Injury characteristics and outcome of road traffic crash victims at Bugando Medical Centre in Northwestern Tanzania

<p>Abstract</p> <p>Background</p> <p>Road traffic crash is of growing public health importance worldwide contributing significantly to the global disease burden. There is paucity of published data on road traffic crashes in our local environment. This study was carried out to describe the injury characteristics and outcome of road traffic crash victims in our local setting and provide baseline data for establishment of prevention strategies as well as treatment protocols.</p> <p>Methods</p> <p>This was a prospective hospital based study of road traffic crash victims carried out at Bugando Medical Centre in Northwestern Tanzania between March 2010 and February 2011. After informed consent to participate in the study, all patients were consecutively enrolled into the study. Data were collected using a pre-tested questionnaire and analyzed using SPSS computer software version 15.0.</p> <p>Results</p> <p>A total of 1678 road traffic crash victims were studied. Their male to female ratio was of 2.1:1. The patients ages ranged from 3 to 78 years with the mean and median of 29.45 (± 24.22) and 26.12 years respectively. The modal age group was 21-30 years, accounting for 52.1% patients. Students (58.8%) and businessmen (35.9%) were the majority of road traffic crash victims. Motorcycle (58.8%) was responsible for the majority of road traffic crashes. Musculoskeletal (60.5%) and the head (52.1%) were the most common body region injured. Open wounds (65.9%) and fractures (26.3%) were the most common type of injuries sustained. The majority of patients (80.3%) were treated surgically. Wound debridement was the most common procedure performed in 81.2% of the patients. The complication rate was 23.7%. The overall average length of hospital stay (LOS) was 23.5 ± 12.3 days. Mortality rate was 17.5%. According to multivariate logistic regression analysis, patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with long bone fractures stayed longer in the hospital and this was significant (P < 0.001) whereas the age of the patient, severe trauma (Kampala Trauma Score II ≤ 6), admission Systolic Blood Pressure < 90 mmHg and severe head injury (Glasgow Coma Score = 3-8) significantly influenced mortality (P < 0.001).</p> <p>Conclusion</p> <p>Road traffic crashes constitute a major public health problem in our setting and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic crashes is necessary to reduce the morbidity and mortality resulting from these injuries. Early recognition and prompt treatment of road traffic injuries is essential for optimal patient outcome.</p

Citywide Trauma Experience in Mwanza, Tanzania: A Need for Urgent Intervention.

Trauma remains a leading cause of morbidity and mortality in resource limited countries. There is paucity of published reports on trauma care in Tanzania, particularly the study area. This study was carried out to describe our experiences in trauma management outlining the etiological spectrum, injury characteristics and treatment outcome of trauma patients at our local setting and compare our results with those from other centers in the world. A descriptive prospective study of trauma patients was conducted at Bugando Medical Centre from April 2010 to March 2012. Statistical data analysis was done using SPSS software version 17.0. A total of 5672 trauma patients were enrolled in the study. The male to female ratio was 2.3: 1. The majority of patients were in the 2nd decade of life. Road traffic accident was the most common cause of trauma accounting for 60.7% of cases. The majority of patients (76.6%) sustained blunt injuries. Musculoskeletal (68.5%) and head/neck (52.6%) were the most frequent body region injured. Soft tissue injuries (open wounds) and fractures were the most common injuries accounting for 82.8% and 76.8% respectively. Majority of patients (74.4%) were treated surgically with wound debridement (94.0%) being the most frequently performed procedure. Postoperative complications were recorded in 31.5% of cases.The overall median duration of hospitalization was 26 days (range 1 day to 144 days). Mortality rate was 16.7%. Patients who had polytrauma, burn injuries and those who had tetanus and long bone fractures stayed longer in the hospital and this was statistically significant (P < 0.001), whereas the age > 65 years, severe trauma, admission Systolic Blood Pressure < 90 mmHg, presence of tetanus, severe head injury, the duration of loss of consciousness, the need for intensive care unit admission and finding of space occupying lesion on CT scan of the brain significantly influenced mortality (P < 0.001). Trauma resulting from road traffic accidents remains a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of road traffic accidents is necessary to reduce the incidence of trauma in this region

Crash characteristics and patterns of injury among hospitalized motorised two-wheeled vehicle users in urban India

<p>Abstract</p> <p>Background</p> <p>Traffic crashes and consequent injuries represent a growing public health concern in India, particularly in light of increasing motorization. Motorised two-wheeled vehicles (MTV) constitute a large portion of the vehicle fleet in India. We report the crash characteristics and injury patterns among a cohort of MTV riders and pillions presenting to hospital post-crash.</p> <p>Methods</p> <p>Consecutive MTV riders and pillions, whether alive or dead, injured in a road traffic crash presenting to the emergency departments of two government hospitals and three branches of a private hospital in urban Hyderabad, India, were recruited to this study.</p> <p>Results</p> <p>378 MTV users were enrolled to the study of whom 333 (88.1%) were male, 252 (66.7%) were riders and median age was 31.3 years. A total of 223 (59%) MTV users were injured in multi-vehicle crashes while one-third had a frontal impact. The majority (77%) were assessed as having a Glasgow coma score (GCS) of 13–15, 12% a GCS of 9–12 and 11% a GCS of 3–8. No difference was seen in the severity distribution of injuries based on GCS among riders and pillions. Open wounds and superficial injuries to the head (69.3%) and upper extremity (27%) and lower extremity (24%) were the most common injuries. 43 (11%) sustained an intracranial injury, including 12 (28%) with associated fracture of the bones of the head. There were few differences in types of injuries sustained by riders and pillions though riders had a significantly lower risk of crush injuries of the lower extremity than pillions (relative risk, RR 0.25, 95% CI 0.08–0.81) and female pillions were at a significantly lower risk of sustaining fractures of the lower extremity than male pillions (RR 0.30, 95% CI 0.09 – 0.94). Overall, 42 (11%) MTV users died, of which 42.8% died before reaching the hospital. Only 74 (19.6%) MTV users had worn a helmet correctly and failure to wear a helmet was associated with a five times greater risk of intracranial injury (RR 4.99, 95% CI 1.23–20.1). Of the 19 pre-hospital deaths, 16 (84%) had not worn a helmet.</p> <p>Conclusion</p> <p>Head injuries accounted for the major proportion of injuries sustained in MTV users. Non-helmet use was associated with increased risk of serious head injuries. The data presented on the nature and severity of injuries sustained by MTV users can assist with planning to deal with these consequences as well as prevention of these injuries given the high use of MTV in India.</p

Diabetic Foot: Need for a Multicentre Study

(Nig J Surg Res 2001; 3:44

Angular Deformities of the Knee in Children

Reports from Ibadan and Zaria showed variations in the types of angular deformities of the knee in children. This work was done to determine the varieties of the deformities and their causes at the University of Ilorin Teaching Hospital Ilorin, Nigeria and review the problem in Nigeria. A prospective analysis of all children with angular knee deformities seen at the orthopaedic clinic of the University of Ilorin Teaching hospital Ilorin, Nigeria was carried out over a one-year period. The patients were evaluated clinically, radiologically and biochemically and their results analysed. Seventy two children comprising 38 males and 34 females (M: F=1.1:1) with deformities in their knee were seen. The age range was 1.5 to 11 years. Forty-two children had physiological changes of growth, 66.6% of them were boys while 18 children had rickets, 14 of them, (77.8%) were girls. Additionally, Blount's disease was seen in ten, six of who were girls. Two boys had posttraumatic genu valga. The commonest presentation was bilateral genu deformities. Diagnosis of rickets was made clinically and radiologically, serum biochemistry was not contributory. Thirty-four patients had corrective osteotomy. When compared with other reports from Nigeria, it appears that the scope of genu deformities in children varies from centre to centre. There is a need to conduct a multi-centre study to determine the true pattern in Nigeria (Nig J Surg Res 2000; 2:62-67) KEY WORDS: Knee deformities, Rickets, Blount's disease, Osteotomy, Geny varum, Genu valgum, Childre

Role of Instructional Materials in the Teaching of Basic Science in Primary Schools in Ilorin South Local Government Area of Kwara State

This study evaluated the availability and utilization of instructional materials in the teaching of basic science in primary schools in Ilorin South Local Government Area of Kwara State. The sample for this study comprised of one hundred (100) primary school teachers kin ten (10) selected primary schools in Ilorin south local government of Kwara state structured questionnaire was the instrument used for data collection and the instrument was face validated by the supervisor. Three research questions guided the study, the data were analyzed using simple percentage and chi-square, the researcher designed  a questionnaire to carry out his research work which is termed the availability and utilization of instructional materials in the teaching of basic science in primary schools (AAUIMTBSIPS). The findings of this research work shows that there is a significant relationship between the availability and the use of instructional materials, based on these findings it was concluded that there is high extent to which the available instructional materials are utilized for teaching basic science in primary schools, there is an impact of instructional materials in teaching and learning of basic science in primary schools. It was recommended among others that; policy on instructional materials adaptation in school be reviewed and fully implemented and the need for recruitment of qualified personnel should be recruited to enhance effective utilization of instructional materials in primary schools, also non-governmental agencies and wealthy Nigerians should participate in the provision of instructional materials in primary schools. DOI: 10.7176/JEP/13-18-11 Publication date:June 30th 202

Tuberculosis of the spine in Ilorin, Nigeria

(East African Medical Journal: 2001 78(4): 197-199

Improved Outcome of Fracture Treatment by Early Operative Reduction: Results of a Surgical Audit

An audit is a useful means of examining improvements in the art and science of clinical practice. We applied this to surgery to determine improved outcomes of fracture treatment by early operative reduction. This was carried out at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, by comparing two years, 1997 when there was less emphasis and 1998 when there was a greater emphasis on operative reduction of fractures. Hospital records in the orthopaedic wards, operating rooms and the physiotherapy unit of all patients admitted were reviewed retrospectively. Two years, 1997 and 1998 were analysed for age, sex, type of treatment and quality of outcome. A total of 247 admissions into orthopaedic wards were made in 1997 leading to 79 major operations, 20 of which were operative reduction of fractures (25.3 %). In 1998, 239 patients were admitted out of which 174 major operations were performed, 72 of which were operative reductions (41.4 %, P = 0.014). Patients' stay in hospital was shorter in 1998 with 81% of patients staying 3 months and less compared to 40 % in 1997 (P = 0.000). Improved outcome of stiff knee joints from physiotherapy was judged good and excellent in 66.7 % and 20 % in 1998 compared to 28.3 % (P = 0.00005) and 1.9 % (P = 0.003) in 1997, respectively. These results suggest generally improved outcome when fractures are treated by early operative reduction because of shorter hospital stay, early return to work, improved nursing care and joint function. (Nig J Surg Res 2000; 2:114-122) KEY WORDS: Surgical Audit, Operative reduction, Fractures, Outcom

Motorcycle injuries in a developing country and the vulnerability of riders, passengers, and pedestrians

At a Nigerian university hospital, none of the motorcyclists who presented over a 12 month period had been wearing a helmet, and of the eight patients who died, seven had head injuries. Of the five collision types described, the rate of motorcycle‐other vehicle collisions was highest at 40.6%, while the motorcycle‐pedestrian rate was 23.4%. Measures to prevent these collisions might reduce overall crashes by 64%; in addition, helmet law should be enforced