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Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry
Copyright policy )Background Child survival initiatives historically prioritized efforts to reduce child morbidity and mortality from infectious diseases and maternal conditions. Little attention has been devoted to paediatric injuries in resource‐limited settings. This study aimed to evaluate the demographics and outcomes of paediatric injury in a sub‐Saharan African country in an effort to improve prevention and treatment. Methods A prospective trauma registry was established at the two university teaching campuses of the University of Rwanda to record systematically patient demographics, prehospital care, initial physiology and patient outcomes from May 2011 to July 2015. Univariable analysis was performed for demographic characteristics, injury mechanisms, geographical location and outcomes. Multivariable analysis was performed for mortality estimates. Results Of 11 036 patients in the registry, 3010 (27·3 per cent) were under 18 years of age. Paediatric patients were predominantly boys (69·9 per cent) and the median age was 8 years. The mortality rate was 4·8 per cent. Falls were the most common injury (45·3 per cent), followed by road traffic accidents (30·9 per cent), burns (10·7 per cent) and blunt force/assault (7·5 per cent). Patients treated in the capital city, Kigali, had a higher incidence of head injury (7·6 per cent versus 2·0 per cent in a rural town, P < 0·001; odds ratio (OR) 4·08, 95 per cent c.i. 2·61 to 6·38) and a higher overall injury‐related mortality rate (adjusted OR 3·00, 1·50 to 6·01; P = 0·019). Pedestrians had higher overall injury‐related mortality compared with other road users (adjusted OR 3·26, 1·37 to 7·73; P = 0·007). Conclusion Paediatric injury is a significant contributor to morbidity and mortality. Delineating trauma demographics is important when planning resource utilization and capacity‐building efforts to address paediatric injury in low‐resource settings and identify vulnerable populations.
This study evaluated the demographics and outcomes of paediatric injury in Rwanda through a prospective trauma registry to inform capacity‐building for prevention and treatment. Patients treated in the capital city had a higher incidence of head injury and a higher overall injury‐related mortality than those in a rural town. Pedestrians had higher overall injury‐related mortality compared with other road‐users. Falls and road traffic accidents significant contributors to pediatric injury in Rwanda
Microsoft Academic Graph classification: medicine.medical_specialty Poison control Occupational safety and health Epidemiology Injury prevention medicine business.industry Mortality rate Incidence (epidemiology) Head injury Odds ratio medicine.disease Emergency medicine business
Library of Congress Subject Headings: lcsh:Surgery lcsh:RD1-811
Male, Emergency Medical Services, Adolescent, Humans, Prospective Studies, Registries, General, Child, Incidence, Infant, Newborn, Rwanda, Infant, Original Articles, General Medicine, Logistic Models, Child, Preschool, Multivariate Analysis, Wounds and Injuries, Original Article, Female
Male, Emergency Medical Services, Adolescent, Humans, Prospective Studies, Registries, General, Child, Incidence, Infant, Newborn, Rwanda, Infant, Original Articles, General Medicine, Logistic Models, Child, Preschool, Multivariate Analysis, Wounds and Injuries, Original Article, Female
Microsoft Academic Graph classification: medicine.medical_specialty Poison control Occupational safety and health Epidemiology Injury prevention medicine business.industry Mortality rate Incidence (epidemiology) Head injury Odds ratio medicine.disease Emergency medicine business
Library of Congress Subject Headings: lcsh:Surgery lcsh:RD1-811
- University of Florida United States
- University of Virginia United States
- University of Virginia
- Florida Southern College United States
- Kampala International University Tanzania (United Republic of)
3714
1 United Nations Inter‐agency Group for Child Mortality Estimation (UN‐IGME) . Levels and T rends in Child Mortality: Report 2017 https://www.unicef.org/publications/files/Child_Mortality_Report_2017.pdf [accessed 3 September 2019].
2 Wang H, Liddell CA, Coates MM, Mooney MD, Levitz CE, Schumacher AE et al Global, regional, and national levels of neonatal, infant, and under‐5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 957–979.24797572 [OpenAIRE] [PubMed]
3 Citron I, Chokotho L, Lavy C. Prioritisation of surgery in the National Health Strategic Plans of Africa: a systematic review. World J Surg 2016; 40: 779–783.26711637 [OpenAIRE] [PubMed]
4 Gajewski J, Bijlmakers L, Brugha R. Global Surgery – informing national strategies for scaling up surgery in sub‐Saharan Africa. Int J Health Policy Manag 2018; 7: 481–484.29935124 [OpenAIRE] [PubMed]
5 Price R, Makasa E, Hollands M. World Health Assembly Resolution WHA68.15: ‘Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage’ – addressing the public health gaps arising from lack of safe, affordable and accessible surgical and anesthetic services. World J Surg 2015; 39: 2115–2125.26239773 [OpenAIRE] [PubMed]
6 Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR et al An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 2008; 372: 139–144.18582931 [OpenAIRE] [PubMed]
7 Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367: 1747–1757.16731270 [PubMed]
8 WHO . Injuries and Violence: The Facts. WHO: Geneva, 2010.
9 WHO . Global Burden of Disease: 2004 Update. WHO: Geneva, 2008.
10 Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, Weigel JL. Reduced premature mortality in Rwanda: lessons from success. BMJ 2013; 346: f65.23335479 [OpenAIRE] [PubMed]
- National Institutes of Health (NIH)
- 5T32AI078875-02
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES
- National Institutes of Health (NIH)
- 5R24TW007988-04
- FOGARTY INTERNATIONAL CENTER
- University of Florida United States
- University of Virginia United States
- University of Virginia
- Florida Southern College United States
- Kampala International University Tanzania (United Republic of)
- University of Rwanda Rwanda
- Kampala International University Uganda
- Montreal Children's Hospital Canada
- Kampala International University Uganda
Background Child survival initiatives historically prioritized efforts to reduce child morbidity and mortality from infectious diseases and maternal conditions. Little attention has been devoted to paediatric injuries in resource‐limited settings. This study aimed to evaluate the demographics and outcomes of paediatric injury in a sub‐Saharan African country in an effort to improve prevention and treatment. Methods A prospective trauma registry was established at the two university teaching campuses of the University of Rwanda to record systematically patient demographics, prehospital care, initial physiology and patient outcomes from May 2011 to July 2015. Univariable analysis was performed for demographic characteristics, injury mechanisms, geographical location and outcomes. Multivariable analysis was performed for mortality estimates. Results Of 11 036 patients in the registry, 3010 (27·3 per cent) were under 18 years of age. Paediatric patients were predominantly boys (69·9 per cent) and the median age was 8 years. The mortality rate was 4·8 per cent. Falls were the most common injury (45·3 per cent), followed by road traffic accidents (30·9 per cent), burns (10·7 per cent) and blunt force/assault (7·5 per cent). Patients treated in the capital city, Kigali, had a higher incidence of head injury (7·6 per cent versus 2·0 per cent in a rural town, P < 0·001; odds ratio (OR) 4·08, 95 per cent c.i. 2·61 to 6·38) and a higher overall injury‐related mortality rate (adjusted OR 3·00, 1·50 to 6·01; P = 0·019). Pedestrians had higher overall injury‐related mortality compared with other road users (adjusted OR 3·26, 1·37 to 7·73; P = 0·007). Conclusion Paediatric injury is a significant contributor to morbidity and mortality. Delineating trauma demographics is important when planning resource utilization and capacity‐building efforts to address paediatric injury in low‐resource settings and identify vulnerable populations.
This study evaluated the demographics and outcomes of paediatric injury in Rwanda through a prospective trauma registry to inform capacity‐building for prevention and treatment. Patients treated in the capital city had a higher incidence of head injury and a higher overall injury‐related mortality than those in a rural town. Pedestrians had higher overall injury‐related mortality compared with other road‐users. Falls and road traffic accidents significant contributors to pediatric injury in Rwanda