scholarly journals Paediatric Trauma Burden in Tanzania: Analysis of Prospective Registry Data from Thirteen Health Facilities

2021 ◽  
Author(s):  
Hendry Robert Sawe ◽  
Sveta Milusheva ◽  
Kevin Croke ◽  
Saahil Karpe ◽  
Juma A Mfinanga
Keyword(s):  
Low Income ◽  
Road Traffic ◽  
Health Facilities ◽  
Road Traffic Crash ◽  
Trauma Patients ◽  
Middle Income ◽  
Fall From Height ◽  
Emergency Units ◽  
Serious Injuries ◽  
At Home

Abstract BackgroundTrauma is among the leading causes of morbidity and mortality among paediatric and adolescent populations worldwide, with over ninety percent of childhood injuries occurring in low-income and middle-income countries. Lack of region-specific data on paediatric injuries is among the major challenges limiting ability to implement interventions to prevent injuries and improve outcomes. We aimed to characterise the burden of paediatric injuries seen at thirteen diverse health facilities in Tanzania.MethodsThis was a prospective descriptive cohort study of children aged up to 18 years, and presenting to emergency units (EUs) of thirteen multi-level health facilities in Tanzania from 1st October 2019 to 30th September 2020. We describe injury patterns, mechanisms and early interventions performed at the emergency units of these health facilities.ResultsAmong 18,553 trauma patients seen in all thirteen-health facilities, 4368 (23.5%) were children, of whom 2894 (66.7%) were male. The overall median age was 8 years (Interquartile range 4-12 years). Fall 1592 (36.5%) and Road Traffic Crash (RTC) 840 (19.2%) were the top mechanisms of injury. Most patients 3748 (85.8%) arrived at EU directly from the injury site, using motorized (two or three) wheeled vehicles 2401 (55%). At EU 651 (14.9%) were triaged as an emergency category. Multiple superficial injuries (14.4%), fracture of forearm (11.7%), and open wounds (11.1%) were the top EU diagnoses, while 223 (5.2%) had intracranial injuries. Children aged 0-4 years had the highest proportion (16.3%) of burn injuries. Being referred, and being triaged as an emergency category was associated with high likelihood of serious injuries with risk ratio 3.3 (95%CI 2.7-4.0) and 2.3 (95% CI 2.0-2.8) respectively. 1095 (25.1%) of patients were admitted to inpatient care and 25 (0.6%) died in the EU.ConclusionsIn these multilevel health facilities in Tanzania, paediatric injuries accounted for nearly one-quarter of all injuries. Over half of injuries occurred at home. Fall from height was the leading mechanism of injury, followed by RTC. Most patients sustained fractures of extremities. Future studies of paediatric injuries should focus on evaluating various preventive strategies that can be instituted at home to reduce the incidence and associated impact of such injuries.

scholarly journals Strengthening the Capacity of Emergency Medical Services in Low and Middle Income Countries using Dispatcher-Coordinated Taxis

2020 ◽  
Vol 2674 (9) ◽  
pp. 338-345
Author(s):  
Vipul Mishra ◽  
Richa Ahuja ◽  
N. Nezamuddin ◽  
Geetam Tiwari ◽  
Kavi Bhalla
Keyword(s):  
Response Time ◽  
Emergency Medical Services ◽  
Road Traffic ◽  
International Standards ◽  
Medical Services ◽  
Road Traffic Crash ◽  
Middle Income ◽  
Middle Income Countries ◽  
Emergency Medical ◽  
Low And Middle Income

International standards recommend provision of one ambulance for every 50,000 people to fulfill demand for transporting patients to definitive care facilities in low and middle income countries (LMICs). Governments’ consistent attempt to build capacity of emergency medical services (EMS) in LMICs has been financially demanding. This study is an attempt to assess the feasibility of capacity building of existing EMS in Delhi, India by using taxis as an alternative mode of transport for emergency transportation of road traffic crash victims to enable improvement in response time for road traffic crashes where time criticality is deemed important. Performance of the proposed system is evaluated based on response time, coverage and distance. The system models the performance and quantifies the taxi–ambulance configuration for achieving EMS performance within international standards.

scholarly journals Factors Influencing Recovery among Children with Moderate Acute Malnutrition Treated at Kirehe District Health Centers

2020 ◽  
Vol 3 (1) ◽  
pp. 20-27
Author(s):  
Vianney Bihibindi Kabundi ◽  
Camille Kayihura ◽  
Onesmus Marete ◽  
Nicodeme Habarurema ◽  
Erigene Rutayisire
Keyword(s):  
Low Income ◽  
Family Income ◽  
Health Facilities ◽  
Health Centers ◽  
Acute Malnutrition ◽  
District Health ◽  
Middle Income ◽  
Factors Associated ◽  
Income Status ◽  
Moderate Acute Malnutrition

Acute malnutrition affects nearly 52 million of under five years children globally, 75% of them live in low to middle income countries. The treatment of acute malnutrition using supplement foods could help children recovering and could reduce the risk of sickness. The present study investigated the factors associated with recovery among children with moderate acute malnutrition (MAM) under a follow-up program at health facilities. A prospective study was conducted in 16 health centers of Kirehe District of Rwanda and included 200 children from 6 to 59 months. A semi-structured questionnaire was used for data collection. All children enrolled in the study spent three months in nutrition program at health centers. The results show that after 3 months in the program 77.5% recovered from MAM. Children aged above 36 to 59 months were recovered at 90% whereas children aged from 24-35 months were recovered at 73.5%. Micronutrients and deworming provided at health facility were contributed to the recovery as children who received them were recovered at 89.1% and for those who didn’t were recovery at 72.1%. The findings demonstrated that boys were 16 times more likely to recover from MAM in three months of intervention than girls (AOR=16.19, p<0.001, 95% CI: 5.39- 48.63). Children from moderate income families were 3 more likely to recover than those from very low income families (AOR=2.8, p=0.029, 95% CI: 1.11-7.51). Male gender, receiving micronutrients and deworming from health facilities and family income status were factors associated with MAM recovery status

scholarly journals Establishment of a road traffic trauma registry for northern Sri Lanka

2020 ◽  
Vol 5 (1) ◽  
pp. e001818 ◽  
Author(s):  
Thayasivam Gobyshanger ◽  
Alison M Bales ◽  
Claire Hardman ◽  
Mary McCarthy
Keyword(s):  
Sri Lanka ◽  
Low Income ◽  
Trauma Registry ◽  
Road Traffic ◽  
Prehospital Care ◽  
Public Health Problem ◽  
Global Public Health ◽  
Middle Income ◽  
Road Traffic Crashes ◽  
Middle Income Countries

Road traffic injuries are a neglected global public health problem. Over 1.25 million people are killed each year, and middle-income countries, which are motorising rapidly, are the hardest hit. Sri Lanka is dealing with an injury-related healthcare crisis, with a recent 85% increase in road traffic fatality rates. Road traffic crashes now account for 25 000 injuries annually and 10 deaths daily. Development of a trauma registry is the foundation for injury control, care and prevention. Five northern Sri Lankan provinces collaborated with Jaffna Teaching Hospital to develop a local electronic registry. The Centre for Clinical Excellence and Research was established to provide organisational leadership, hardware and software were purchased, and data collectors trained. Initial data collection was modified after implementation challenges were resolved. Between 1 June 2017 and 30 September 2017, 1708 injured patients were entered into the registry. Among these patients, 62% were male, 76% were aged 21–50, 71.3% were motorcyclists and 34% were in a collision with another motorcyclist. There were frequent collisions with uncontrolled livestock (12%) and with fixed objects (14%), and most patients were transported by private vehicles without prehospital care. Head (n=315) and lower extremity (n=497) injuries predominated. Establishment of a trauma registry in low-income and middle-income countries is a significant challenge and requires invested local leadership; the most challenging issue is ongoing funding. However, this pilot registry provides a valuable foundation, identifying unique injury mechanisms, establishing priorities for prevention and patient care, and introducing the concept of an organised system to this region.

scholarly journals Global trends in adolescents’ road traffic injury mortality, 1990–2019

2021 ◽  
pp. archdischild-2020-319184
Author(s):  
Uzma Rahim Khan ◽  
Junaid A Razzak ◽  
Martin Gerdin Wärnberg
Keyword(s):  
Low Income ◽  
Road Traffic ◽  
Mortality Rates ◽  
Road Traffic Injury ◽  
Low Income Countries ◽  
Middle Income ◽  
Income Levels ◽  
Middle Income Countries ◽  
Traffic Injury ◽  
Road Users

ObjectiveThe aim of this study was to determine the trends of road traffic injury (RTI) mortality among adolescents aged 10–14 years and 15–19 years across different country income levels with respect to the type of road users from 1990 to 2019.MethodsWe conducted an ecological study. Adolescents’ mortality rates from RTIs at the level of high-income countries (HICs), upper-income to middle-income countries (UMICs), lower-income to middle-income countries and low-income countries were extracted from the Global Burden of Disease study. Time series were plotted to visualise the trends in mortality rates over the years. We also conducted Poisson regression using road traffic mortality rates as the dependent variable and year as the independent variable to model the trend of the change in the annual mean mortality rate, with incidence rate ratios (IRRs) and 95% CIs.ResultsThere were downward mortality trends in all types of road users and income levels among adolescents from 1990 to 2019. HICs had more pronounced reductions in mortality rates than countries of any other income level. For example, the reduction in pedestrians in HICs was IRR 0.94 (95% CI 0.90 to 0.98), while that in UMICs was IRR 0.97 (95% CI 0.95 to 0.99) in adolescents aged 10-14 years.ConclusionsThere are downward trends in RTI mortality in adolescents from 1990 to 2019 globally at all income levels for all types of road users. The decrease in mortality rates is small but a promising finding. However, prevention efforts should be continued as the burden is still high.

scholarly journals Development and pilot study road traffic injury surveillance, Kaduna Nigeria

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Obafemi J. Babalola
Keyword(s):  
Sustainable Development ◽  
Surveillance System ◽  
Road Traffic ◽  
Seat Belt ◽  
Road Traffic Injury ◽  
Injury Surveillance ◽  
Health Facilities ◽  
World Health ◽  
Middle Income ◽  
Traffic Injury

ObjectiveWe pilot a RTI surveillance system using data from FRSC, Policemotor traffic division and Health facilities in Kaduna metropolis,Nigeria to ascertain its feasibility and generate data needed for actiontoward achieving sustainable development goals 3.6 target.IntroductionRoad Traffic Injury is common cause of unintentional injuryglobally and Low and middle income countries account for 90%of 1.3 million Road Traffic Injury (RTI) deaths. In Africa region,Nigeria accounts for 25% of RTI mortality but has no comprehensiveand reliable RTI surveillance system. Data from Federal RoadSafety Commissions (FRSC) shows gaps in RTI reporting with largedisparity with estimated value from World Health Organization.MethodsKaduna metropolis is the capital of Kaduna State with estimatedpopulation of 1.96 million. It is a major route between Abuja, theNational capital and 15 northern Nigeria states with high vehicularmovement. We adapted WHO Injury surveillance guideline andCenters for Disease Control and Prevention surveillance trainingmanual for this study. A case of RTI is any person injured or diedwithin 30 days as a result injuries incurred from vehicular collision ona public road in Kaduna Metropolis. Data collected using a pretestedquestionnaire for RTI cases at health facilities, Police and FRSC.Data were linked by deterministic method, cleaned and analysed.Frequency and proportion were calculated to characterize the RTI.The study was supported by a mini-grant from Center for DiseaseControl and Prevention.ResultsData was collected from February to April 2016. Of the 324crashes reported, 566 people injured and 66 deaths with case fatalityrate of 11.7%. Male gender accounts for 81.8% and age 20 – 39 yearswere 64.6%. Commercial drivers were 20.7%, pedestrian 21% andpassengers were 53.7%. Sixty percent of the crash occurred betweencars or buses while 21% were without collision with any vehicle orstationary objects. Of the 66 deaths reported 61(92.4%) died at crashsite. FRSC evacuated 21%, 38.6% were evacuated by other road users.No use of seat belt and crash helmets reported and only 5.1% receivedfirst aid care before reaching reporting facility. RTI Incidence peakedbetween 6:00 PM to 8:59 PM with 26 persons per hour.ConclusionsEssential to sustainable development goal 3, a multisectorRTI surveillance system that generate data for action in Kadunametropolis, Nigeria is feasible and data generated was used for actionat different levels to mitigate against the burden of RTI

scholarly journals Analysis of Pedestrian-Vehicle Crashes Using Artificial Learning Methods: City of Sakarya Case Study

2021 ◽  
Vol 4 (2) ◽  
pp. 221-230
Author(s):  
Zeliha Cagla Kuyumcu ◽  
Suhrab Ahadi ◽  
Hakan Aslan
Keyword(s):  
Low Income ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Low Income Countries ◽  
Road Traffic Crash ◽  
Traffic Crashes ◽  
Road Traffic Crashes ◽  
Traffic Crash ◽  
Artificial Learning

The lives of approximately 1.3 million people are cut short every year as a result of road traffic crashes. Between 20 and 50 million people suffer non-fatal injuries, with many incurring a disability as a result of their injury. The risk of dying in a road traffic crash is more than 3 times higher in low-income countries than in high-income countries [1]. In Turkey, 18% of traffic accidents was related to pedestrian-vehicle collisions in urban roads in 2020. In addition, 20% of death toll caused by accidents is pedestrians in 2020 [2]. This study deals with the some of classifiers to forecast the number of injuries as a result of traffic accidents. The classifier’s performance ratios were also examined.

scholarly journals Etiology, pattern and outcome of management of facial lacerations in Dar es Salaam, Tanzania

2020 ◽  
Vol 21 (2) ◽  
pp. 1-10
Author(s):  
Karpal Singh Sohal ◽  
Jeremiah Robert Moshy
Keyword(s):  
Road Traffic ◽  
Tissue Injury ◽  
Maxillofacial Surgery ◽  
Soft Tissue Injury ◽  
Health Facilities ◽  
Road Traffic Crash ◽  
Oral And Maxillofacial Surgery ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Female Ratio

Background: Facial laceration is amongst the commonly encountered soft tissue injury in the care of the traumatized patients, and its optimal treatment is important for minimizing subsequent complications. This study aimed at determining the etiology, pattern, and outcome of management of facial lacerations among patients attended at Muhimbili National Hospital, Tanzania. Methods: This was a four months’ prospective study of all consecutive patients with facial lacerations who were attended in the department of oral and maxillofacial surgery of the Muhimbili National Hospital (MNH). The variables examined included socio-demographic characteristics, etiology of a facial laceration, prior management before referral to MNH, and the outcome of treatment. The data were analysed using IBM SPSS statistics for windows version 22 (Armonk, NY: IBM Corp) software. Results: Seventy-six patients with facial lacerations were included in the study. The male to female ratio was 8:1. The age of the patients ranged from 16 to 57 years, with a mean age of 31.63 ± 10.02 years. Motor traffic crashes (51, 67.1%), violence (18, 23.7%) and falls (7, 9.2%) were the etiological factors. The commonest affected facial esthetic zones were forehead (25, 32.9%), and the upper lip (24, 31.6%). The majority (60%) of wounds that were sutured/repaired in other health facilities prior to referral to MNH had a poor approximation of wound edges. Scarring was the commonest complication. Conclusion: Facial laceration affected males eight times more than females. Road traffic crash was the most common etiological factor. The forehead was the most frequently affected facial esthetic zone. The majority of patients treated in other health facilities prior to referral to a tertiary hospital had poorly approximated wound edges. Scarring was the most common complication of facial lacerations.

scholarly journals Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance

2021 ◽  
pp. archdischild-2020-321198
Author(s):  
Dan Magnus ◽  
Santosh Bhatta ◽  
Julie Mytton ◽  
Elisha Joshi ◽  
Sumiksha Bhatta ◽  
...  
Keyword(s):  
Low Income ◽  
Emergency Departments ◽  
Road Traffic ◽  
Injury Surveillance ◽  
Child Injury ◽  
Middle Income ◽  
Road Traffic Injuries ◽  
Number Of Children ◽  
Significant Burden ◽  
Injury Burden

BackgroundGlobally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5–24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited.MethodsA new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations.ResultsThe total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%.ConclusionInjuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.

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