Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry.

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.

ANTECEDENTES: Históricamente, las iniciativas relativas a la supervivencia pediátrica han priorizado los esfuerzos para reducir la morbilidad y la mortalidad debida a enfermedades infecciosas y patología materna. Se ha prestado escasa atención a los traumatismos en pediatría en entornos de recursos limitados. El objetivo de este estudio ha sido evaluar la demografía y los resultados de los traumatismos pediátricos en un país del África subsahariana en un intento para mejorar la prevención y el tratamiento. MÉTODOS: Se estableció un registro prospectivo de traumatismos en dos campus universitarios de Ruanda para recoger sistemáticamente las características demográficas, atención pre-hospitalaria, fisiología inicial y resultados, de mayo de 2011 a julio de 2015. Se efectuó un análisis univariado para los datos demográficos, mecanismos del traumatismo, localización geográfica y resultados. Para las estimaciones de mortalidad se llevó a cabo un análisis multivariable. RESULTADOS: De un total de 11.036 pacientes incluidos en el registro, 3.010 (27,3%) tenían menos de 18 años. Los pacientes pediátricos eran predominantemente varones (69,9%) con una edad media de 8,3 años. Las caídas fueron la causa más frecuente del traumatismo (45,3%) seguidas de los accidentes de tráfico (30,9%), quemaduras (10,7%) y traumatismo cerrado/asalto (7,5%). Los pacientes tratados en la capital presentaban una incidencia más elevada de traumatismos craneales (7,5% versus 2,0%, P < 0,0001, razón de oportunidades, odds ratio, OR 4,08, i.c. del 95% 2,6-6,4) y una mayor mortalidad global relacionada con el traumatismo (P = 0,019, OR ajustado 3,00, i.c. del 95% 1,5-6,0). Los peatones presentaron una mortalidad global relacionada con el traumatismo más alta en comparación con otros usuarios de la carretera (P = 0,0074, OR ajustado 3,26, i.c. del 95% 1,37-7,73). CONCLUSIÓN: Los traumatismos pediátricos contribuyen significativamente a la morbilidad y mortalidad. Delinear la demografía de los traumatismos es importante a la hora de planificar el uso de recursos y el desarrollo de capacidades dirigidas al esfuerzo para abordar los traumatismos pediátricos en entornos de bajos recursos e identificar poblaciones vulnerables.

Profie and Economic Impact of Motorcycle Injuries Treated at a University Referral Hospital in Kigali; Rwanda

Background: Motorcycle injuries constitute a major public health problem in developing countries; leading to significant disability and straining healthcare resources. We aim to present the basic epidemiology of motorcycle injuries presenting to an urban referral hospital in Rwanda and to evaluate patient outcomes and associated costs arising from injuries sustained on motorcycles. Methods: We conducted a retrospective cross-sectional study of motorcycle injury patients presenting to Kigali Teaching University Hospital from January-December; 2011. Patients were identified through review of ward registers and trauma registries and stratified into 3 groups based upon length of stay. A representative sample of 269 patients was randomly selected from each group for financial analysis. Data were collected from patient medical; police; and financial records as well as patient interviews. Cost analysis was based upon the standard road accident cost conceptual framework. Data were collected using Epi data 3.1; Excel and analyzed using SPSS 16. Results: A total of 269 motorcycle accident files were examined. Males were more affected than females with sex ratio F:M;1:6.72.Youths were more involved in motorcycle accident (53.2) than other age group(16-30 years) .The majority of Motorcycles victims were motorcyclists; (30.86); businessmen (20.45) and students (11.53). Motorcycle-vehicle (41.61) was the fist cause of motorcycle injuries then motorcycle-pedestrian (30.86). Helmet use was 92.75. Head injuries and fractures were the predominant diagnoses (82.15). About 46.7 had pre-hospital care. The mean hospital stay was 15.43 days; and 38.3 spent more than 15 days in hospitalization. Permanent disability was confirmed in 11.5 (n=31); and mortality was 10.4 (n=28). The total economic cost was estimated at US$1;236;207.31 with 39.40 (US$487;030.30) due to loss of labor and 21.76 due to direct medical costs (US$269;000.84). Conclusions: Motorcycle injuries create a substantial disability and cost burden in Kigali; Rwanda. Prevention and early treatment should be promoted to decrease the morbidity and financial burden

Patterns of Injury at Two University Teaching Hospitals in Rwanda: Baseline Injury Epidemiology Using the Rwanda Injury Registry

Introduction: Globally; more worldwide deaths in 2010 could be attributed to injuries than the total number of deaths from infection with AIDS; tuberculosis; and malaria combined; with a disproportionate number of these deaths occurring in low- and middle-income countries. Yet; worldwide research and plans for prevention of injuries are far below other world health problems; especially in developing countries. Methods: A 31-item; 2-page registry form was adapted from regional trauma registries for use in Rwanda to collect data at the two main university referral hospitals in Kigali and Butare. Beginning in 2011; registrars recorded demographics; pre-hospital care; initial physiology; early interventions; and disposition of injured patients who met our selection criteria. Inpatient 30-day discharge status; mortality; and complications were abstracted from patient charts; ward reports and operating room logs. Descriptive analysis was used to evaluate patterns of injury and basic injury epidemiology at the two study hospitals from August 1; 2011-January 31; 2013. Results: A total of 3599 patients were registered from August 1; 2011 to January 31; 2013. Patients were predominantly male; and road traffic crashes were the leading cause of injury overall; contributing to a greater proportion of injuries in the more urban capital than the smaller city of Butare. The majority of patients were admitted to the hospital. All variables evaluated except for the percentage of injuries acquired via a penetrating mechanism showed statistically signifiant differences at an alpha signifiance level of 0.05; illustrating that the trauma population presenting at the two hospitals may be quite different. Conclusion: The Rwanda Injury Registry indicates a high burden of road traffic injuries in a predominantly working age male population over an eighteen-month period. This information can be useful in expanding injury surveillance programs and hopefully implementing population-based prevention programs

Comprehensive national analysis of emergency and essential surgical capacity in Rwanda.

BACKGROUND: Disparities in the global availability of operating theatres, essential surgical equipment and surgically trained providers are profound. Although efforts are ongoing to increase surgical care and training, little is known about the surgical capacity in developing countries. The aim of this study was to create a baseline for surgical development planning at a national level. METHODS: A locally adapted World Health Organization survey was conducted in November 2010 to assess emergency and essential surgical capacity and volumes, with on-site interviews at 44 district and referral hospitals in Rwanda. Results were compiled for education and capacity development discussions with the Rwandan Ministry of Health and the Rwanda Surgical Society. RESULTS: Among 10·1 million people, there were 44 hospitals and 124 operating rooms (1·2 operating rooms per 100,000 persons). There was a total of 50 surgeons practising full- or part-time in Rwanda (0·49 total surgeons per 100,000 persons). The majority of consultant surgeons worked in the capital (covering 10 per cent of the population). Anaesthesia was performed primarily by anaesthesia technicians, and six of 44 hospitals had no trained anaesthesia provider. Continuous availability of electricity, running water and generators was lacking in eight hospitals, and 19 reported an absence or shortage in the availability of pulse oximetry. Equipment for life-saving surgical airway procedures, particularly in children, was lacking. A dedicated emergency area was available in only 19 hospitals. In 2009 and 2010 over 80,000 surgical procedures (major and minor) were recorded annually in Rwanda. CONCLUSION: A comprehensive countrywide assessment of surgical capacity in resource-limited settings found severe shortages in available resources. Immediate local feedback is a useful tool for creating a baseline of surgical capacity to inform country-specific surgical development.