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Drake JH, Kiwango G, Mashili F, Kitapondya D, Kivlehan SM. Effectiveness of a Bleeding Control Course for Public Transit Drivers in Dar es Salaam, Tanzania. J Surg Res 2024; 301:447-454. [PMID: 39033595 DOI: 10.1016/j.jss.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/24/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
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.
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Affiliation(s)
| | - George Kiwango
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Fredirick Mashili
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deus Kitapondya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Morgan-Asiedu PK, Fryhofer GW, Hardaker WM, Premkumar A, Shin M, Ramesh S, Pean C, Jusabani MA, Temu R, Massawe H, Sheth NP. Systems issues limiting acute fracture care delivery at a tertiary care hospital in Northern Tanzania. Pan Afr Med J 2024; 48:29. [PMID: 39220554 PMCID: PMC11364886 DOI: 10.11604/pamj.2024.48.29.41286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/09/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction sub-Saharan Africa experiences a significant musculoskeletal trauma burden. Among patients who receive surgical treatment, there have been no reports as to how often surgical care is determined to be "adequate" or, if "inadequate", then what hospital and orthopaedic specialty-specific systems limitations might be prohibitive. Methods data from patients presenting to the orthopaedic trauma service at a tertiary care center in sub-Saharan Africa were prospectively collected over a 6-week period and then retrospectively reviewed to determine whether the surgical treatment was "adequate" (or otherwise, "inadequate") according to the principle of restoring length, alignment, and rotation. Exclusion criteria included insufficient clinical information; isolated spinal injury; infection; cases involving only removal of hardware; soft-tissue procedures; tumor cases; and medical (non-surgical) conditions. Results 112 cases were included for analysis. Surgery was indicated in 106 of 112 cases (94.6%), and of those, surgery was performed in 62 cases (58.4%). Among patients who underwent surgery with available post-operative imaging (n=56), surgical treatment was "inadequate" in 24 cases (42.9%). The most common reasons treatment was deemed "inadequate" included unavailability of appropriate implants (n=16), unavailability of intraoperative fluoroscopy (n=10) and incomplete intraoperative evaluation of injury (n=5). Conclusion several systems limitations prevent the delivery of adequate surgical treatment in patients with acute orthopaedic traumatic injuries, including lack of intraoperative fluoroscopy and lack of implant availability. This study will serve as a useful baseline for ongoing efforts seeking to improve orthopaedic specialty resource availability and facilitate more effective fracture care in this region.
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Affiliation(s)
| | - George William Fryhofer
- Department of Orthopaedic Surgery, University of Pennsylvania, Market Street, United States of America
| | - William Mack Hardaker
- Department of Orthopaedic Surgery, Duke University Medical Centre, Durham, United States
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, United States
| | - Max Shin
- Department of Cardiothoracic Surgery, University of Pennsylvania, Market Street, United States
| | - Sireesh Ramesh
- Life Sciences and Management Program, University of Pennsylvania, Philadelphia, United States of America
| | - Christian Pean
- Harvard Orthopaedic Trauma Initiative, Brigham and Women´s Hospital, Massachusetts General Hospital
| | | | - Rogers Temu
- Kilimanjaro Christian Medical University College, Sokoine Rd, Moshi, Tanzania
| | - Honest Massawe
- Kilimanjaro Christian Medical University College, Sokoine Rd, Moshi, Tanzania
| | - Neil Perry Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Pennsylvania Hospital, Spruce Street, Philadelphia, United States of America
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Lule H, Mugerwa M, Ssebuufu R, Kyamanywa P, Bärnighausen T, Posti JP, Wilson ML. Effect of Rural Trauma Team Development on the Outcomes of Motorcycle Accident-Related Injuries (Motor Registry Project): Protocol for a Multicenter Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55297. [PMID: 38713507 PMCID: PMC11109866 DOI: 10.2196/55297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Injury is a global health concern, and injury-related mortality disproportionately impacts low- and middle-income countries (LMICs). Compelling evidence from observational studies in high-income countries shows that trauma education programs, such as the Rural Trauma Team Development Course (RTTDC), increase clinician knowledge of injury care. There is a dearth of such evidence from controlled clinical trials to demonstrate the effect of the RTTDC on process and patient outcomes in LMICs. OBJECTIVE This multicenter cluster randomized controlled clinical trial aims to examine the impact of the RTTDC on process and patient outcomes associated with motorcycle accident-related injuries in an African low-resource setting. METHODS This is a 2-arm, parallel, multi-period, cluster randomized, controlled, clinical trial in Uganda, where rural trauma team development training is not routinely conducted. We will recruit regional referral hospitals and include patients with motorcycle accident-related injuries, interns, medical trainees, and road traffic law enforcement professionals. The intervention group (RTTDC) and control group (standard care) will include 3 hospitals each. The primary outcomes will be the interval from the accident to hospital admission and the interval from the referral decision to hospital discharge. The secondary outcomes will be all-cause mortality and morbidity associated with neurological and orthopedic injuries at 90 days after injury. All outcomes will be measured as final values. We will compare baseline characteristics and outcomes at both individual and cluster levels between the intervention and control groups. We will use mixed effects regression models to report any absolute or relative differences along with 95% CIs. We will perform subgroup analyses to evaluate and control confounding due to injury mechanisms and injury severity. We will establish a motorcycle trauma outcome (MOTOR) registry in consultation with community traffic police. RESULTS The trial was approved on August 27, 2019. The actual recruitment of the first patient participant began on September 01, 2019. The last follow-up was on August 27, 2023. Posttrial care, including linkage to clinical, social support, and referral services, is to be completed by November 27, 2023. Data analyses will be performed in Spring 2024, and the results are expected to be published in Autumn 2024. CONCLUSIONS This trial will unveil how a locally contextualized rural trauma team development program impacts organizational efficiency in a continent challenged with limited infrastructure and human resources. Moreover, this trial will uncover how rural trauma team coordination impacts clinical outcomes, such as mortality and morbidity associated with neurological and orthopedic injuries, which are the key targets for strengthening trauma systems in LMICs where prehospital care is in the early stage. Our results could inform the design, implementation, and scalability of future rural trauma teams and trauma education programs in LMICs. TRIAL REGISTRATION Pan African Clinical Trials Registry (PACTR202308851460352); https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=25763. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55297.
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Affiliation(s)
- Herman Lule
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Micheal Mugerwa
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Department of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Patrick Kyamanywa
- Mother Kevin Postgraduate Medical School, Uganda Martyr's University, Nkozi, Uganda
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of Heidelberg, Heidelberg, Germany
| | - Jussi P Posti
- Neurocentre, Department of Neurosurgery and Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH), University Hospital and University of Heidelberg, Heidelberg, Germany
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Tupper H, Oke R, Juillard C, Dissak-DeLon F, Chichom-Mefire A, Mbianyor MA, Etoundi-Mballa GA, Kinge T, Njock LR, Nkusu DN, Tsiagadigui JG, Carvalho M, Yost M, Christie SA. The CBS test: Development, evaluation & cross-validation of a community-based injury severity scoring system in Cameroon. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002110. [PMID: 37494346 PMCID: PMC10370767 DOI: 10.1371/journal.pgph.0002110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 07/28/2023]
Abstract
Injury-related deaths overwhelmingly occur in low and middle-income countries (LMICs). Community-based injury surveillance is essential to accurately capture trauma epidemiology in LMICs, where one-third of injured individuals never present to formal care. However, community-based studies are constrained by the lack of a validated surrogate injury severity metric. The primary objective of this bipartite study was to cross-validate a novel community-based injury severity (CBS) scoring system with previously-validated injury severity metrics using multi-center trauma registry data. A set of targeted questions to ascertain injury severity in non-medical settings-the CBS test-was iteratively developed with Cameroonian physicians and laypeople. The CBS test was first evaluated in the community-setting in a large household-based injury surveillance survey in southwest Cameroon. The CBS test was subsequently incorporated into the Cameroon Trauma Registry, a prospective multi-site national hospital-based trauma registry, and cross-validated in the hospital setting using objective injury metrics in patients presenting to four trauma hospitals. Among 8065 surveyed household members with 503 injury events, individuals with CBS indicators (CBS+) were more likely to report ongoing disability after injury compared to CBS- individuals (OR 1.9, p = 0.004), suggesting the CBS test is a promising injury severity proxy. In 9575 injured patients presenting for formal evaluation, the CBS test strongly predicted death in patients after controlling for age, sex, socioeconomic status, and injury type (OR 30.26, p<0.0001). Compared to established injury severity scoring systems, the CBS test comparably predicts mortality (AUC: 0.8029), but is more feasible to calculate in both the community and clinical contexts. The CBS test is a simple, valid surrogate metric of injury severity that can be deployed widely in community-based surveys to improve estimates of injury severity in under-resourced settings.
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Affiliation(s)
- Haley Tupper
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Rasheedat Oke
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Catherine Juillard
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | | | | | - Mbiarikai Agbor Mbianyor
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | | | - Thompson Kinge
- Hospital Administration, The Limbe Regional Hospital, Lime, Cameroon
| | - Louis Richard Njock
- Hospital Administration, The Laquintinie Hospital of Douala, Douala, Cameroon
| | - Daniel N Nkusu
- Hospital Administration, The Catholic Hospital of Pouma, Pouma, Cameroon
| | | | - Melissa Carvalho
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - Mark Yost
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
| | - S Ariane Christie
- Department of Surgery, Program for the Advancement of Surgical Equity (PASE), University of California Los Angeles, Los Angeles, California, United States of America
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Tatah L, Foley L, Oni T, Pearce M, Lwanga C, Were V, Assah F, Wasnyo Y, Mogo E, Okello G, Mogere S, Obonyo C, Woodcock J. Comparing travel behaviour characteristics and correlates between large and small Kenyan cities (Nairobi versus Kisumu). JOURNAL OF TRANSPORT GEOGRAPHY 2023; 110:None. [PMID: 37456923 PMCID: PMC10345788 DOI: 10.1016/j.jtrangeo.2023.103625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/05/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Abstract
Understanding urban travel behaviour is crucial for planning healthy and sustainable cities. Africa is urbanising at one of the fastest rates in the world and urgently needs this knowledge. However, the data and literature on urban travel behaviour, their correlates, and their variation across African cities are limited. We aimed to describe and compare travel behaviour characteristics and correlates of two Kenyan cities (Nairobi and Kisumu). We analysed data from 16,793 participants (10,000 households) in a 2013 Japan International Cooperation Agency (JICA) household travel survey in Nairobi and 5790 participants (2760 households) in a 2016 Institute for Transportation and Development Policy (ITDP) household travel survey in Kisumu. We used the Heckman selection model to explore correlations of travel duration by trip mode. The proportion of individuals reporting no trips was far higher in Kisumu (47% vs 5%). For participants with trips, the mean number [lower - upper quartiles] of daily trips was similar (Kisumu (2.2 [2-2] versus 2.4 [2-2] trips), but total daily travel durations were lower in Kisumu (65 [30-80] versus 116 [60-150] minutes). Walking was the most common trip mode in both cities (61% in Kisumu and 42% in Nairobi), followed by motorcycles (17%), matatus (minibuses) (11%), and cars (5%) in Kisumu; and matatus (28%), cars (12%) and buses (12%) in Nairobi. In both cities, females were less likely to make trips, and when they did, they travelled for shorter durations; people living in households with higher incomes were more likely to travel and did so for longer durations. Gender, income, occupation, and household vehicle ownership were associated differently with trip making, use of transport modes and daily travel times in cities. These findings illustrate marked differences in reported travel behaviour characteristics and correlates within the same country, indicating setting-dependent influences on travel behaviour. More sub-national data collection and harmonisation are needed to build a more nuanced understanding of patterns and drivers of travel behaviour in African cities.
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Affiliation(s)
- Lambed Tatah
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Matthew Pearce
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Charles Lwanga
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), P.O. Box 1578, Kisumu 40100, Kenya
| | - Vincent Were
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), P.O. Box 1578, Kisumu 40100, Kenya
| | - Felix Assah
- Health of Populations in Transition (HoPiT) Research Group, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Yves Wasnyo
- Health of Populations in Transition (HoPiT) Research Group, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
| | - Ebele Mogo
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Gabriel Okello
- Institute of Sustainability Leadership, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Mogere
- Japan International Cooperation Agency (JICA), Britam Tower 22nd & 23rd Flrs, Upper Hill Road, P.O. Box 50572-00200, Nairobi, Kenya
| | - Charles Obonyo
- Center for Global Health Research, Kenya Medical Research Institute (KEMRI), P.O. Box 1578, Kisumu 40100, Kenya
| | - James Woodcock
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
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Mamo DE, Abebe A, Beyene T, Alemu F, Bereka B. Road traffic accident clinical pattern and management outcomes at JUMC Emergency Department; Ethiopia. Afr J Emerg Med 2023; 13:1-5. [PMID: 36582970 PMCID: PMC9792392 DOI: 10.1016/j.afjem.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Background Road Traffic Accident is an incident on a way or street open to public traffic. It becomes one of the most significant public health problems in the world especially in developing countries. In Ethiopia, it represents a significant risk for morbidity and mortality. It is also the major public health problem even though studies done on this topic in the study area is limited. Objective To assess clinical pattern, associated factors and management outcomes among road traffic accident Victims attending emergency department of Jimma University Medical Center. Methods Hospital based cross sectional study design was employed to review patients' chart visited the hospital from March to April 2021. A systematic random sampling technique was applied. The data were collected using pretested checklist and analyzed using SPSS version 26. Descriptive statistics and multivariate logistic regression were computed. Variables with P<0.05 were considered statistically significant. Results About 49.6%) were pedestrians injured of which motorcycle accounted 42.9%. More than half of victims never got any type of prehospital care. On arrival, 38.7% were classified as Red of which 71.4% of them were managed surgically. About 84.9% of victims were discharged with improvement whereas12.6% were died. Victims with head injury (AOR= 16.61: 95% CI; 3.85, 71.71), time elapsed to reach nearby health facility (AOR= 3.30; 95 CI (1.13, 9.60), condition of patient at Emergency Department (AOR= 7.78; 95% CI: 2.33, 26.06), GCS at admission (AOR= 20.12; 95% CI: 7.23, 55.96) and days spent in hospital (AOR= 6.85; 95% CI 5.81, 8.06) were independent predictors of unfavorable outcome. Conclusion Road Traffic Accident represents a significant risk for morbidity and mortality in Ethiopia, of which head injury and multiple sites injury increase injury severity. Targeted approaches to improving care of the injured victims may improve outcomes. Thus, the clinician should take into consideration the clinical presentation and give due attention to the identified contributing factors in its management.
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Affiliation(s)
- Dereje Endale Mamo
- Department of Nursing, College of Health Sciences, Dilla University, Southern Nations, Nationalities and Peoples (SNNP), Ethiopia,Corresponding author.
| | - Asmamaw Abebe
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Temesgen Beyene
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Filipos Alemu
- Department of Nursing, College of Health Sciences, Dilla University, Southern Nations, Nationalities and Peoples (SNNP), Ethiopia
| | - Bayisa Bereka
- School of Nursing, Institute of health, Jimma University, Jimma, Ethiopia
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Mwenda V, Yellman MA, Oyugi E, Mwachaka P, Gathecha G, Gura Z. Piloting a hospital-based road traffic injury surveillance system in Nairobi County, Kenya, 2018-2019. Injury 2023; 54:S0020-1383(23)00182-1. [PMID: 36925372 PMCID: PMC10599333 DOI: 10.1016/j.injury.2023.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 02/14/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Kenya's estimated road traffic injury (RTI) death rate is 27.8/100,000 population, which is 1.5 times the global rate. Some RTI data are collected in Kenya; however, a systematic and integrated surveillance system does not exist. Therefore, we adopted and modified the World Health Organization's injury surveillance guidelines to pilot a hospital-based RTI surveillance system in Nairobi County, Kenya. METHODS We prospectively documented all RTI cases presenting at two public trauma hospitals in Nairobi County from October 2018-April 2019. RTI cases were defined as injuries involving ≥1 moving vehicles on public roads. Demographics, injury circumstances, and outcome information were collected using standardized case report forms. The Kampala Trauma Score (KTS) was used to assess injury severity. RTI cases were characterized with descriptive statistics. RESULTS Of the 1,840 RTI cases reported during the seven-month period, 73.2% were male. The median age was 29.8 years (range 1-89 years). Forty percent (n = 740) were taken to the hospital by bystanders. Median time for hospital arrival was 77 min. Pedestrians constituted 54.1% (n = 995) of cases. Of 400 motorcyclists, 48.0% lacked helmets. Similarly, 65.7% of bicyclists (23/35) lacked helmets. Among 386 motor vehicle occupants, 59.6% were not using seat belts (19.9% unknown). Seven percent of cases (n = 129) reported alcohol use (49.0% unknown), and 8.8% (n = 161) reported mobile phone use (59.7% unknown). Eleven percent of cases (n = 199) were severely injured (KTS <11), and 220 died. CONCLUSION We demonstrated feasibility of a hospital-based RTI surveillance system in Nairobi County. Integrating information from crash scenes and hospitals can guide prevention.
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Affiliation(s)
- Valerian Mwenda
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya; Division of Non-communicable Diseases, Ministry of Health, Nairobi, Kenya.
| | - Merissa A Yellman
- Division of Injury Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elvis Oyugi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | | | - Gladwell Gathecha
- Division of Non-communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
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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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Bezabih Y, Tesfaye B, Melaku B, Asmare H. Pattern of Orthopedic Injuries Related to Road Traffic Accidents Among Patients Managed at the Emergency Department in Black Lion Hospital, Addis Ababa, Ethiopia, 2021. Open Access Emerg Med 2022; 14:347-354. [PMID: 35903799 PMCID: PMC9314752 DOI: 10.2147/oaem.s368324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Studies showed that each year people lose their life on the road and many people are disabled. The majority of this disability was caused by orthopedic injury related to road traffic accidents. However, in the context of Ethiopia, studies ascribed to orthopedic injuries related to road traffic accidents are limited. The study aimed to assess the pattern of orthopedic injuries related to road traffic accidents among patients managed at the emergency department of Black Lion Hospital. Methods An institutional-based cross-sectional study was conducted on 354 victims of road traffic accidents with orthopedic injuries who were visiting the Emergency department of Black Lion Hospital. Patient charts were selected by systematic random sampling technique and the data was entered into Epi-data version 4.4.2.2 and exported to the static package for social science window version 26, and descriptive statistics were used for analysis. Results The study reveals that males were mostly injured persons (71.7%) with the age group of 13-24 were the most injured. Passenger car accounts 36.3% of causes of injury followed by motorbikes (27.4%) and lower limbs were the most common anatomic site of injuries (47.9). Of all injury types, a fracture is the most common one with 71.1%, especially lower limb fracture (42.1%). More than half victims (59.5%) had open wounds, and almost half of the study subjects (51.8%) experience Road traffic accidents while they are crossing or walking along the way. Conclusion Orthopedic injuries related to road traffic accidents are the main cause of death and disability in many individuals, especially in reproductive age groups. Therefore, policy-makers should be aware of different patterns of orthopedic injuries associated with a victim of road traffic accidents to have an appropriate and sustainable capacity to manage the orthopedic injuries.
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Affiliation(s)
- Yetnayet Bezabih
- Department of Emergency and Critical Care Nursing, Saint Peter Hospital, Addis Ababa, Ethiopia
| | - Birhanu Tesfaye
- Department of Emergency Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birhanu Melaku
- Department of Emergency Medicine, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Hailu Asmare
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Sodo, Ethiopia
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Pedestrians’ Perception of Pedestrian Bridges—A Qualitative Study in Dar es Salaam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031238. [PMID: 35162260 PMCID: PMC8835090 DOI: 10.3390/ijerph19031238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
Background: About 30 percent of all road traffic deaths in Tanzania involve pedestrians. As one of the strategies to protect them, pedestrian overhead bridges have been constructed across busy roads, and plans to build more bridges are in place. It has, however, been shown that such pedestrian bridges do not necessarily discourage street-level road crossing, even when pedestrians must cross multiple lanes with heavy traffic. This paper explores the perceptions of pedestrians when crossing urban roads emphasizing pedestrian bridge users. Methods: Nineteen semi-structured interviews were conducted in situ around six pedestrian bridges in Dar es Salaam. All interviews were conducted in Swahili, recorded using digital devices, transcribed verbatim then translated into English. Content analysis was employed using qualitative data analysis software (MAXQDA). Results: We identified three overarching themes, namely, I don’t know if it’s right or wrong, they already decided; the bridge is just a crossing facility, not for other purposes; and follow your gut feeling, even if you don’t know how things will end. The results suggest that many participants prefer to look for alternative means of transport and resorted to more alternative routes just to avoid using pedestrian bridges due to bridges length and crossing time. Conclusion: These findings highlight the concerns caused by alternative uses of pedestrian bridges and underscore the importance of involving local communities and other stakeholders during planning.
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Peralta-Santos A, Gimbel S, Sorensen R, Covele A, Kawakatsu Y, Wagenaar BH, Augusto O, Ásbjörnsdóttir KH, Gloyd SS, Cuembelo F, Sherr K. The neglected epidemic-Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000163. [PMID: 36962258 PMCID: PMC10021512 DOI: 10.1371/journal.pgph.0000163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
In 2019, 93% of road traffic injury related mortality occurred in low- and middle-income countries, an estimated burden of 1.3 million deaths. This problem is growing; by 2030 road traffic injury will the seventh leading cause of death globally. This study both explores factors associated with RTIs in the central region of Mozambique, as well as pinpoints geographical "hotspots" of RTI incidence. A cross-sectional, population-level survey was carried out in two provinces (Sofala and Manica) of central Mozambique where, in addition to other variables, the number of road traffic injuries sustained by the household within the previous six months, was collected. Urbanicity, household ownership of a car or motorcycle, and socio-economic strata index were included in the analysis. We calculated the prevalence rate ratios using a generalized linear regression with a Poisson distribution, as well as the spatial prevalence rate ratio using an Integrated Nested Laplace Approximation. The survey included 3,038 households, with a mean of 6.29 (SD 0.06) individuals per household. The road traffic injury rate was 6.1% [95%CI 7.1%, 5.3%]. Urban residence was associated with a 47% decrease in rate of injury. Household motorbike ownership was associated with a 92% increase in the reported rate of road traffic injury. Higher socio-economic status households were associated with a 26% increase in the rate of road traffic injury. The rural and peri-urban areas near the "Beira corridor" (national road N6) have higher rates of road traffic injuries. In Mozambique, living in the rural areas near the "Beira corridor", higher household socio-economic strata, and motorbike ownership are risk factors for road traffic injury.
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Affiliation(s)
- André Peralta-Santos
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Child, Family and Population Health Nursing, University of Washington, Seattle, Washington, United States of America
| | - Reed Sorensen
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | | | - Yoshito Kawakatsu
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Orvalho Augusto
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Health Alliance International, Beira, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Kristjana Hrönn Ásbjörnsdóttir
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Stephen S Gloyd
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | | | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
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12
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Petitfour L, Bonnet E, Mathevet I, Nikiema A, Ridde V. Out-of-pocket payments and catastrophic expenditures due to traffic injuries in Ouagadougou, Burkina Faso. HEALTH ECONOMICS REVIEW 2021; 11:46. [PMID: 34928432 PMCID: PMC8691006 DOI: 10.1186/s13561-021-00344-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/21/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the out-of-pocket expenditures linked to Road Traffic Injuries in Ouagadougou, Burkina Faso, as well as the prevalence of catastrophic expenditures among those out-of-pocket payments, and to identify the socio-economic determinants of catastrophic expenditures due to Road Traffic Injuries. METHODS We surveyed every admission at the only trauma unit of Ouagadougou between January and July 2015 at the time of their admission, 7 days and 30 days later. We estimate a total amount of out-of-pocket expenditures paid by each patient. We considered an expense as catastrophic when it represented 10% at least of the annual global consumption of the patient's household. We used linear models to determine if socio-economic characteristics were associated to a greater or smaller ratio between out-of-pocket payment and global annual consumption. FINDINGS We surveyed 1323 Road injury victims three times (admission, Days 7 and 30). They paid in average 46,547 FCFA (83.64 US dollars) for their care, which represent a catastrophic expenditure for 19% of them. Less than 5% of the sample was covered by a health insurance scheme. Household economic status is found to be the first determinant of catastrophic health expenditure occurrence, exhibiting a significant and negative on the ratio between road injury expenditures and global consumption. CONCLUSION Our findings highlight the importance of developing health insurance schemes to protect poor households from the economic burden of road traffic injuries and improve equity in front of health shocks.
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Affiliation(s)
| | - Emmanuel Bonnet
- Institut de Recherche sur le Développement, Bondy, 93140 France
- Résiliences, Research Institute for Development, Bondy, 93140 France
| | | | - Aude Nikiema
- Institut des Sciences des Sociétés, Ouagadougou, Burkina Faso
| | - Valéry Ridde
- Institut de Recherche sur le Développement, Bondy, 93140 France
- CEPED, Research Institute for Development, Paris, 75007 France
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Karim N, Mumporeze L, Nsengimana VJP, Gray A, Kearney A, Aluisio AR, Mutabazi Z, Baird J, Clancy CM, Lubetkin D, Uwitonze JE, Nyinawankusi JD, Nkeshimana M, Byiringiro JC, Levine AC. Epidemiology of Patients with Head Injury at a Tertiary Hospital in Rwanda. West J Emerg Med 2021; 22:1374-1378. [PMID: 34787565 PMCID: PMC8597684 DOI: 10.5811/westjem.2021.4.50961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/19/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Traumatic injuries disproportionately affect populations in low and middle-income countries (LMIC) where head injuries predominate. The Rwandan Ministry of Health (MOH) has dramatically improved access to emergency services by rebuilding its health infrastructure. The MOH has strengthened the nation’s acute emergency response by renovating emergency departments (ED), developing the field of emergency medicine as a specialty, and establishing a prehospital care service: Service d’Aide Medicale Urgente (SAMU). Despite the prevalence of traumatic injury in LMIC and the evolving emergency service in Rwanda, data regarding head trauma epidemiology is lacking. Methods We conducted this retrospective cohort study at the University Teaching Hospital of Kigali (UTH-K) and used a linked prehospital database to investigate the demographics, mechanism, and degree of acute medical interventions amongst prehospital patients with head injury. Results Of the 2,426 patients transported by SAMU during the study period, 1,669 were found to have traumatic injuries. Data from 945 prehospital patients were accrued, with 534 (56.5%) of these patients diagnosed with a head injury. The median age was 30 years, with most patients being male (80.3%). Motor vehicle collisions accounted for almost 78% of all head injuries. One in six head injuries were due to a pedestrian struck by a vehicle. Emergency department interventions included intubations (6.7%), intravenous fluids (2.4%), and oxygen administration (4.9%). Alcohol use was not evaluated or could not be confirmed in 81.3% of head injury cases. The median length of stay (LOS) in the ED was two days (interquartile range: 1,3). A total of 184 patients were admitted, with 13% requiring craniotomies; their median in-hospital care duration was 13 days. Conclusion In this cohort of Rwandan trauma patients, head injury was most prevalent amongst males and pedestrians. Alcohol use was not evaluated in the majority of patients. These traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of head injury, may be beneficial in the Rwandan setting.
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Affiliation(s)
- Naz Karim
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Lise Mumporeze
- University of Rwanda, College of Medicine and Health Sciences, Department of Anesthesia, Critical Care, and Emergency Medicine, Kigali, Rwanda
| | - Vizir J P Nsengimana
- University of Rwanda, College of Medicine and Health Sciences, Department of Anesthesia, Critical Care, and Emergency Medicine, Kigali, Rwanda
| | - Ashley Gray
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Alexis Kearney
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Adam R Aluisio
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Zeta Mutabazi
- University Teaching Hospital-Kigali (UTH-K), Department of Accident & Emergency Medicine, Kigali, Rwanda
| | - Janette Baird
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Camille M Clancy
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Derek Lubetkin
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
| | - Jean Eric Uwitonze
- Service d'Aide Médicale Urgente (SAMU), Rwanda Ministry of Health, Kigali Rwanda
| | | | - Menelas Nkeshimana
- University Teaching Hospital-Kigali (UTH-K), Department of Accident & Emergency Medicine, Kigali, Rwanda
| | - Jean Claude Byiringiro
- University Teaching Hospital-Kigali (UTH-K), Division of Clinical Education and Research, Kigali, Rwanda
| | - Adam C Levine
- Warren Alpert School of Medicine, Brown University, Department of Emergency Medicine, Providence, Rhode Island, United States of America
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Denu ZA, Osman MY, Bisetegn TA, Biks GA, Gelaye KA. Prevalence and risk factors for road traffic injuries and mortalities in Ethiopia: systematic review and meta-analysis. Inj Prev 2021; 27:384-394. [PMID: 33579673 DOI: 10.1136/injuryprev-2020-044038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/04/2021] [Accepted: 01/09/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Road traffic injuries, which are responsible for premature deaths and functional losses, are the leading causes of unintentional injuries in Ethiopia. As most studies on road traffic injuries, so far, have been either local or regional, it is believed that combining the regional or local data to get nationally representative information could help programme implementers in setting priorities. OBJECTIVE The aim of this review was to estimate the proportion of road traffic injuries, mortality and risk factors for the problem among all age groups in Ethiopia. DATA SOURCES A systematic review of articles using MEDLINE/PubMed SCOPUS Web of Science and science direct was conducted. Additional studies were identified via manual search. STUDY SELECTION Only studies that reported road traffic injuries and/or mortalities for all age groups were included in this review. DATA SYNTHESIS All pooled analyses were based on random-effect models. Twenty-six studies for the prevalence of RTIs (n=37 424), 24 studies for road traffic injuries (RTI) mortality, (n=38 888), 9 studies for prevalence of fracture among RTIs (n=2817) and 5 studies for the prevalence of post-traumatic stress disorder (n=1733) met our inclusion criteria. Driving in the dark increased severity of injury by 1.77, 95% CI 1.60 to 1.95). The certainty of the evidence was assessed using GRADEpro Guideline Development Tool. CONCLUSION In this review, the burden of road traffic injuries and mortalities remains high in Ethiopia. Human factors are the most common causes of the problem in Ethiopia. The existing safety regulations should be re-evaluated and supported by continuous behavioural interventions. PROSPERO REGISTRATION NUMBER CRD42019124406.
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Affiliation(s)
- Zewditu Abdissa Denu
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Mensur Yassin Osman
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Telake Azale Bisetegn
- Department of Health Communication and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Gashaw Andargie Biks
- Department of Health Policy and Management, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
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15
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Du RY, Thiong'o GM, LoPresti MA, Mohan NK, Dewan MC, Lepard J, Lam S. Pediatric Neurosurgery in East Africa: An Education and Needs-Based Survey. World Neurosurg 2020; 141:e374-e382. [PMID: 32454199 DOI: 10.1016/j.wneu.2020.05.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION A pediatric neurosurgery training workshop was organized for residents and consultants in East Africa. We aimed to compile feedback from the course participants to 1) characterize the state of neurosurgical education; and 2) identify the perceived practical education needs. METHODS The survey of demographic, clinical background and practice, and feedback questions was distributed to all attendees. Responses were elicited via yes/no questions and Likert scales, with the score ranging from 1 (not important, not useful, never) to 5 (very important, very useful, often). The data were de-identified and analyzed in aggregate. RESULTS A total of 11 neurosurgeons and trainees completed the survey, including 6 residents (55%) and 5 consultants (45%). Although 5 countries of origin were represented, all attendees (100%) have completed their neurosurgery training in Kenya. The respondents had most frequently treated trauma (least common to most common, 1-5; mean, 4.55 ± 0.93), hemorrhagic stroke (mean, 4.27 ± 0.79), and pediatric tumors (mean, 4.27 ± 1.01). In training, the most commonly used study resources were online resources (9; 82%), textbooks (7; 64%), and online lectures (7; 64%). The areas of greatest perceived need in education and training included general neurosurgery (least to most need, 1-10: 9; 82%), pediatric (9; 82%), trauma and neurocritical care (7; 64%), and neuro-oncology (7; 64%). All 11 respondents (100%) reported that more direct operative teaching was important for educational improvement. Hydrocephalus (least to most useful, 1-5: 5.00 ± 0.00), neuro-endoscopy (4.91 ± 0.30), and tumor (4.91 ± 0.30) were considered the most useful content covered in the pediatric neurosurgery-focused training program to improve skills and knowledge base. CONCLUSIONS The results from the present survey identified areas of education and training needs to guide further neurosurgical education efforts in East Africa.
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Affiliation(s)
- Rebecca Y Du
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
| | - Grace M Thiong'o
- Division of Pediatric Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Nilesh K Mohan
- Department of Neurosurgery, Moi Teaching and Referral Hospital, Eldoret, Kenya; Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael C Dewan
- Division of Pediatric Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob Lepard
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, Alabama, USA
| | - Sandi Lam
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine and Lurie Children's Hospital, Chicago, Illinois, USA
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Nickenig Vissoci JR, Krebs E, Meier B, Vieira IF, de Andrade L, Byiringiro F, Rulisa S, Staton CA. Road traffic crash experience among commercial motorcyclists in Kigali, Rwanda. Int J Inj Contr Saf Promot 2020; 27:181-187. [PMID: 32138575 DOI: 10.1080/17457300.2020.1724158] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Road traffic injuries (RTI) cause ∼1.2 million deaths and 50 million injuries annually, disproportionately occurring in low- and middle-income countries. Although policy changes and infrastructural developments have continued to contribute to the decrease in RTI-related deaths, limited studies have investigated the relationship between motorcycle taxi driver behaviors and RTIs in Rwanda. This study aims to describe the safety behaviors of commercial motorcyclists in Kigali, Rwanda.Methods: We surveyed 609 commercial motorcyclists in January 2014 then conducted a cross-sectional analysis of the results, including descriptive and bivariate logistic regression analyses.Results: We found that 38.7% of surveyed motorcycle drivers experienced a crash during their lifetime, of which, more than half (n = 134, 56.8%) suffered injuries. Of all injuries, 38.8% (n = 52) resulted in hospitalization, and 14.2% (n = 19) in disability. Among motorcyclists, 100% reported always wearing a helmet, 99% reported always wearing a chin strap, and 98.8% reported always having a passenger helmet. There was an association between sustaining a crash and believing that helmets (p = 0.08) and chin straps (p = 0.05) reduced crash risk.Conclusions: Rwandan commercial motorcyclists demonstrate generally proper safety behaviors, but remain a high-risk occupational group. Road safety policy initiatives have been effective in changing driver behavior regardless of driver safety beliefs.
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Affiliation(s)
- Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Elizabeth Krebs
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Meier
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | | | - Luciano de Andrade
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA.,Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Fidele Byiringiro
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stephen Rulisa
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Catherine A Staton
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.,Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Yusuf M, Gebrye T, Fatoye F. Burden of musculoskeletal-related disorders resulting from non-fatal road traffic collisions in Africa: a protocol of a systematic review. BMJ Open 2019; 9:e032687. [PMID: 31662401 PMCID: PMC6830634 DOI: 10.1136/bmjopen-2019-032687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In addition to their high mortality rates, road traffic collisions (RTC) are considered a burden within those who do survive. In Africa, injuries related to RTC have been identified as the 10th most common cause of disability-adjusted life years lost for all ages and categories. Moreover, non-fatal RTC are the biggest cause associated with the burden of musculoskeletal disorders (MSD) in Africa. Despite this, the epidemiology of MSD related to non-fatal RTC within this region is still unknown.The objective of this review is to identify and summarise available data regarding the prevalence, incidence and patterns of MSD resulting from non-fatal RTC in Africa. METHODS AND ANALYSIS A systematic review of observational epidemiological studies will be conducted. On October 2019, MEDLINE, Embase, CINAHL Plus, PsycINFO, Web of Science, Global Health and African Journals OnLine will be searched for literature that is in English and published between 1990 and 2018. Two reviewers (MY ad TG) will independently screen results and extract the data, with a third reviewer (FF) resolving any discrepancies through discussion. Additionally, two reviewers (MY and TG) will independently assess the quality of the eligible studies using the US National Institutes of Health National Heart, Lung, and Blood Institute Quality Assessment Tool.Within the eligible studies, data on citation, methods and results will be extracted. Extracted data will be analysed using a narrative synthesis. Findings will be presented in tables, with the main outcomes being prevalence, incidence and disease pattern of MSD and determinants of non-fatal RTC. The final systematic review will be conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. ETHICS AND DISSEMINATION As individual patients will not be involved in this study, no ethical approval will be sought. Findings from this review will be disseminated through peer-reviewed journals and relevant conferences. TRIAL REGISTRATION NUMBER CRD42019139538.
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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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The burden of road traffic injury among trauma patients in Ethiopia: A systematic review and meta-analysis. Afr J Emerg Med 2019; 9:S3-S8. [PMID: 30976494 PMCID: PMC6440918 DOI: 10.1016/j.afjem.2019.01.013] [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: 06/01/2018] [Revised: 08/05/2018] [Accepted: 01/16/2019] [Indexed: 11/30/2022] Open
Abstract
Background Road traffic injury (RTI) is one of the main reasons for trauma-related admission in Ethiopian hospitals. Nationally representative data is needed to develop and implement the public health emergency management strategy. Therefore, this study was aimed to estimate the national pooled prevalence of RTI among trauma patients in Ethiopia. Methods PubMed, Excerpta Medica Database (EMBASE), psycEXTRA, and Google Scholar databases were searched. Heterogeneity of studies was assessed using the I2 statistics. Publication bias was checked by using funnel plot and Egger’s regression test. The DerSimonian and Laird's random-effects model was used to estimate the pooled prevalence. Subgroup analysis was conducted by age and region. The trend of RTI estimated as well. Results The pooled prevalence of RTI among trauma patients in Ethiopia was 31.5% (95% CI: 25.4%, 37.7%). Regional subgroup analysis showed that the pooled prevalence of RTI was 58.3% in the region of southern, nation, nationalities, and peoples (SNNPR) and 33.3% in Addis Ababa. Subgroup analysis based on patients age showed that the pooled prevalence of RTI was 51.7% in adults, 14.2% in children, and 32.6% in all age group. The time-trend analysis has shown an increasing burden of RTI in Ethiopian hospitals. Conclusion The burden of RTI among trauma patients was high. Therefore, strengthening road safety management throughout the country is needed to reduce RTI.
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Bonnet E, Lechat L, Ridde V. What interventions are required to reduce road traffic injuries in Africa? A scoping review of the literature. PLoS One 2018; 13:e0208195. [PMID: 30500856 PMCID: PMC6267971 DOI: 10.1371/journal.pone.0208195] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
Road traffic accidents are the major cause of mortality among people aged 15–29 years in Africa. World Health Organisation (WHO) and the World Bank launched a Decade of Action for Road Safety in 2011 with the goal of halving the number of injuries and deaths on the roads. No progress has been reported in Low and Middle Income Countries (LMICs) and the number of deaths remains very high. To reach the target set, there is a need for interventions in several areas. This scoping review proposes to produce a synthesis by identifying the kinds of interventions and outcomes which have been carried out on the African continent. Using the scoping studies method, 23 articles were selected and analysed. The study shows that interventions were developed in four fields: road safety policy, health education, safety equipment and data collection. It shows also that there were records of interventions in only twelve countries, mostly in Eastern and Southern Africa. The main conclusion of this study reveals both a lack of road safety interventions and shortcomings in the assessment of those performed and selected for our study.
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Affiliation(s)
- Emmanuel Bonnet
- Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France
- * E-mail:
| | | | - Valéry Ridde
- Institut de Recherche pour le Développement, UMR CEPED, Université Paris Descartes, Paris, France
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Abebe Y, Dida T, Yisma E, Silvestri DM. Ambulance use is not associated with patient acuity after road traffic collisions: a cross-sectional study from Addis Ababa, Ethiopia. BMC Emerg Med 2018; 18:7. [PMID: 29433441 PMCID: PMC5810000 DOI: 10.1186/s12873-018-0158-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/06/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Africa accounts for one sixth of global road traffic deaths-most in the pre-hospital setting. Ambulance transport is expensive relative to other modes of pre-hospital transport, but has advantages in time-sensitive, high-acuity scenarios. Many countries, including Ethiopia, are expanding ambulance fleets, but clinical characteristics of patients using ambulances remain ill-defined. METHODS This is a cross-sectional study of 662 road traffic collisions (RTC) patients arriving to a single trauma referral center in Addis Ababa, Ethiopia, over 7 months. Emergency Department triage records were used to abstract clinical and arrival characteristics, including acuity. The outcome of interest was ambulance arrival. Secondary outcomes of interest were inter-facility referral and referral communication. Descriptive and multivariable statistics were computed to identify factors independently associated with outcomes. RESULTS Over half of patients arrived with either high (13.1%) or moderate (42.2%) acuity. Over half (59.0%) arrived by ambulance, and nearly two thirds (65.9%) were referred. Among referred patients, inter-facility communication was poor (57.7%). Patients with high acuity were most likely to be referred (aOR 2.20, 95%CI 1.16-4.17), but were not more likely to receive ambulance transport (aOR 1.56, 95%CI 0.86-2.84) or inter-facility referral communication (aOR 0.98, 95%CI 0.49-1.94) than those with low acuity. Nearly half (40.2%) of all patients were referred by ambulance despite having low acuity. CONCLUSIONS Despite ambulance expansion in Addis Ababa, ambulance use among RTC patients remains heavily concentrated among those with low-acuity. Inter-facility referral appears a primary contributor to low-acuity ambulance use. In other contexts, similar routine ambulance monitoring may help identify low-value utilization. Regional guidelines may help direct ambulance use where most valuable, and warrant further evaluation.
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Affiliation(s)
- Yonas Abebe
- Department of Emergency and Critical Care Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tolesa Dida
- Department of Emergency and Critical Care Nursing, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Engida Yisma
- School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Robinson Research Institute, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - David M. Silvestri
- National Clinician Scholars Program and Department of Emergency Medicine, Yale School of Medicine, New Haven, USA
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