Trauma registries as a tool for improved clinical assessment of trauma patients in an urban African hospital

This combined retrospective and prospective study describes trauma patients in an urban African Hospital and assesses whether use of trauma registries leads to  improved clinical assesment. The Kampala Trauma Score (KTS) is assessed as an injury  severity filter. The level of clinical assessment was defined by Model Rural Trauma Project (MRTP) trauma triage criteria. Trauma registries were filled out  systematically for every alternate patient on arrival in the casualty department, and the patient status was recorded two weeks after admission. This retrospective study showed that 52% of the trauma patients were inadequately assessed.  Amongst the deaths, 72.7% had been inadequately assessed (p value = 0.0193). Prospective data showed that injuries were most common amongst young males (72.7%), in and around the city following road traffic injuries (50.7%). The  mean time between injury and arrival at the hospital was 0.363 hours (SD 0.331) and the mean hospital response time was 0.36 hours SD 0.245) The rate of inadequate assessment decreased significantly after the introduction of the registry (p value =  0.000). The case fatalities before and after the introduction of the registry was,  however, not statistically significant. The KTS  was found to be a reliable severity filter for injured patients, with a KTS score of less than 14 increasing the likelihood of death by at least three times. The results showed a cut off value of 12 by the ROC curve (0.8755; 95% CI = 0.8455 - 0.9055).Key words: trauma registries, audit, clinical assessment, Afric

Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda

Abstract Background Traumatic brain injuries in Uganda are on the increase, however little is known about the neuropsychological outcomes in survivors. This study characterized patients with traumatic brain injury (TBI) and the associated six-month neuropsychological outcomes in a Ugandan tertiary hospital. Methods Patients admitted at Mulago Hospital with head injury from November 2015 to April 2016 were prospectively enrolled during admission and followed up at six months after discharge to assess cognition, posttraumatic stress symptoms (PTSS), depression symptoms and physical disability. The outcomes were compared to a non-head-injury group recruited from among the caretakers, siblings and neighbours of the patients with age and sex entered as covariates. Results One hundred and seventy-one patients and 145 non-head injury participants were enrolled. The age range for the whole sample was 1 to 69 years with the non-head injury group being older (mean age (SD) 33.34 (13.35) vs 29.34 (14.13) years of age, p = 0.01). Overall, motorcycle crashes (36/171, 38.6%) and being hit by an object (58/171, 33.9%) were the leading causes of TBI. Head injury from falls occurred more frequently in children < 18 years (13.8% vs 2.8%, p = 0.03). In adults 18 years and older, patients had higher rates of neurocognitive impairment (28.4% vs 6.6%, p < 0.0001), PTSS (43.9% vs 7.9%, p < 0.0001), depression symptoms (55.4% vs 10%, p < 0.0001) and physical disability (7.2% vs 0%, p = 0.002). Lower Glasgow Coma Score (GCS) on admission was associated with neurocognitive impairment (11.6 vs 13.1, p = 0.04) and physical disability (10 vs 12.9, p = 0.01) six months later. Conclusion This first such study in the East-African region shows that depth of coma on admission in TBI is associated with neurocognitive impairment and physical disability.https://deepblue.lib.umich.edu/bitstream/2027.42/147735/1/12883_2019_Article_1246.pd

Prevalence, correlates of occupational percutaneous injuries and use of post exposure prophylaxis against HIV, Hepatitis B among health workers in Kampala, Uganda-May 201

Introduction: Of the 3 million percutaneous exposures that occur annually among health workers (HWs), 90% are in low-income countries. The estimated average prevalence of percutaneous exposures among health workers in Uganda was 70% in 2009. However, utilization of post exposure prophylaxis (PEP) following percutaneous exposure remains largely undetermined. We determined the utilization of PEP for HIV and Hepatitis B (Hep B) following percutaneous injuries (PIs) among clinical health workers in Kampala. Methods: In a cross-sectional study, 709 HWs were selected and enrolled using multi-stage sampling from seven health facilities in Kampala City. Data were collected using a semi-structured questionnaire and a facility checklist. Modified Poisson regression modelling was used to estimate prevalence ratios (PRs) of PEP utilization. Results: One hundred and ninety-seven (28%) HWs had sustained PIs in the preceding 12 months with a Hep B vaccination prevalence of 18%. Twenty-nine (15%) of exposed HWs initiated HIV-PEP and one (0.5%) Hepatitis B-PEP. Factors associated with PEP uptake were 1-5years of professional experience (PR= 0.29 95% confidence interval (CI) (0.1-0.92)) compared to less than a year. Being an intern doctor (PR= 0.02 95% CI (&lt;0.01-0.15)), laboratory technologist (PR= 0.05 95% CI (&lt;0.01- 0.51)), nurse (PR= 0.09 95% CI (0.01-0.6)), medical/paramedical student (PR= 0.03 95% CI (&lt;0.01-0.17)) compared to being a consultant. Twenty (69%) completed HIVPEP treatment and one (100%) completed Hepatitis B-PEP treatment. Six of seven health facilities lacked a reporting procedure following percutaneous injury.Conclusion: The prevalence of percutaneous injuries among clinical health workers in Kampala's public health facilities is high while the uptake of PEP therapy is still low. Kampala Capital City Authority should step up measures to ensure HW safety including mandatory Hepatitis B vaccination, occupational exposure surveillance especially targeting lower-level health facilities and HWs with a year or less of clinical experience

Disability Characteristics of Community-Based Rehabilitation Participants in Kayunga District, Uganda

Background: Approximately 80% of individuals with disability reside in low- and middle-income countries where community-based rehabilitation (CBR) has been used as a strategy to improve disability. However, data relating to disability severity among CBR beneficiaries in low-income countries like Uganda remain scarce, particularly at the community or district level. Objectives: To describe severity of disability and associated factors for persons with physical disabilities receiving CBR services in the Kayunga district of Uganda. Methods: A cross-sectional sample of 293 adults with physical disabilities receiving a CBR service in the Kayunga district was recruited. Disability severity was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS2.0), and analyzed as a binary outcome (low: 0-9, high: 10-48). Inferential statistics using odds ratios were used to determine factors associated with impairment severity. Findings: The mean WHODAS 2.0 score of persons with physical disabilities was 12.7 (standard deviation = 8.3). More than half (52.90%) of people with physical disabilities reported a high level of functional impairment. Increased disability severity was significantly associated with limited access to assistive devices (adjusted odds ratio [AOR] = 4.55, 95% confidence interval [CI]: 1.87-14.08, 'P' 'These findings suggest a high level of moderate to severe functional impairments in persons with physical disabilities receiving CBR in Kayunga district. These data provide support for efforts to enhance CBR's ability to liaise with local health care, education, and community resources to promote access to needed services and ultimately improve the functional status of persons with disabilities in low-resource settings

Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy

BackgroundDespite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality.AimTo estimate the epidemiology of the injury seen in patients presenting to the government hospital in Kampala, the capital city of Uganda.MethodsA secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005.ResultsFrom 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance.ConclusionsRoad traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development

An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study

Introduction:&nbsp;gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015. Methods:&nbsp;we obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics. Results:&nbsp;a total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected. Conclusion:&nbsp;road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions

Emergency care surveillance and emergency care registries in low-income and middle-income countries: Conceptual challenges and future directions for research

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future

Interventions to reduce pedestrian road traffic injuries: A systematic review of randomized controlled trials, cluster randomized controlled trials, interrupted time-series, and controlled before-after studies

BACKGROUND: Road traffic injuries are among the top ten causes of death globally, with the highest burden in low and middle-income countries, where over a third of deaths occur among pedestrians and cyclists. Several interventions to mitigate the burden among pedestrians have been widely implemented, however, the effectiveness has not been systematically examined. OBJECTIVES: To assess the effectiveness of interventions to reduce road traffic crashes, injuries, hospitalizations and deaths among pedestrians. METHODS: We considered studies that evaluated interventions to reduce road traffic crashes, injuries, hospitalizations and/or deaths among pedestrians. We considered randomized controlled trials, interrupted time-series studies, and controlled before-after studies. We searched MEDLINE, EMBASE, Web of Science, WHO Global Health Index, Health Evidence, Transport Research International Documentation and ClinicalTrials.gov through 31 August 2020, and the reference lists of all included studies. Two reviewers independently screened titles and abstracts and full texts, extracted data and assessed the risk of bias. We summarized findings narratively with text and tables. RESULTS: A total of 69123 unique records were identified through the searches, with 26 of these meeting our eligibility criteria. All except two of these were conducted in high-income countries and most were from urban settings. The majority of studies observed either a clear effect favoring the intervention or an unclear effect potentially favoring the intervention and these included: changes to the road environment (19/27); changes to legislation and enforcement (12/12); and road user behavior/education combined with either changes to the road environment (3/3) or with legislation and enforcement (1/1). A small number of studies observed either a null effect or an effect favoring the control. CONCLUSIONS: Although the highest burden of road traffic injuries exists in LMICs, very few studies have examined the effectiveness of available interventions in these settings. Studies indicate that road environment, legislation and enforcement interventions alone produce positive effects on pedestrian safety. In combination with or with road user behavior/education interventions they are particularly effective in improving pedestrian safety

Saving lives beyond 2020: The next steps

Road safety analysis can be used to understand what has been successful in the past and what needs to be changed in order to be successful to reduce severe road trauma going forward and ultimately what\u27s needed to achieve zero. This chapter covers some of the tools used to retrospectively evaluate real-life benefits of road safety measures and methods used to predict the combined effects of interventions in a road safety action plan as well as to estimate if they are sufficient to achieve targets near-term and long-term. Included are also a brief overview of methods to develop boundary conditions on what constitutes a Safe System for different road users. Further to that, the chapter lists some arguments for the need of high-quality mass and in-depth data to ensure confidence in the results and conclusions from road safety analysis. Finally, a few key messages are summarized

Injury prevention and safety promotion in Africa - local actors and global partners

No Abstract. African Safety Promotion: A Journal of Injury and Violence Prevention Vol. 4(1) 2006: 44-5