The role of Ugandan District Hospital orthopedic units in the care of vulnerable road users: a cross-sectional study.

BACKGROUND: Musculoskeletal injuries are a common cause of morbidity after road traffic injury (RTI) in motorizing countries. District hospitals provide front-line orthopedic care in Uganda and other sub-Saharan African nations. Improving care at the district hospital level is an important component of the World Health Organization's strategy for surgical and trauma systems strengthening, but the data necessary to inform RTI safety and care initiatives has previously been insufficient at the district hospital level. The objective of this study was to provide data on the patient population and patterns of musculoskeletal injury caused by RTI at Ugandan district hospitals. METHODS: In this cross-sectional study, all patients with musculoskeletal injuries identified on x-ray presenting to three Ugandan district hospitals from October 2013 to January 2014 were interviewed and examined to obtain data on patient demographics and injury context by road user category. This manuscript is a sub-group analysis of RTI victims from a broader dataset of all musculoskeletal injuries. RESULTS: Vulnerable road users comprised 92 % of musculoskeletal RTI patients, with 49 % (95 % CI 41-57 %) pedestrians, 41 % (95 % CI 33-49 %) motorcyclists, and 2 % (95 % CI 0-4 %) cyclists. Commonly injured subgroups included student pedestrians (33 % (95 % CI 22-44 %) of pedestrians) and motorcyclists with less than a post-secondary education (74 % (95 % CI 63-85 %) of motorcyclists). The morning hours were the most common time of injury for all RTI patients (37 %%; 95 % CI 30-44 %) and motorcyclists (46 %; 95 % CI 34-58 %), while pedestrians were most commonly injured in the evening (32 %; 95 % CI 21-43 %). CONCLUSIONS: By demonstrating commonly injured demographic groups and high frequency times of day for injury, this surveillance study of musculoskeletal RTI suggests targeted avenues for future road safety research in the districts of Uganda. Compared with previous studies from the capital of Uganda, these results suggest that Ugandan district hospitals care for a disproportionate share of vulnerable road users, a discrepancy which may pertain to other sub-Saharan African nations, as well. Strengthening district hospital orthopedic care should be considered a priority of strategies aimed at improving outcomes for these vulnerable groups.

Estimating the healthcare burden of osteomyelitis in Uganda.

Chronic osteomyelitis is a considerable healthcare burden in many developing countries, but this burden is poorly quantified. To estimate the clinical burden of osteomyelitis we systematically sampled the medical records of orthopaedic clinics at five hospitals in Uganda. To estimate the surgical burden of osteomyelitis we reviewed the diagnosis in 9354 operations conducted during a 1 year period at the same five hospitals. Of 1844 outpatients with a documented diagnosis sampled over 1 year, 187 (10%) had osteomyelitis. Only 20% of those with osteomyelitis were older than 20 years, whereas this age group accounted for 52% of patients with another orthopaedic diagnosis or no diagnosis (P<0.001). Osteomyelitis was diagnosed in 325 (3.5%) of the surgical operations; in 32% of these operations the patients were children aged between 10 and 14 years. The tibia was the bone most frequently involved (31%), and sequestrectomy was the most frequent surgical procedure (60%). These findings suggest that osteomyelitis disproportionately affects the young, and is a burden on both clinical and surgical services. To decrease this burden in populations with limited resources, improved diagnosis and more timely treatment of acute osteomyelitis is needed.

Towards effective Ponseti clubfoot care: the Uganda Sustainable Clubfoot Care Project.

UNLABELLED: Neglected clubfoot is common, disabling, and contributes to poverty in developing nations. The Ponseti clubfoot treatment has high efficacy in correcting the clubfoot deformity in ideal conditions but is demanding on parents and on developing nations' healthcare systems. Its effectiveness and the best method of care delivery remain unknown in this context. The 6-year Uganda Sustainable Clubfoot Care Project (USCCP) aims to build the Ugandan healthcare system's capacity to treat children with the Ponseti method and assess its effectiveness. We describe the Project and its achievements to date (March 2008). The Ugandan Ministry of Health has approved the Ponseti method as the preferred treatment for congenital clubfoot in all its hospitals. USCCP has trained 798 healthcare professionals to identify and treat foot deformities at birth. Ponseti clubfoot care is now available in 21 hospitals; in 2006-2007, 872 children with clubfeet were seen. USCCP-designed teaching modules on clubfoot and the Ponseti method are in use at two medical and three paramedical schools. 1152 students in various health disciplines have benefited. USCCP surveys have (1) determined the incidence of clubfoot in Uganda as 1.2 per 1000 live births, (2) gained knowledge surrounding attitudes, beliefs, and practices about clubfoot across different regions, and (3) identified barriers to adherence to Ponseti treatment protocols. USCCP is now following a cohort of treated children to evaluate its effectiveness in the Ugandan context. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.