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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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Shaikh MA, Lule H, Bärnighausen T, Lowery Wilson M, Abio A. Self‐reported involvement in road traffic crashes in Kenya: A cross‐sectional survey of a nationally representative sample. Health Sci Rep 2022; 5:e809. [PMID: 36177397 PMCID: PMC9475121 DOI: 10.1002/hsr2.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022] Open
Abstract
Background Road traffic crashes (RTCs) are a global public health burden whose resulting morbidity and mortality disproportionately impact low‐ and middle‐income countries with stressed health systems. There is a paucity of published studies that evaluate the sociodemographic distribution of RTCs using nationally representative samples from the African region. Aim To examine population‐wide associations between sociodemographic factors and involvement in RTCs in Kenya. Methods Data were obtained from the 2014 Kenyan Demographic Health Survey, representing all 47 counties in Kenya, from May to October of 2014. We estimated the prevalence of RTCs and utilized logistic regression for bivariate and multivariable analyses to determine the sociodemographic factors associated with RTCs. Study variables included age, place of residence, household wealth index, educational attainment, and history of alcohol consumption. We computed odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results A higher prevalence was reported among men (8.76%) versus women (3.22%). The risk factors among men included being 20−34 years of age, living in a rural area (OR 1.38, 95% CI 1.09, 1.74), drinking alcohol (OR 1.33, 95% CI 1.11, 1.59), and having not higher than a primary (OR 1.90, 95% CI 1.19, 3.03) or secondary (OR 1.68, 95% CI 1.04, 2.71) education. The strongest risk factors for women included the being aged 45−49 (OR 2.30, 95% CI 1.44, 3.67) and 20−24 years (OR 1.81, 95% 1.17, 2.79) as well as being in the fourth wealth quintile (OR 1.83, 95% CI 1.15, 2.91). Conclusion Men and the most economically productive age groups were more likely to report being involved in RTCs. Strategies to reduce the occurrences of RTCs should prioritize the most vulnerable sociodemographic groups.
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Affiliation(s)
- Masood Ali Shaikh
- Injury Epidemiology and Prevention (IEP) Research Group, Department of Clinical Neurosciences, Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
| | - Herman Lule
- Injury Epidemiology and Prevention (IEP) Research Group, Department of Clinical Neurosciences, Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH) University Hospital and University of Heidelberg Heidelberg Germany
| | - Michael Lowery Wilson
- Heidelberg Institute of Global Health (HIGH) University Hospital and University of Heidelberg Heidelberg Germany
| | - Anne Abio
- Injury Epidemiology and Prevention (IEP) Research Group, Department of Clinical Neurosciences, Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
- Heidelberg Institute of Global Health (HIGH) University Hospital and University of Heidelberg Heidelberg Germany
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Severe traumatic brain injuries secondary to motor vehicle crashes in two Namibian regions: A retrospective review. Afr J Emerg Med 2022; 12:225-230. [PMID: 35719186 PMCID: PMC9188956 DOI: 10.1016/j.afjem.2022.04.009] [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: 05/26/2021] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Traumatic Brain Injuries (TBIs) are a leading cause of morbidity and mortality among trauma patients globally, with motor vehicle crashes (MVCs) being a major contributor. Namibia had a World Health Organization (WHO) estimated MVC-related fatality rate of 30.4 per 100 000 population in 2016, higher than that of the African continent, while no epidemiological studies describing the distribution and determinants of TBIs exist in the country. The study aimed to describe the characteristics of adult patients (≥18 years) with severe TBI secondary to MVCs which occurred in two regions of Namibia between the years 2014-2018. Methods A retrospective descriptive observational study was conducted in adult patients who sustained severe TBIs secondary to MVCs in two Namibian regions. The inclusion criteria were patients ≥18 years with a severe (as described on the Motor Vehicle Accident Fund system) MVC-related TBI who sustained an injury in the Otjozondjupa or Khomas regions between the years 2014-2018. Results A total of 87 patients met the inclusion criteria, 65 (74.7%) from the Khomas region, and 22 (25.3%) from the Otjozondjupa region. The overall mean age of patients was 34 years (SD 11.79), most were male (n = 78. 89.7%) and 55.2% (n = 48) of all patients sustained an isolated TBI. The majority of the patients were admitted to a state healthcare facility (n = 52, 59.8%). Pedestrians were the most injured (n = 34, 52.3%) in the Khomas region while vehicle drivers were the most injured (n = 11, 50%) in the Otjozondjupa Region. A total of 34 (39.1%) patients died and 53 (60.9%) were discharged from hospital. Overall, there were no statistically significant relationships between patient outcomes and independent variables. Conclusions The study was to our knowledge the first to describe the epidemiology of TBIs in Namibia. Young individuals are the main people who sustained TBIs, which may subsequently place a socio-economic burden on the country. There is however limited research in Namibia to guide healthcare planning.
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Ryan-Coker MFD, Davies J, Rinaldi G, Hasselberg M, Marke DH, Necchi M, Haghparast-Bidgoli H. Economic burden of road traffic injuries in sub-Saharan Africa: a systematic review of existing literature. BMJ Open 2021; 11:e048231. [PMID: 34526339 PMCID: PMC8444250 DOI: 10.1136/bmjopen-2020-048231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This systematic review aims to explore and synthesise existing literature on the direct and indirect costs from road traffic injuries (RTIs) in sub-Saharan Africa (SSA), the quality of existing evidence, methods used to estimate and report these costs, and the factors that drive the costs. METHODOLOGY MEDLINE, SCOPUS, ProQuest Central, Web of Science, Global Index Medicus, Embase, World Bank Group e-Library, Econlit, Google Scholar and WHO webpages were searched for relevant literature. References of selected papers were also examined for related articles. Screening was done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were included in this review if they were published by March 2019, written in English, conducted in SSA and reported original findings on the cost of illness or economic burden of RTIs. The results were systematically examined, and the quality assessed by two reviewers using a modified Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Eleven studies met the inclusion criteria. RTIs can cost between INT$119 and 178 634 per injury and INT$486 and 12 845 per hospitalisation. Findings show variability in costing methods and inadequacies in the quality of existing evidence. Prolonged hospital stays, surgical sundries and severity of injury were the most common factors associated with cost. CONCLUSION While available data are limited, evidence shows that the economic burden of RTIs in SSA is high. Poor quality of existing evidence and heterogeneity in costing methods limit the generalisability of costs reported.
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Affiliation(s)
- Marcella Farrelle Dorothea Ryan-Coker
- Emergency Hospital, Goderich Surgical Centre, Freetown, Sierra Leone
- Institute for Global Health, University College London, Faculty of Population Health Sciences, London, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Marie Hasselberg
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Dennis H Marke
- Emergency Hospital, Goderich Surgical Centre, Freetown, Sierra Leone
| | - Marco Necchi
- Emergency Hospital, Goderich Surgical Centre, Freetown, Sierra Leone
| | - Hassan Haghparast-Bidgoli
- Institute for Global Health, University College London, Faculty of Population Health Sciences, London, UK
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Chweya RN, Mambo SN, Gachohi JM. Demographic, occupational and societal risk exposures to physical injuries in a rural community in Western Kenya: a 12-week longitudinal study. BMJ Open 2021; 11:e053161. [PMID: 34521680 PMCID: PMC8442073 DOI: 10.1136/bmjopen-2021-053161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE We studied factors associated with the weekly occurrence of physical injuries in a rural setting to determine injury-related burden and risk exposures. DESIGN Prospective cohort study. SETTING Suna-West subcounty, Migori County, Western Kenya. PARTICIPANTS 390 study participants (subjects) cluster sampled from 92 households, recruited and followed up for 12 weeks, between August and October 2019. METHODS We collected data weekly on occurrence of injuries, individual-level and household-level independent variables using a standard interviewer-administered questionnaire adapted from the WHO survey tool for injuries. Analyses related occurrence of injuries and independent variables using a multilevel Poisson regression model, adjusting for age and sex. OUTCOME MEASURES Quantifying injury-related burden and patterns by demographic, occupational and societal risk exposures. RESULTS We documented 44 injuries, coming from 38 subjects dwelling in 30 of the 92 study households. On average, each study subject and household experienced 1.2 and 1.5 episodes of injuries across the 12 study weeks. Open wounds and bruises were the most frequent injuries commonly reported among middle-aged (18-54 years) and young (5-17 years) subjects at 32.2 and 7.6 episodes per 1000-person week, respectively. The common cause of injuries among young, middle-aged and old subjects (>54 years) were falls, road accidents and person-related assault or being hit by an object, each at 15.2, 18.9, and 11.4 episodes per 1000-person week, respectively. Subjects not domesticating animals (incidence rate ratio (IRR)=7.6, 95% CI 1.4 to 41.7) and those making a visit outside the local subcounty of residence (IRR=2.2, 95% CI 1.5 to 3.1) were at higher risk of reporting injuries. CONCLUSION We provide evidence of a higher burden of physical injuries associated with demographic, occupational and societal risk exposures with the most injuries resulting from falls. Further studies could better define granular characteristics constituting these factors.
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Affiliation(s)
- Reagan Ngoge Chweya
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Susan Njoki Mambo
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - John Mwangi Gachohi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Global Health Program Kenya, Washington State University, Nairobi, Kenya
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Glèlè-Ahanhanzo Y, Kpozèhouen A, Sossa-Jerôme C, Sopoh GE, Tedji H, Yete K, Levêque A. "My right to walk, my right to live": pedestrian fatalities, roads and environmental features in Benin. BMC Public Health 2021; 21:162. [PMID: 33468090 PMCID: PMC7816405 DOI: 10.1186/s12889-021-10192-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background The implementation of road safety interventions in many developing countries usually focuses on the behavior of users. In order to draw more attention on the role of road infrastructure and physical environment in road safety interventions, this study aims to analyze the environmental and road factors associated with the pedestrians involved in traffic crashes in Benin. Method The method used was an analysis of national road crash statistics for the period 2008 to 2015. The information available included the circumstances surrounding the collision, the road infrastructure, the vehicles and the individuals involved. A multiple logistic regression was used to identify predictors of pedestrian mortality in traffic crashes. Results During the period studied, 3760 crashes involved at least one pedestrian. The death rate among these pedestrians was 27.74% (CI 95%: 26.31–29.20). The mortality predictors were the area in which the crash occurred (OR = 4.94; CI 95%: 4.10–5.94), the day of the crash (OR = 2.17; CI 95%:1.34–3.52), light levels (OR = 1.30; CI 95%: 1.06–1.59), road classification (OR = 1.79; CI 95%: 1.46–2.20), the condition of the road surface (2.04, CI 95%: 1.41–2.95) and the position of the pedestrian during the crash (OR = 1.69; CI 95%: 1.19–2.38). Conclusions These results support the need for a holistic approach to interventions aiming to tackle deaths on roads. Interventions should integrate environmental factors for greater pedestrian safety around roads with appropriate signs, roads in good condition and awareness campaigns for a proper use of road infrastructures.
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Affiliation(s)
- Yolaine Glèlè-Ahanhanzo
- Multidisciplinary Research Unity for Road Crashes Prevention (ReMPARt), Epidemiology and Bio-statistic Department, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin.
| | - Alphonse Kpozèhouen
- Multidisciplinary Research Unity for Road Crashes Prevention (ReMPARt), Epidemiology and Bio-statistic Department, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Charles Sossa-Jerôme
- Health Promotion Department, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | - Ghislain E Sopoh
- Department of Health and Environment, Regional Institute of Public Health, University of Abomey-Calavi, Ouidah, Benin
| | | | - Koovy Yete
- National Centre for Road Safety, Cotonou, Benin
| | - Alain Levêque
- Public Health School (Université Libre de Bruxelles) - Center for Research in Epidemiology, Biostatistics and Clinical Research, Brussels, Belgium
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Kidokoro T, Fuku N, Yanagiya T, Takeshita T, Takaragawa M, Annear M, Xiaojie T, Waiganjo LB, Bogonko LF, Isika JK, Kigaru MD, Mwangi FM. Physical Activity and Sedentary Behaviour Patterns among Kenyan and Japanese Children: A Comprehensive Cross-Country Comparison. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124254. [PMID: 32549222 PMCID: PMC7344811 DOI: 10.3390/ijerph17124254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 02/07/2023]
Abstract
Health benefits of physical activity are well known, yet available physical activity data is limited from children living in African and Asian countries. The purpose of the cross-sectional study was to evaluate and compare physical activity and sedentary behavior patterns, particularly hourly variations, among children in Kenya and Japan. Participants included 298 primary school students (122 Kenyan, 176 Japanese) aged 9-12 years. Physical activity and sedentary behavior were measured with accelerometers. Domain-specific physical activity, screen time, and proportion of children using active transport to school were measured by questionnaire. A two-way ANOVA (countries × time) was used to examine the differences in the activity patterns between Kenyan and Japanese children. The results from the present study demonstrated that Kenyan children spent more time in moderate-to-vigorous physical activity compared to Japanese children (p < 0.05) with the greatest differences found for weekday evenings (for boys and girls) and weekend afternoons (for girls). This suggests that these were 'critical periods' to differentiate the physical activity levels between Kenyan and Japanese children. However, a higher proportion of the children from Japan used active transport to school and spent less time in television viewing and computer gaming. The results suggest that both countries have successes and challenges that can aid in developing effective and country-specific intervention strategies for promoting physical activity.
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Affiliation(s)
- Tetsuhiro Kidokoro
- Physical Fitness Research Institute, Meiji Yasuda Life Foundation of Health and Welfare, Tokyo 192-0001, Japan
- Department of Health & Physical, Education College of Arts & Science, International Christian University, Tokyo 181-8585, Japan
- Correspondence:
| | - Noriyuki Fuku
- Graduate School of Health and Sports Science, Juntendo University, Chiba 270-1695, Japan; (N.F.); (T.Y.); (T.T.); (M.T.)
| | - Toshio Yanagiya
- Graduate School of Health and Sports Science, Juntendo University, Chiba 270-1695, Japan; (N.F.); (T.Y.); (T.T.); (M.T.)
| | - Tomonari Takeshita
- Graduate School of Health and Sports Science, Juntendo University, Chiba 270-1695, Japan; (N.F.); (T.Y.); (T.T.); (M.T.)
| | - Mizuki Takaragawa
- Graduate School of Health and Sports Science, Juntendo University, Chiba 270-1695, Japan; (N.F.); (T.Y.); (T.T.); (M.T.)
| | - Michael Annear
- Faculty of Sport Sciences, Waseda University, Tokyo 202-0021, Japan;
| | - Tian Xiaojie
- Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki 305-8574, Japan;
| | - Luka B. Waiganjo
- Department of Physical Education, Exercise & Sports Science, Kenyatta University, Nairobi, P.O. Box 43844-0010, Kenya; (L.B.W.); (L.F.B.); (F.M.M.)
| | - Lamec F. Bogonko
- Department of Physical Education, Exercise & Sports Science, Kenyatta University, Nairobi, P.O. Box 43844-0010, Kenya; (L.B.W.); (L.F.B.); (F.M.M.)
| | - Juliet K. Isika
- Department of Fashion Design and Marketing, Kenyatta University, Nairobi, P.O. Box 43844-0010, Kenya;
| | - Mbithe D. Kigaru
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, P.O. Box 43844-0010, Kenya;
| | - Francis M. Mwangi
- Department of Physical Education, Exercise & Sports Science, Kenyatta University, Nairobi, P.O. Box 43844-0010, Kenya; (L.B.W.); (L.F.B.); (F.M.M.)
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Adanu EK, Jones S, Odero K. Identification of factors associated with road crashes among functionally classified transport modes in Namibia. SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fuller AT, Corley J, Tran TM, Butler EK, Vissoci JR, Andrade L, Makumbi F, Luboga S, Muhumuza C, Ssennono VF, Chipman JG, Galukande M, Haglund MM, Smith ER. Prevalence of Surgically Untreated Face, Head, and Neck Conditions in Uganda: A Cross-Sectional Nationwide Household Survey. World Neurosurg 2017; 110:e747-e754. [PMID: 29180091 DOI: 10.1016/j.wneu.2017.11.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/18/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Surgeons OverSeas Assessment of Surgical Need tool (SOSAS) was created to evaluate the burden of surgically treatable conditions in low- and middle-income countries. The goal of our study is to describe the face, head, and neck (FHN) conditions that need surgical care in Uganda, along with barriers to that care and disability from these conditions. METHODS A 2-stage cluster randomized SOSAS survey was administered in a cross-sectional manner between August and September 2014. Participants included randomly selected persons in 105 enumeration areas in 74 districts throughout Uganda with 24 households in each cluster. The SOSAS survey collected demographic and clinical data on all respondents. Univariate and multivariate logistic models evaluated associations of demographic characteristics and clinical characteristics of the FHN conditions and outcomes of whether health care was sought or surgical care was received. RESULTS Of the 4428 respondents, 331 (7.8%) reported having FHN conditions. The most common types of conditions were injury-related wounds. Of those who reported an FHN condition, 36% reported receiving no surgical care whereas 82.5% reported seeking health care. In the multivariate model, literacy and type of condition were significant predictors of seeking health care whereas village type, literacy, and type of condition remained significant predictors of receiving surgical care. CONCLUSIONS Many individuals in Uganda are not receiving surgical care and barriers include costs, rural residency, and literacy. Our study highlights the need for targeted interventions in various parts of Uganda to increase human resources for surgery and expand surgical capacity.
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Affiliation(s)
- Anthony T Fuller
- Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacquelyn Corley
- Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Tu M Tran
- Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA
| | - Elissa K Butler
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Joao Ricardo Vissoci
- Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University Global Health Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Luciano Andrade
- State University of West of Parana, Unioeste, Foz do Iguaçu, Brazil; Public Health Research Group, Unioeste, Toledo, Brazil
| | | | - Samuel Luboga
- Department of Anatomy, Makerere University School of Medicine, Kampala, Uganda
| | - Christine Muhumuza
- Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Makerere University School of Public Health, Kampala, Uganda
| | | | - Jeffrey G Chipman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Moses Galukande
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda
| | - Michael M Haglund
- Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University School of Medicine, Durham, North Carolina, USA; Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | - Emily R Smith
- Duke University Division of Global Neurosurgery and Neuroscience, Durham, North Carolina, USA; Duke University Global Health Institute, Duke University Medical Center, Durham, North Carolina, USA
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Reardon JM, Andrade L, Hertz J, Kiwango G, Teu A, Pesambili M, El-Gabri D, Hocker M, Mvungi M, Vissoci JRN, Staton CA. The epidemiology and hotspots of road traffic injuries in Moshi, Tanzania: An observational study. Injury 2017; 48:1363-1370. [PMID: 28529012 PMCID: PMC5545685 DOI: 10.1016/j.injury.2017.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/02/2017] [Indexed: 02/02/2023]
Abstract
Road traffic injuries (RTIs) continue to increase with the proliferation of motor vehicles, especially in low-income countries where safe road infrastructure is lacking. Knowing where and why RTIs occur would allow for increased safety and prevention planning. In this study, police records of 300 motor vehicle collisions which occurred between February 2013 and January 2014 in Moshi, Tanzania were reviewed. Analysis of variables including victim age, gender, type of collision, conditions, and use of safety equipment were analyzed. Geographic information system (GIS) analysis was performed to identify areas with the most collisions. Most injuries occurred at four intersections on two main corridor. Car crashes represented 48% of reports while motorcycle collisions were 35% of reports. Victims were predominantly male. The majority (64%) of RTI victims in cars used seatbelts while only 43% of motorcyclists wore helmets; none of those who used the helmet or seatbelt suffered a grievous injury. These data demonstrate that RTIs in Moshi occur in predictable high traffic locations. RTIs injure victims of all backgrounds and safety equipment is not universally utilized. More investment is needed in improved data collection methods, and a greater emphasis on intersection safety is needed to reduce these preventable injuries.
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Affiliation(s)
- Joseph M Reardon
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Luciano Andrade
- Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil
| | - Julian Hertz
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | | | - Anneth Teu
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Deena El-Gabri
- Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States
| | - Michael Hocker
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Mark Mvungi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - João Ricardo N Vissoci
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States; Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States; Duke Global Health Institute, Duke University, Durham, NC, United States.
| | - Catherine A Staton
- Division of Emergency Medicine, Departmento of Surgery, Duke University Medical Center, Durham, NC, United States; Division of Global Neurosurgery and Neuroscience, Department of Neurosurgery, Duke Univertsity School of Medicine, Durham, NC, United States; Duke Global Health Institute, Duke University, Durham, NC, United States
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Patel A, Krebs E, Andrade L, Rulisa S, Vissoci JRN, Staton CA. The epidemiology of road traffic injury hotspots in Kigali, Rwanda from police data. BMC Public Health 2016; 16:697. [PMID: 27485433 PMCID: PMC4971670 DOI: 10.1186/s12889-016-3359-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/22/2016] [Indexed: 11/26/2022] Open
Abstract
Background Road traffic injuries (RTIs) are the eighth-leading cause of death worldwide, with low- and middle-income countries sharing a disproportionate number of fatalities. African countries, like Rwanda, carry a higher burden of these fatalities and with increased economic growth, these numbers are expected to rise. We aim to describe the epidemiology of RTIs in Kigali Province, Rwanda and create a hotspot map of crashes from police data. Methods Road traffic crash (RTC) report data from January 1, 2013 to December 31, 2013 was collected from Kigali Traffic Police. In addition to analysis of descriptive data, locations of RTCs were mapped and analyzed through exploratory spatial data analysis to determine hotspots. Results A total of 2589 of RTCs were reported with 4689 total victims. The majority of victims were male (94.7 %) with an average age of 35.9 years. Cars were the most frequent vehicle involved (43.8 %), followed by motorcycles (14.5 %). Motorcycles had an increased risk of involvement in grievous crashes and pedestrians and cyclists were more likely to have grievous injuries. The hotspots identified were primarily located along the major roads crossing Kigali and the two busiest downtown areas. Conclusions Despite significant headway by the government in RTC prevention, there continue to be high rates of RTIs in Rwanda, specifically with young males and a vulnerable road user population, such as pedestrians and motorcycle users. Improvements in police data and reporting by laypersons could prove valuable for further geographic information system analysis and efforts towards crash prevention and targeting education to motorcycle taxis could help reduce RTIs in a severely affected population.
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Affiliation(s)
- Anjni Patel
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Section of Prehospital and Disaster Medicine, Emory University, Atlanta, GA, USA
| | - Elizabeth Krebs
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC, USA
| | | | - Stephen Rulisa
- Department of Obstetrics & Gynecology, University of Rwanda School of Medicine, Kigali, Rwanda
| | - João Ricardo N Vissoci
- Department of Medicine, Faculdade Ingá, Maringá, Paraná, Brazil.,Duke University Medical Center, DUMC Box 3096 2301 Erwin Road, Duke North, Suite 2600, Durham, NC, 27710, USA.,Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, USA
| | - Catherine A Staton
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC, USA. .,Duke University Medical Center, DUMC Box 3096 2301 Erwin Road, Duke North, Suite 2600, Durham, NC, 27710, USA. .,Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, USA.
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Padovese V, Marrone R, Dassoni F, Vignally P, Barnabas GA, Morrone A. The diagnostic challenge of mapping elephantiasis in the Tigray region of northern Ethiopia. Int J Dermatol 2015; 55:563-70. [PMID: 26518364 DOI: 10.1111/ijd.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 05/09/2015] [Accepted: 05/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Ethiopia, lymphatic filariasis and podoconiosis are the two neglected tropical diseases planned to be mapped together within the recently launched Ethiopian neglected tropical diseases master plan (2013-2015). However, other disorders cause tropical lymphedema, and this report aims to identify clinical epidemiological aspects of limb swelling in northern Ethiopia and to provide an algorithm orienting the clinical diagnosis. METHODS Medical records of patients with lower limb elephantiasis attending the Italian Dermatological Centre of Mekele, Tigray capital city, over a 4-year period (2005-2009) were retrospectively analyzed. Nine variables were collected from the charts comprising demographic data, job, origin, literacy, clinical, histopathologic, microscopic, and cultural findings. RESULTS Over a total of 511 patients, lymphedema resulted from trauma (40.7%), chronic venous insufficiency (12.5%), deep mycoses (10.8%), lymphatic filariasis (9.2%), elephantiasis nostras verrucosa (7.0%), tropical ulcer (6.3%), leprosy (4.9%), recurrent infections (3.1%), podoconiosis (1.8%), tuberculosis (1.0%), malignancy (1.3%), Kaposi's sarcoma (1.0%), leishmaniasis (0.2%), and neurofibromatosis (0.2%). CONCLUSIONS Advanced-stage elephantiasis, chronic osteomyelitis, and podoconiosis not previously reported in Tigray were observed. Further epidemiological investigation and training programs addressed to healthcare providers at the peripheral level are needed to detect elephantiasis early, prevent disabilities, and improve patients' quality of life.
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Affiliation(s)
- Valeska Padovese
- National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy
| | - Rosalia Marrone
- National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy
| | - Federica Dassoni
- National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy
| | - Pascal Vignally
- National Institute for Health, Migration and Poverty (NIHMP), Rome, Italy
| | | | - Aldo Morrone
- Fondazione IME, Istituto Mediterraneo di Ematologia
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Larouche R, Oyeyemi AL, Prista A, Onywera V, Akinroye KK, Tremblay MS. A systematic review of active transportation research in Africa and the psychometric properties of measurement tools for children and youth. Int J Behav Nutr Phys Act 2014; 11:129. [PMID: 25326031 PMCID: PMC4210576 DOI: 10.1186/s12966-014-0129-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/07/2014] [Indexed: 01/14/2023] Open
Abstract
Background Previous systematic reviews indicate that active transportation (AT; the use of non-motorized travel modes such as walking, running and cycling) is an important source of daily physical activity (PA). However, no previous systematic review has examined travel behaviours among African children and youth or the psychometric properties of measurement tools used among children and youth worldwide. Methods Studies on AT among African children and youth (aged 5–17 years) were identified through 1) the MEDLINE and Embase databases; 2) manual searches of six African journals that are not indexed in these databases; and 3) the articles included in a previous systematic review on PA among children and youth in Sub-Saharan Africa. Second, literature on the psychometric properties of measurement tools for children and youth was searched using the MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, SportDiscus, and Health and Psychosocial Instruments databases. Study quality was assessed with a modified version of the Downs and Black checklist. Results Twenty studies reported original data on AT among African children and youth. This evidence suggests that rates of AT to/from school are lower in urban areas and in youth attending higher SES schools. Two population-based studies reported rates of AT ranging between 19.8% and 66.6% in multiple countries. Studies conducted in Africa seldom examined non-school travel and only one reported data on the psychometric properties of their measures of travel behaviours. Nineteen studies conducted predominantly in high-income countries provided psychometric data. Child and parent reports were used in 17 studies, and these measures generally showed substantial to almost perfect test-retest reliability and convergent validity for school trips. Limited information was available regarding non-school trips. Objective measures of travel behaviours have been used much less often, and further validity and reliability assessments are warranted. Conclusion These findings emphasize a need for more research examining travel behaviours among African children and youth, particularly for non-school travel. Further research is needed to develop valid and reliable measures of non-school travel and to examine their psychometric properties in the African context. These measures could then be used to evaluate AT promotion interventions.
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Affiliation(s)
- Richard Larouche
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Room R242, Ottawa K1H 8L1, ON, Canada.
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