Associations between social determinants of health and interpersonal violence-related injury in Cameroon: a cross-sectional study.

INTRODUCTION: Risk factors for interpersonal violence-related injury (IPVRI) in low-income and middle-income countries (LMICs) remain poorly defined. We describe associations between IPVRI and select social determinants of health (SDH) in Cameroon. METHODS: We conducted a cross-sectional analysis of prospective trauma registry data collected from injured patients >15 years old between October 2017 and January 2020 at four Cameroonian hospitals. Our primary outcome was IPVRI, compared with unintentional injury. Explanatory SDH variables included education level, employment status, household socioeconomic status (SES) and alcohol use. The EconomicClusters model grouped patients into household SES clusters: rural, urban poor, urban middle-class (MC) homeowners, urban MC tenants and urban wealthy. Results were stratified by sex. Categorical variables were compared via Pearsons χ 2 statistic. Associations with IPVRI were estimated using adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). RESULTS: Among 7605 patients, 5488 (72.2%) were men. Unemployment was associated with increased odds of IPVRI for men (aOR 2.44 (95% CI 1.95 to 3.06), p<0.001) and women (aOR 2.53 (95% CI 1.35 to 4.72), p=0.004), as was alcohol use (men: aOR 2.33 (95% CI 1.91 to 2.83), p<0.001; women: aOR 3.71 (95% CI 2.41 to 5.72), p<0.001). Male patients from rural (aOR 1.45 (95% CI 1.04 to 2.03), p=0.028) or urban poor (aOR 2.08 (95% CI 1.27 to 3.41), p=0.004) compared with urban wealthy households had increased odds of IPVRI, as did female patients with primary-level/no formal (aOR 1.78 (95% CI 1.10 to 2.87), p=0.019) or secondary-level (aOR 1.54 (95% CI 1.03 to 2.32), p=0.037) compared with tertiary-level education. CONCLUSION: Lower educational attainment, unemployment, lower household SES and alcohol use are risk factors for IPVRI in Cameroon. Future research should explore LMIC-appropriate interventions to address SDH risk factors for IPVRI

Imaging completion cohorts.

Despite having the highest rates of injury-related mortality in the world, trauma system capacity in sub-Saharan Africa remains underdeveloped. One barrier to prompt diagnosis of injury is limited access to diagnostic imaging. As part of a larger quality improvement initiative and to assist priority setting for policy makers, we evaluated trauma outcomes among patients who did and did not receive indicated imaging in the Emergency Department (ED). We hypothesize that receiving imaging is associated with increased early injury survival. We evaluated patterns of imaging performance in a prospective multi-site trauma registry cohort in Cameroon. All trauma patients enrolled in the Cameroon Trauma Registry (CTR) between 2017 and 2019 were included, regardless of injury severity. Patients prescribed diagnostic imaging were grouped into cohorts who did and did not receive their prescribed study. Patient demographics, clinical course, and outcomes were compared using chi-squared and Kruskal-Wallis tests. Multivariate logistic regression was used to explore associations between radiologic testing and survival after injury. Of 9,635 injured patients, 47.5% (4,574) were prescribed at least one imaging study. Of these, 77.8% (3,556) completed the study (COMPLETED) and 22.2% (1,018) did not receive the prescribed study (NC). Compared to COMPLETED patients, NC patients were younger (p = 0.02), male (p</div

Physiologic parameters and injury characteristics of injured patients.

Physiologic parameters and injury characteristics of injured patients.</p

Associations with emergency department survival.

Despite having the highest rates of injury-related mortality in the world, trauma system capacity in sub-Saharan Africa remains underdeveloped. One barrier to prompt diagnosis of injury is limited access to diagnostic imaging. As part of a larger quality improvement initiative and to assist priority setting for policy makers, we evaluated trauma outcomes among patients who did and did not receive indicated imaging in the Emergency Department (ED). We hypothesize that receiving imaging is associated with increased early injury survival. We evaluated patterns of imaging performance in a prospective multi-site trauma registry cohort in Cameroon. All trauma patients enrolled in the Cameroon Trauma Registry (CTR) between 2017 and 2019 were included, regardless of injury severity. Patients prescribed diagnostic imaging were grouped into cohorts who did and did not receive their prescribed study. Patient demographics, clinical course, and outcomes were compared using chi-squared and Kruskal-Wallis tests. Multivariate logistic regression was used to explore associations between radiologic testing and survival after injury. Of 9,635 injured patients, 47.5% (4,574) were prescribed at least one imaging study. Of these, 77.8% (3,556) completed the study (COMPLETED) and 22.2% (1,018) did not receive the prescribed study (NC). Compared to COMPLETED patients, NC patients were younger (p = 0.02), male (p</div

Demographics of injured patients.

Despite having the highest rates of injury-related mortality in the world, trauma system capacity in sub-Saharan Africa remains underdeveloped. One barrier to prompt diagnosis of injury is limited access to diagnostic imaging. As part of a larger quality improvement initiative and to assist priority setting for policy makers, we evaluated trauma outcomes among patients who did and did not receive indicated imaging in the Emergency Department (ED). We hypothesize that receiving imaging is associated with increased early injury survival. We evaluated patterns of imaging performance in a prospective multi-site trauma registry cohort in Cameroon. All trauma patients enrolled in the Cameroon Trauma Registry (CTR) between 2017 and 2019 were included, regardless of injury severity. Patients prescribed diagnostic imaging were grouped into cohorts who did and did not receive their prescribed study. Patient demographics, clinical course, and outcomes were compared using chi-squared and Kruskal-Wallis tests. Multivariate logistic regression was used to explore associations between radiologic testing and survival after injury. Of 9,635 injured patients, 47.5% (4,574) were prescribed at least one imaging study. Of these, 77.8% (3,556) completed the study (COMPLETED) and 22.2% (1,018) did not receive the prescribed study (NC). Compared to COMPLETED patients, NC patients were younger (p = 0.02), male (p</div

S1 Data -

Despite having the highest rates of injury-related mortality in the world, trauma system capacity in sub-Saharan Africa remains underdeveloped. One barrier to prompt diagnosis of injury is limited access to diagnostic imaging. As part of a larger quality improvement initiative and to assist priority setting for policy makers, we evaluated trauma outcomes among patients who did and did not receive indicated imaging in the Emergency Department (ED). We hypothesize that receiving imaging is associated with increased early injury survival. We evaluated patterns of imaging performance in a prospective multi-site trauma registry cohort in Cameroon. All trauma patients enrolled in the Cameroon Trauma Registry (CTR) between 2017 and 2019 were included, regardless of injury severity. Patients prescribed diagnostic imaging were grouped into cohorts who did and did not receive their prescribed study. Patient demographics, clinical course, and outcomes were compared using chi-squared and Kruskal-Wallis tests. Multivariate logistic regression was used to explore associations between radiologic testing and survival after injury. Of 9,635 injured patients, 47.5% (4,574) were prescribed at least one imaging study. Of these, 77.8% (3,556) completed the study (COMPLETED) and 22.2% (1,018) did not receive the prescribed study (NC). Compared to COMPLETED patients, NC patients were younger (p = 0.02), male (p</div

Imaging completion by hospital.

HLD is a central hospital in Cameroon’s capital city, Yaoundé. HRL, HCP, and HRE are regional/district hospitals in the Littoral and Southwest Regions of Cameroon.</p