D. K. Kisitu1, L. Eyler2, I. Kajja3, G. Waiswa3, T. Beyeza4, I. Feldhaus2, C. Juillard2, R. Dicker2 1Mbarara University Of Science And Technology,Department Of Surgery,Mbarara, , Uganda 2University Of California – San Francisco,Center For Global Surgical Studies, Department Of Surgery,San Francisco, CA, USA 3Makerere University College Of Health Sciences,Department Of Orthopaedics,Kampala, , Uganda 4Mulago National Referral And Teaching Hospital,Kampala, , Uganda
Introduction: Musculoskeletal injury is a growing but neglected public health problem that disproportionately affects low- and middle-income countries like Uganda. Evidence-based policies for injury prevention and management in the districts of Uganda are hindered by the lack of available data regarding patterns of musculoskeletal injuries presenting to district hospitals. Our pilot orthopedic trauma registry establishes a framework for broader district hospital injury surveillance systems.
Methods: We collected data via patient interview, examination, and x-rays from all patients presenting to Mityana, Entebbe, and Nakaseke Hospitals with musculoskeletal injuries from October 2013 to January 2014. We compared patient demographics to the 2011 Ugandan Demographic and Health Survey (DHS) dataset and determined predictors of delayed presentation for care greater than 24 hours after injury via multivariate logistic regression.
Results: Men, adults, and individuals with post-secondary education were more common among patients than in the DHS population. Common causes included road traffic injuries (RTI) (48.5%) and falls (25.1%). Closed, simple fractures comprised 70% of injuries. The major extremity long bones comprised 84% of fractures. Patients suffering assaults or falls were more likely delayed to care than victims of RTI, with OR 3.97 (95% CI: 1.41, 11.16) and OR 2.34 (95% CI: 1.21, 4.55), respectively. Compared to the self-employed, subsistence farmers (OR 2.99, 95% CI: 1.15, 7.91), motorcycle taxi drivers (OR 10.50, 95% CI: 1.92, 64.57), and pre-school children (OR 4.24, 95% CI: 1.05, 17.39) were significantly more likely to be delayed to care after adjustment for covariates. Subsistence farmers were more likely than other occupations to seek care from traditional bonesetters prior to seeking hospital care (23% v 7%, p=0.001). All patients who visited bonesetters were delayed to hospital care, compared to 28% of patients who sought hospital care first (p<<0.001).
Conclusion: Understanding patterns of musculoskeletal injury at district hospitals facilitates allocation of limited resources for orthopedic provider training, referral protocols, and trauma systems strengthening. To promote the safety of all Ugandans, policies should target interventions aimed at improving access to timely care to vulnerable groups such as subsistence farmers, motorcycle taxi drivers, and pre-school children. Effective policy can only be enacted by engaging local stakeholders such as traditional bonesetters in the advocacy conversation. Development of evidence-based national injury prevention and orthopedic healthcare policies would similarly benefit from district hospital data from across Uganda, in the form of a national trauma registry.
