Injuries In Uganda Research Articles

Boda Bodas and Road Traffic Injuries in Uganda

Feng, Austin Y BS; Vaca, Silvia D BS; Ku, Seul; Jin, Michael C; Kakusa, Bina BS; Ho, Allen L MD; Zhang, Michael MD; Fuller, Anthony; Haglund, Michael M MD, PhD; Grant, Gerald A MD Author Information

Pre-participation Evaluations And The Relative Risk Of Injuries In Ugandan Sports

PURPOSE: The aim of this study was to examine the relative risk of sports injuries based on pre-participation evaluation among Uganda athletes. METHODS: This cohort included 546 athletes, > or = 18 years old, who were free from injury at the beginning of the study. This investigation focused on the relative risk of injuries from 4 main sports (football/soccer n= 161, track and field, n= 106, basketball, n = 120 and rugby, n= 159). RESULTS: After a one year follow up, seventy- five lost-time injuries (n= 75) in both male and female athletes who sustained abrasions, concussion, contusion, dislocations, laceration, fainting, fractures, sprains and strain injuries were reported. There was an increased risk of sports injuries among athletes who didn’t undergo pre-participation evaluation compared to those who did. The relative risk for sports injuries in athletes without pre-participation evaluation was greater in rugby (relative risk, 21.8, 95% CI, 13.6 - 33.88), followed by football/soccer (relative risk, 21.6, 95% CI, 3.1 - 33.78), followed by track and field (relative risk, 14.1, 95% CI, 9.0- 23.17) and basketball (relative risk, 12.2, 95% CI, 7.56 to 19.63). CONCLUSION: Pre-participation evaluation is an important risk factor in sports injury acquisition. Our findings reveal gaps in practice among personnel involved in the prevention of sports-related injuries in Uganda, thus warranting specific sports regulations.

Boda Bodas and Road Traffic Injuries in Uganda: An Overview of Traffic Safety Trends from 2009 to 2017.

Introduction: Road traffic injuries (RTIs) are an important contributor to the morbidity and mortality of developing countries. In Uganda, motorcycle taxis, known as boda bodas, are responsible for a growing proportion of RTIs. This study seeks to evaluate and comment on traffic safety trends from the past decade. Methods: Traffic reports from the Ugandan police force (2009 to 2017) were analyzed for RTI characteristics. Furthermore, one month of casualty ward data in 2015 and 2018 was collected from the Mulago National Referral Hospital and reviewed for casualty demographics and trauma type. Results: RTI motorcycle contribution rose steadily from 2009 to 2017 (24.5% to 33.9%). While the total number of crashes dropped from 22,461 to 13,244 between 2010 and 2017, the proportion of fatal RTIs increased from 14.7% to 22.2%. In the casualty ward, RTIs accounted for a greater proportion of patients and traumas in 2018 compared to 2015 (10%/41% and 36%/64%, respectively). Conclusions: Although RTIs have seen a gross reduction in Uganda, they have become more deadly, with greater motorcycle involvement. Hospital data demonstrate a rising need for trauma and neurosurgical care to manage greater RTI patient burden. Combining RTI prevention and care pathway improvements may mitigate current RTI trends.

Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda

BackgroundTraumatic brain injuries in Uganda are on the increase, however little is known about the neuropsychological outcomes in survivors. This study characterized patients with traumatic brain injury (TBI) and the associated six-month neuropsychological outcomes in a Ugandan tertiary hospital.MethodsPatients admitted at Mulago Hospital with head injury from November 2015 to April 2016 were prospectively enrolled during admission and followed up at six months after discharge to assess cognition, posttraumatic stress symptoms (PTSS), depression symptoms and physical disability. The outcomes were compared to a non-head-injury group recruited from among the caretakers, siblings and neighbours of the patients with age and sex entered as covariates.ResultsOne hundred and seventy-one patients and 145 non-head injury participants were enrolled. The age range for the whole sample was 1 to 69 years with the non-head injury group being older (mean age (SD) 33.34 (13.35) vs 29.34 (14.13) years of age, p = 0.01). Overall, motorcycle crashes (36/171, 38.6%) and being hit by an object (58/171, 33.9%) were the leading causes of TBI. Head injury from falls occurred more frequently in children < 18 years (13.8% vs 2.8%, p = 0.03). In adults 18 years and older, patients had higher rates of neurocognitive impairment (28.4% vs 6.6%, p < 0.0001), PTSS (43.9% vs 7.9%, p < 0.0001), depression symptoms (55.4% vs 10%, p < 0.0001) and physical disability (7.2% vs 0%, p = 0.002). Lower Glasgow Coma Score (GCS) on admission was associated with neurocognitive impairment (11.6 vs 13.1, p = 0.04) and physical disability (10 vs 12.9, p = 0.01) six months later.ConclusionThis first such study in the East-African region shows that depth of coma on admission in TBI is associated with neurocognitive impairment and physical disability.

Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry

BackgroundTraumatic brain injury (TBI) is an important cause of morbidity and mortality in low/middle-income countries. The objective was to assess causes and outcomes of unintentional and intentional TBI among patients...

Epidemiology of non-traumatic spinal cord injury in Uganda: a single center, prospective study with MRI evaluation

BackgroundA few reliable national data concerning the etiology of non-traumatic spinal cord injury (SCI) in sub-Sahara Africa exists, mainly because of the limitations of diagnostic imaging. These are both expensive and mostly unavailable in several resource-limited settings. Only a few studies have employed the magnetic resonance imaging (MRI) in documenting non-traumatic SCI and most of these studies are from South Africa. We sought to describe the clinical presentation, MRI radiological patterns, and one-year survival among subjects with non-traumatic SCI in Uganda.MethodsWe enrolled a prospective cohort of 103 participants with non-traumatic SCI at Mulago National Referral Hospital Kampala, Uganda in 2013–2015. Participants received standard of care management, with surgical intervention as needed, with one-year follow up. Data were analyzed using Descriptive statistics.ResultsIn 103 participants with non-traumatic SCI, the median (IQR) age was 37 (18, 85) years and 25% of the participants were HIV-infected. Paraplegia/paraparesis was the most common clinical presentation in 70% (n = 72). Severe disease was present in 82% (n = 85) as per American Spinal Injury Association (ASIA) scale A-C. On MRI, 50% had extradural lesions. However, bone lesions accounted for only 75% of all the extradural lesions. More than 60% of the patients had lesions that could only be diagnosed on MRI. Deaths occurred in 42% (n = 44) of participants, with the highest mortality among those with extradural lesions (60%).ConclusionThe mortality following non-traumatic spinal cord injuries in Uganda is high. We demonstrated an equal distribution between extradural and intradural lesions, which differs from the historical predominance of extradural lesions. Increased utilization of MRI particularly among young age groups is needed to make a diagnosis.

Road traffic injuries in Uganda: pre-hospital care time intervals from crash scene to hospital and related factors by the Uganda Police

A cross-sectional survey was conducted to collect primary data prospectively on pre-hospital care time intervals of Road Traffic Crash (RTC) victims that had been rescued by the Uganda police and to determine what factors were related to those intervals. The survey was conducted between 1 May 2015 and 31 May 2015. The Police responses to 96 RTCs were recorded, but only 74 of them were considered serious enough to warrant hospital transfer, and those 74 are the subject of the analysis. Pre-hospital care time ranged between 10 and 220 min. Seventy-two per cent of the calls were completed within 1 h of call initiation. The scene to hospital transport interval was the longest with a mean of 19.07 min (SD 10.11). Activation time was the shortest interval with a mean of 4.58 min (SD 5.67). Key factors for delays included: understaffing, lack of skills and long distances. A toll-free Universal Access Number, a law mandating provision of free basic emergency medical services at every health facility and gazetting of lanes for emergency services and might decrease on pre-hospital care time and could reduce on the notification and transport time interval respectively.

Postgraduate training for trauma prevention, injury surveillance and research, Uganda.

ProblemThe burden of trauma and injuries in Uganda is substantial and growing. Two important gaps that need addressing are the shortage of trained people and a lack of national data on noncommunicable diseases and their risk factors in Uganda.ApproachWe developed and implemented a new track within an existing master of public health programme, aimed at developing graduate-level capacity and promoting research on key national priorities for trauma and injuries. We also offered training opportunities to a wider audience and set up a high-level national injury forum to foster national dialogue on addressing the burden of trauma, injuries and disability.Local settingThe Chronic Consequences of Trauma, Injuries and Disability in Uganda programme was implemented in 2012 at Makerere University School of Public Health in Kampala, Uganda, in conjunction with Johns Hopkins Bloomberg School of Public Health in Baltimore, United States of America.Relevant changesOver the years 2012 to 2017 we supported four cohorts of master’s students, with a total of 14 students (9 females and 5 males; mean age 30 years). Over 1300 individuals participated in workshops and seminars of the short-term training component of the programme. The forum hosted three research symposia and two national injury forums.Lessons learntInstitutional support and collaborative engagement is important for developing and implementing successful capacity development programmes. Integration of training components within existing academic structures is key to sustainability. Appropriate mentorship for highly motivated and talented students is valuable for guiding students through the programme.

Etiologies and Outcomes among Non-Traumatic Spinal Cord Injuries in Uganda (P5.155)

Etiologies and Outcomes among Non-Traumatic Spinal Cord Injuries in Uganda (P5.155)

The Socioeconomic Implications of Isolated Tibial and Femoral Fractures from Road Traffic Injuries in Uganda.

The purpose of this study was to determine the socioeconomic implications of isolated tibial and femoral fractures caused by road traffic injuries in Uganda. This prospective longitudinal study included adult patients who were admitted to Uganda's national referral hospital with an isolated tibial or femoral fracture. The primary outcome was the time to recovery following injury. We assessed recovery using 4 domains: income, employment status, health-related quality of life (HRQoL) recovery, and school attendance of the patients' dependents. The majority of the study participants (83%) were employed, and they were the main income earner for their household (74.0%) at the time of injury, earning a mean annual income of 2,375 U.S. dollars (USD). All of the patients had been admitted with the intention of surgical treatment; however, because of resource constraints, only 56% received operative treatment. By 2 years postinjury, only 63% of the participants had returned to work, and 34% had returned to their previous income level. Overall, the mean monthly income was 62% less than preinjury earnings, and participants had accumulated 1,069 USD in debt since the injury; 41% of the participants had regained HRQoL scores near their baseline, and 62% of school-aged dependents, enrolled at the time of injury, were in school at 2 years postinjury. At 2 years postinjury, only 12% of our cohort of Ugandan patients who had sustained an isolated tibial or femoral fracture from a road traffic injury had recovered both economically and physically. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Mechanism of Pediatric Traumatic Brain Injury in Southwestern Uganda: AProspective Cohort of 100 Patients.

Road traffic incidents (RTIs), falls, and violence contribute to more than two thirds of pediatric traumatic brain injuries in sub-Saharan Africa. In this study, we sought to assess mechanisms of pediatric traumatic brain injury in an effort to propose interventions for more effective pediatric head injury prevention. A cohort of 100 patients who were <18 years treated at Mbarara Regional Referral Hospital between November 2016 and June 2017 were enrolled in the study. Information on etiology of injury was obtained via a questionnaire administered to patient caretakers at the time of admission. The mean age was found to be 7.5 years (standard deviation 5.2) and 38% were female. In our sample, 61% had computed tomography imaging done, of whom 88.5% had a positive finding. A majority of patients presented with a mild head injury (55%). RTIs were the predominant mechanism of injury across age groups (75%). Across all age groups, falls were responsible for a greater proportion of injuries in children aged 10-14 years (13.3%), whereas the greatest proportion of intentional injuries was reported in age group 10-14 and 15-17 years, 20% and 31.3%, respectively. Patients involved in pedestrian RTIs were significantly younger compared with those injured in nonpedestrian RTIs. Most parents (87.9%) were not with their children at the time of a pedestrian RTI. In Southwestern Uganda, the majority of pediatric neurotrauma patients are injured pedestrians, with no adult supervision at the time of the injury. Conducting a public awareness and education campaign on the necessity of child supervision is critical to decreasing pediatric head injuries in Uganda.

An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study.

IntroductionGobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015.MethodsWe obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics.ResultsA total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected.ConclusionRoad traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions.

Analysis of a five year (2011-2015), trends and distribution of the burden of road traffic injuries in Uganda: a retrospective study

Introduction : globally, 1.25 million lives are lost to road traffic injuries every year. Over ninety percent occur in Low and Middle-Income Countries despite owning just about half of the world’s vehicles. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the Police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted intervention. This study describes the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015. Methods : monthly data on road traffic injuries, from 112 districts, obtained from Ministry of Health was analyzed retrospectively. The districts were grouped into ten sub regions as per Uganda Demographic Health Survey 2011 and analysis done to generate descriptive statistics. Results : a total of 645,805 road traffic injuries were reported between January 2011 and December 2015 and 2807 deaths reported between 2011 and 2014. Injuries increased more than five times from 37,219 in 2011 to 222,267 in 2014, and sharply dropped in 2015 to 57,149. Kampala had the highest 18.3% (117,950/645,805) injuries and deaths 22.6% (634/2807) whereas Karamoja had the lowest 1.7% (10,823/645,805) injuries and 0.8% (21/2807) deaths respectively. Under-fives accounted for 21.9% (615/2807) deaths, mostly females 81% (498/615). Conclusion : there was a more than five-fold increase of road traffic injuries in 2014 from 2011. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries, as such, it is likely that the burden of these injuries is higher but under reported. This data is only from health facilities, hence do not reflect deaths at pre-hospital. Concerted efforts are needed to link pre-hospital deaths to understand the burden of road traffic crashes and appropriate interventions.

More than just a beating: the burden of injuries due to gender based violence in Uganda - a 5 year analysis

Introduction : globally, injuries are a growing public health problem; with about 5 million deaths annually. Gender-Based Violence (GBV) is one of the neglected causes of these injuries that is silently affecting lives of many women and men. In Uganda, 56% of women and 55% of men aged between 15 and 49 years’ experience physical violence at some point in life. GBV has fatal and non-fatal consequences that greatly affect one’s health and social wellbeing. Methods : we analyzed data from 2011 to 2015 from the Health Management Information System (HMIS) regarding Gender-Based Violence in Uganda. The HMIS is a national system for routine collection and reporting of data on key health indicators. Univariate analysis was done according to regions in Uganda as per the Uganda Demographic and Health Survey 2011. Results : of the patients with injuries, 4.97 (n = 178,489/3,593,312) presented with injuries due to GBV. The most at risk were females and patients aged 5 years and above were the most victims at 59.8% and 93.4% respectively. Patients from the Northern region presented with the highest number of injuries (20.6%). There was an upward trend of injuries from 2011 up to a peak in 2013. Conclusion : close to 5% of the Injuries in Uganda are due to GBV and although presenting more in females, it affects people of all ages. The government should strengthen existing programs to eliminate the root causes of GBV through inter-sectoral collaboration. Reporting of injuries and seeking medical care should be prioritized by the victims with a supportive environment by the government.

Road traffic incidents in Uganda: a systematic review study of a five-year trend.

:Background:Over the years, Uganda has been one of the low and middle-income countries bearing the heaviest burden of road traffic incidents (RTI). Since the proclamation of the United Nations Decade of Action for Road Safety 2011 – 2020, a number of measures have been taken to reduce the burden. However, they ought to be premised on existing evidence-based research; therefore, the present review ventures to report the most recent five-year trend of RTI in Uganda.Methods:Based on Preferred Reporting Items for Systematic Reviews and Meta-Data Analysis (PRISMA) guidelines, a systematic review was employed. Using a thematic analysis, the articles were grouped into: trauma etiology, trauma care, mortality, cost, trauma registry and communication, intervention and treatment for final analysis. Results:Of the nineteen articles that were identified to be relevant to the study, the etiology of RTI was inevitably observed to be an important cause of injuries in Uganda. The risk factors cut across: the crash type, injury physiology, cause, victims, setting, age, economic status, and gender. All studies that were reviewed have advanced varying recommendations aimed at responding to the trend of RTIs in Uganda, of which some are in tandem with the five pillars of the United Nations Decade of Action for Road Safety 2011 – 2020. Conclusions:Peripheral measures of the burden of RTIs in Uganda were undertaken within a five-year timeframe (2011-2015) of implementing the United Nations Decade of Action for Road Safety. The measures however, ought to be scaled-up on robust evidence based research available from all the concerned stakeholders beyond Kampala or central region to other parts of Uganda.

Epidemiology of child injuries in Uganda: challenges for health policy.

Globally, 90% of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden, with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala, Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. Data were collected when patients were seen initially and included patient condition, demographics, clinical variables, cause, severity, as measured by the Kampala trauma score, and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005, 872 injury visits for children <18 years old were recorded. The mean age was 11 years (95% CI 10.9–11.6); 68% (95% CI 65–72%) were males; 64% were treated in casualty and discharged; 35% were admitted. The most common causes were traffic crashes (34%), falls (18%) and violence (15%). Most children (87%) were mildly injured; 1% severely injured. By two weeks, 6% of the patients admitted for injuries had died and, of these morbidities, 16% had severe injuries, 63% had moderate injuries and 21% had mild injuries. We concluded that, in Kampala, children bear a large burden of injury from preventable causes. Deaths in low severity patients highlight the need for improvements in facility based care. Further studies are necessary to capture overall child injury mortality and to measure chronic morbidity owing to sequelae of injuries.

Estimating the burden of injuries in Uganda from all available data sources

BackgroundEstimating injury burden in low income countries is hampered by lack of structured nationally representative data collection systems.ObjectiveTo demonstrate the construction of estimates of the national burden of injuries using...

Estimates of the gross domestic product loss due to violence in Uganda

IntroductionThere is lack of information on economic cost of violent related injuries in Uganda. The study estimates both direct and indirect costs incurred as a result of interpersonal and self...

A self critique of a decade of injury research by the Injury Control Center Uganda (ICCU)

BackgroundThe ICCU has been doing injury research, advocacy and training for the last 12 years. Here we provide a review of their findings to provide coherent information and identify priorities...

Musculoskeletal Trauma Services in Uganda

Approximately 2000 lives are lost in Uganda annually through road traffic accidents. In Kampala, they account for 39% of all injuries, primarily in males aged 16-44 years. They are a result of rapid motorization and urbanization in a country with a poor economy. Uganda's population is an estimated 28 million with a growth rate of 3.4% per year. Motorcycles and omnibuses, the main taxi vehicles, are the primary contributors to the accidents. Poor roads and drivers compound the situation. Twenty-three orthopaedic surgeons (one for every 1,300,000 people) provide specialist services that are available only at three regional hospitals and the National Referral Hospital in Kampala. The majority of musculoskeletal injuries are managed nonoperatively by 200 orthopaedic officers distributed at the district, regional and national referral hospitals. Because of the poor economy, 9% of the national budget is allocated to the health sector. Patients with musculoskeletal injuries in Uganda frequently fail to receive immediate care due to inadequate resources and most are treated by traditional bonesetters. Neglected injuries typically result in poor outcomes. Possible solutions include a public health approach for prevention of road traffic injuries, training of adequate human resources, and infrastructure development.