identifying injury hotspots are valuable for introducing preventive measures. This is usually accomplished by using police data, but these are often unreliable in low-income countries. This study aimed to identify hotspots for injuries by collecting geographical data in the emergency room. METHODS This was a cross-sectional study of adult road traffic injury patients presenting to the Casualty Department in the central hospital in Lilongwe, the capital of Malawi. An electronic tablet with downloaded maps and satellite photos was used to establish the exact location of the injuries. The geographical data were analyzed with geographic information software. RESULTS We included 1244 road traffic injured patients, of which 23.9% were car passengers or drivers, 18.6% were motorcyclists, 17.8% were pedestrians and 18.0% were cyclists or bicycle passengers. Heatmaps of the injuries identified 5 locations where the incidence of injuries was especially high, and 148 patients were injured in these hotspots during the 90 days of inclusion. Four of these hotspots were along the main road through the capital. Age over 55, rural setting, alcohol use before the injury, high speed limit at the site of injury and being a pedestrian or motorcyclist were significantly associated with a higher degree of injury severity. Around half of the patients that were injured in a four-wheeled vehicle did not use a seat belt, and these patients had a much higher risk of getting a more severe injury. CONCLUSION We have identified specific locations with a high incidence of road traffic injuries in Lilongwe, Malawi, with a simple methodology and within a short time frame. The study demonstrates the feasibility of collecting geographical data at admission to hospital.
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Affiliation(s)
- Mads Sundet
- Diakonhjemmet Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Gift Mulima
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Chifundo Kajombo
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | | - Jan Erik Madsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Sven Young
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; College of Medicine, University of Malawi, Lilongwe, Malawi; Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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El-Gabri D, Toomey N, Gil NM, de Oliveira AC, Calvo PRS, Tchuisseu YP, Williams S, Andrade L, Vissoci JRN, Staton C. Association Between Socioeconomic and Demographic Characteristics and Non-fatal Alcohol-Related Injury in Maringá, Brazil. Front Public Health 2020; 8:66. [PMID: 32269983 PMCID: PMC7109310 DOI: 10.3389/fpubh.2020.00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Previous research has corroborated a high burden of alcohol-related injury in Brazil and the presence of socioeconomic disparities among the injured. Yet, individual-level data is scarce. To fill this gap, we examined the association between demographic and socioeconomic characteristics with non-fatal alcohol-related injury in Maringá, Brazil. Methods: We used household survey data collected during a 2015 cross-sectional study. We conducted univariate and multivariate analyses to evaluate associations of demographic (age, gender, race) and socioeconomic characteristics (employment, education, income) with non-fatal alcohol-related injury. Results: Of the 995 participants who reported injuries, 62 (6.26%) were alcohol-related. Fifty-three (85%) alcohol-related injuries were reported by males. Multivariate analysis indicated being male (OR = 5.98 95% CI = 3.02, 13.28), 15–29 years of age (OR = 3.62 95% CI = 1.72, 7.71), and identifying as Black (OR = 2.38 95% CI = 1.09, 4.95) were all significantly associated with increased likelihood of reporting an alcohol-related injury, whereas unemployment was significantly associated with decreased likelihood of reporting an alcohol-related injury (OR = 0.41 95% CI = 0.18, 0.88). Conclusion: Our findings suggest that in Maringá, being male, between the ages of 15 and 29, employed, or identifying as Black were characteristics associated with a higher risk for non-fatal alcohol-related injury. Individual level data, such as ours, should be considered in combination with area-level and country-level data when developing evidence-based public-health policies.
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Affiliation(s)
- Deena El-Gabri
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Nelly Moraes Gil
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | | | | | | | - Sarah Williams
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Luciano Andrade
- Department of Nursing, State University of Maringá, Maringá, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Emergency Medicine, Duke University Medical Center, Durham, NC, United States
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Kourouma K, Delamou A, Lamah L, Camara BS, Kolie D, Sidibé S, Béavogui AH, Owiti P, Manzi M, Ade S, Harries AD. Frequency, characteristics and hospital outcomes of road traffic accidents and their victims in Guinea: a three-year retrospective study from 2015 to 2017. BMC Public Health 2019; 19:1022. [PMID: 31366335 PMCID: PMC6668061 DOI: 10.1186/s12889-019-7341-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic accidents (RTA) remain a global public health concern in developing countries. The aim of the study was to document the frequency, characteristics and hospital outcomes of road traffic accidents in Guinea from 2015 to 2017. METHODS We conducted a retrospective cohort study using medical records of RTA victims from 20 hospitals and a cross-sectional study of RTA cases from eight police stations in eight districts in Guinea, West Africa. Data analysis included descriptive statistics, trends of RTA, a sequence of interrupted time-series models and a segmented ordinary least-squares (OLS) regression. RESULTS Police stations recorded 3,140 RTA over 3 years with an overall annual increase in RTA rates from 14.0 per 100,000 population in 2015, to 19.2 per 100,000 population in 2016 (37.1% annual increase), to 28.7 per 100,000 population in 2017 (49.5% annual increase). Overall, the injury rates in 2016 and 2017 were .05 per 100,000 population higher on average per month (95% CI: .03-.07). Deaths from RTA showed no statistical differences over the 3 years and no association of RTA trends with season was found. Overall, 27,751 RTA victims were admitted to emergency units, representing 22% of all hospitals admissions. Most victims were males (71%) and young (33%). Deaths represented 1.4% of all RTA victims. 90% of deaths occurred before or within 24 h of hospital admission. Factors associated with death were being male (p = .04), being a child under 15 years (p = .045) or an elderly person aged ≥65 years (p < .001), and having head injury or coma (p < .001). CONCLUSIONS RTA rates in Guinea are increasing. There is a need for implementing multisectoral RTA prevention measures in Guinea.
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Affiliation(s)
- Karifa Kourouma
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea.
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea.,Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Léopold Lamah
- Department of Traumatology and Orthopedics, University Teaching Hospital of Donka, Conakry, Guinea
| | - Bienvenu Salim Camara
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea
| | - Delphin Kolie
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea
| | - Sidikiba Sidibé
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea.,Department of Public Health, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Abdoul Habib Béavogui
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099, Maferinyah, Forécariah, Guinea
| | - Philip Owiti
- International Union Against Tuberculosis and Lung Disease, Paris, France.,The National Tuberculosis, Leprosy and Lung Disease Program, Ministry of Health, Nairobi, Kenya
| | - Marcel Manzi
- Medical Department, Médecins Sans Frontière Bruxelles, Bruxelles, Belgium
| | - Serge Ade
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Faculté de Médecine, Université de Parakou, Parakou, Benin
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France.,London School of Hygiene and Tropical Medicine, London, UK
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van Adrichem DC, Ratering MRHA, Rashid SM, Jusabani MA, Poppe VE, Mwaitele HA, Massawe HH, Howlett WP, Moshi HI, Dekker MCJ. Penetrating spinal cord injury causing paraplegia in a bird hunter in rural Tanzania. Spinal Cord Ser Cases 2019; 5:49. [PMID: 31632707 PMCID: PMC6786419 DOI: 10.1038/s41394-019-0195-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction Cultural and socioeconomic factors influence the risk of sustaining a Traumatic Spinal Cord Injury (TSCI). The standard of management and rehabilitation available to TSCI patients differs greatly between high-income and low-income countries. Case presentation We report a 17-year-old male bird hunter, with no prior medical history, presenting with paraplegia and sensory loss from the xiphoid process down after being struck by an arrow in the left lateral side of the neck. Discussion Penetrating neck injuries are potentially life threatening because of the complex arrangement of vital structures in the neck. Management of spinal cord trauma resulting from such injuries in low-resource settings is challenging.
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Affiliation(s)
| | | | - Sakina Mehboob Rashid
- Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mubashir Alavi Jusabani
- Department of Orthopaedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - Honest Herman Massawe
- Department of Orthopaedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | | - Marieke Cornelia Johanna Dekker
- Department of Orthopaedics and Traumatology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Paediatrics and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Neurology, Radboudumc Nijmegen, Nijmegen, Netherlands
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Nguyen T, Vissoci JRN, Joelson T, Pesambili M, Haglund M, Gerardo CJ, Mvungi M, Staton CA. Injury prevalence and safety habits of boda boda drivers in Moshi, Tanzania: A mixed methods study. PLoS One 2018; 13:e0207570. [PMID: 30481196 PMCID: PMC6258469 DOI: 10.1371/journal.pone.0207570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Traffic crashes are a major cause of global morbidity and mortality disproportionately affecting low- and middle-income countries (LMICs). Motorcycle taxi (boda boda) drivers are particularly vulnerable because they are exposed to traffic risks with limited safety equipment. This study aims to characterize injury prevalence and safety habits among boda boda drivers, as well as ways to improve road traffic safety in LMICs. METHODS A cross-sectional mixed methods study was conducted with 300 boda boda drivers between 24 March and 3 April 2014 in urban Moshi, Tanzania. A convenience sample of participants was drawn from 25 of 58 registered boda boda stands and 2 of 31 unregistered stands. Data were analyzed using R, and content thematic analysis was performed and agreed upon by three investigators. Logistic regression models were used to evaluate the association between boda boda characteristics and injury risk. RESULTS In total, 300 drivers participated, of whom 148 (49.3%) had experienced a crash during their lifetime, and 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalized. Of all participants, 220 (73.3%) reported consistent helmet usage, despite 285 participants (95.0%) agreeing that helmet usage reduces injury severity. From the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. Having a cracked helmet was associated with higher risk of being involved in a traffic crash. Owning a helmet with a proper fit was associated with reduced risk for a traffic crash (OR = 0.06) and road traffic injuries (OR = 0.07). A thematic analysis of boda boda drivers' suggestions to increase road safety identified four intervention areas: 1) roadway infrastructure and traffic regulation, 2) road user attitudes and safe driving behaviors, 3) education and training, and 4) law enforcement. CONCLUSION Our study demonstrates boda boda drivers' safety behaviors and identifies four intervention areas that can be leveraged to increase overall road traffic safety. Unfortunately, while boda boda drivers are aware of ways to improve safety, adherence to safety habits remains low. Successful multi-sectoral interventions are needed to improve road safety for boda boda drivers in Tanzania.
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Affiliation(s)
- TuanDat Nguyen
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
| | | | | | - Michael Haglund
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
| | - Charles J. Gerardo
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mark Mvungi
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Duke University, Durham, North Carolina, United States of America
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Wang L, Yu C, Zhang Y, Luo L, Zhang G. An analysis of the characteristics of road traffic injuries and a prediction of fatalities in China from 1996 to 2015. TRAFFIC INJURY PREVENTION 2018; 19:749-754. [PMID: 29969283 DOI: 10.1080/15389588.2018.1487061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study analyzed the characteristics and burdens of road traffic injuries (RTIs) from the 3 perspectives of time, space, and population in China and predicted traffic fatalities using 2 models. METHODS By extracting data from the China Statistical Yearbooks and GBD 2015 (Global Health Data Exchange), we described the change in the time trend of traffic crashes and economic losses associated with the rate of motorization in China from 1996 to 2015; analyzed the geographical distribution of these events by geographic information system; and evaluated the age-, sex-, and cause-specific death rate, disability-adjusted life year (DALY) rate, years of life lost (YLL) rate, and years lost due to disability (YLD) rate lost from RTIs from 1990 to 2015. In addition, we predicted the traffic fatality (per population or vehicles) trend using the log-linear model derived from Smeed's and Borsos' models. RESULTS From 1996 to 2015, the motorization rate showed rapid growth, increasing from 0.023 to 0.188. With the growth in the motorization rate, the time trends of traffic crashes and economic losses in China changed, showing a tendency to first increase and then later decrease. The crashes and losses were closely correlated and mainly distributed in some of the economically developed provinces, including Zhejiang, Jiangsu, Anhui, Sichuan, and Guangdong provinces. The health burden of RTIs presented a time trend similar to that of the economic burden, and it was higher among males than females. The death rate among older pedestrians was higher. The DALY rate and YLL rate among young and middle-aged pedestrians were higher. The YLD rate among older motor vehicle drivers was higher. In addition, the fatalities per 10,000 vehicles continued to decline, and Borsos's model was better fitted to the reported traffic fatalities than Smeed's model. CONCLUSIONS Although the burden of RTIs in China has declined, the burden of RTIs is still heavy. Hence, RTIs remain a universal problem of great public health concern in China, and we need to work hard to reduce them.
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Affiliation(s)
- Lu Wang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Chuanhua Yu
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
- b Global Health Institute, Wuhan University, Wuchang District , Wuhan , China
| | - Yunquan Zhang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Lisha Luo
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Ganshen Zhang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
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