S. Zafar3, J. Canner2, N. Nagarajan1,2, G. SOSAS4 Research4, A. L. Kushner4 1Brigham And Women’s Hospital,Surgery,Boston, MA, USA 2Johns Hopkins University School Of Medicine,Center For Outcomes Research,Baltimore, MD, USA 3Howard University College Of Medicine,Surgery,Washington, DC, USA 4Surgeons OverSeas,New York, NY, USA
Introduction:
Road traffic injuries (RTI) are the leading causes of morbidity and mortality in people under the age of 45 years. The burden is highest in low and middle-income countries (LMICs) and is increasing. We aimed to describe the epidemiology of RTIs in 4 low-income countries using recent nationally representative survey data.
Methods:
The Surgeons Overseas Assessment of Surgical Needs (SOSAS) survey tool was administered in four countries: Sierra Leone, Rwanda, Nepal and Uganda. We performed nationally representative cross-sectional, cluster randomized surveys in each country. Information regarding demographics, injury characteristics, anatomic location of injury, healthcare seeking behavior, disability from injury, and injury-related deaths was collected. Data were reported with descriptive statistics and evaluated for differences between the four countries using statistical tests where appropriate.
Results:
A total of 13,765 respondents from 7,115 households in the four countries were surveyed. RTIs occurred in 2.2% (95% CI , 2.0-2.5%) of the population and accounted for 12.9% (95% CI: 11.5-14.2%) of all injuries incurred. The mean age was 34 years (standard deviation ±1years);74% of road injured were male. Motorcycle crashes accounted for 44.7% of all RTIs. The body regions most affected included head/face/neck (36.5%) followed by extremity fractures (32.2%). Healthcare was sought by 78% road injured; 14.8% underwent a major procedure (i.e., a procedure requiring anesthesia). Serious disability (resulting in limitations of work or daily activity) occurred in 38.5% (33.0-43.9%). Three of the four countries reported death data (death data was not reported from Rwanda). RTIs accounted for 2.5% (95% CI 1.8-3.3%) of all deaths and 40.6% (95% CI; 30.8-50.4%) of all injury-related deaths. Healthcare was sought prior to death by 68% of road injured. Of those who died, a surgical procedure was not performed even when indicated due to lack of finances in 29% of people. In 57% of cases the patient died before arrangement could be made.
Conclusion:
RTIs account for a significant proportion of death and disability from injury. Younger men are most affected, raising concerns for potential detrimental consequences to local economies. Prevention initiatives are urgently needed to stem this growing burden of disease; additionally, access to timely emergency, trauma and surgical care may help alleviate the burden for RTI in LICs.
