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Mowafi H, Rice B, Nambaziira R, Nirere G, Wongoda R, James M, Group GW, Bisanzo M, Post L. Household economic impact of road traffic injury versus routine emergencies in a low-income country. Injury 2021; 52:2657-2664. [PMID: 34210454 DOI: 10.1016/j.injury.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Road traffic injuries (RTIs) are increasing and have disproportionate impact on residents of low- and middle-income countries (LMICs) where 90% of deaths occur. RTIs are a leading cause of death for those aged 15 - 29 years with costs estimated to be up to 3% of GDP. Despite this fact, little primary research has been done on the household economic impact of these events. METHODS From July to October 2016, 860 consecutive emergency department patients were enrolled and followed up at 6-8 weeks to assess the household financial impacts of these emergency presentations. At follow-up, patients were queried regarding health status, lost wages or schooling, household costs incurred due to their injury or illness, and assets sold. RESULTS 860 patients were enrolled and 675 patients (78%) completed follow-up surveys. Of those, 660 had a confirmed reason for visit - 303 (45%) road traffic injuries, 357 (53%) other emergency presentations (non-RTI) - encompassing medical presentations and other types of injury, and reason for visit was missing for 15 patients (2%). More than 90% of RTI patients were working or in school prior to their injury. In the economically productive ages (15-44 years) RTI predominated (70%) vs non-RTI (39%). RTI patients were more likely to report residual disability (78.2% RTI vs 68.1% non-RTI, p=0.004). All emergency patients reported difficulty paying for basic needs (food, housing and medical expenses). More than ⅓ of emergency patients reported having to sell assets in order to meet basic needs after their illness or injury. Despite similar hospital costs and fewer lost days of work for both patients and caregivers, the mean financial impact on households of RTI patients was 37% more than for non-RTI patients. These costs equalled between 6-16 weeks of income for patients based on their occupation type and median reported pre-hospitalization income. DISCUSSION Ugandan emergency care patients suffered significant personal and household economic hardship. In addition to the need for policy and infrastructural changes to improve road safety, these findings highlight the need for basic emergency care systems to secure economic gains in vulnerable households and prevent medical impoverishment of marginal communities.
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Affiliation(s)
- Hani Mowafi
- Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, USA.
| | - Brian Rice
- Stanford University, 900 Welch Rd, Suite 350, Palo Alto, CA, 94304, USA; Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA
| | - Rashida Nambaziira
- Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA
| | - Gloria Nirere
- Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA
| | | | - Matthew James
- Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, USA
| | - Gecc Writing Group
- Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA
| | - Mark Bisanzo
- Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA; University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA
| | - Lori Post
- Northwestern University, 211 E. Ontario St, Suite 200, Chicago, IL, 60611, USA
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