Traumatic injury in Sierra Leone: results from a nationwide survey

Abstract

BackgroundTraumatic injuries are an important cause of disability and mortality worldwide and more than 90% of injury-related deaths occur in low-income and middle-income countries. Despite its overall significance, little information exists about the burden of injuries in developing countries. We aim to estimate the prevalence of traumatic injuries, describe injury mechanisms, and assess the degree of associated disability in Sierra Leone. MethodsWe used the Surgeons OverSeas Assessment of Surgical Need instrument to do a nationwide population-based survey in Sierra Leone in January 2012. We used a two-stage random sampling method to generate a target population of 3750 participants across the 14 districts of Sierra Leone. In the first stage of sampling, 75 clusters were randomly chosen (with a random calculator program on the iPad) with a probability proportional to population stratified for urban and rural settings. In the second stage, 25 households within each cluster were randomly selected. Each participant had a verbal head to toe examination to record information about timing of injuries, mechanism of injury, body regions involved, and injury-related disability. The head of each participating household provided information about injury-related deaths within the household in the preceding year. We used bivariate logistic regression models to test associations between sociodemographic factors (age, sex, residency, occupation, and education) and injury. We did the analyses with SAS OnDemand Enterprise Guide (version 4.3). FindingsWe obtained data from 1843 households and 3645 respondents, yielding a response rate of 97·2%. 1316 injuries were reported in total. 486 respondents (13%) reported at least one traumatic injury in the preceding year. Falls were the most common cause of injury, accounting for 563 cases (43%). Extremities were the most frequently injured body region (n=720, 55%). Of the 57 reported injuries to the groin, 24 (42%) were associated with disability. 14 (25%) of these groin injuries prevented the person from working as they did before the injury. Although injuries related to motor vehicles were uncommon (4th most common overall), they were the leading cause of injury-related deaths, accounting for 13 of 41 deaths (32%). The odds of having a traumatic injury in the previous year were not significantly different between groups when analysed for residency, occupation, or education level. However, women were less likely to have had a traumatic injury in the previous year compared with men (odds ratio [OR] 0·69, 95% CI 0·57–0·83). Also, elderly people were less likely to have had a traumatic injury in the previous year compared with children (OR 0·51, 95% CI 0·31–0·83). InterpretationThis study provides baseline data for the burden of traumatic injuries in a poor country. In addition to injury-prevention measures, strategies to address current injury-related health problems are urgently needed in such resource-poor areas. FundingSurgeons OverSeas, Sierra Leone Ministry of Health & Sanitation, College of Medicine and Allied Health Sciences, Connaught Hospital, Stanford University.