Injuries among Children and Young Adults in Uganda : Epidemiology and Prevention

Background Injuries are a major morbidity and mortality cause among children and young adults worldwide. Previous Ugandan studies were limited in scope and biased towards severe adulthood injuries in referral care. Aims and Objectives This study explored the epidemiology of childhood and young adulthood injuries in Uganda: specifically their extent, pattern, distribution, risk and determinants, and stakeholder perceptions their regarding prevention and control. Methods Cross-sectional survey was used to describe unintentional domestic injury patterns and determinants among under-fives; facility-based surveillance, to determine the distribution, characteristics, and outcomes of violent injuries among 13-23-year-olds and all injuries among under-13s; cohort design, to explore the extent, nature and determinants of school-related risk; FGDs and KIIs, to explore stakeholder perceptions of prevention. Chi-square tests were used to evaluate categorical differences, t-tests, quantitative differences, odds ratios, associations, survival and multi-level modelling, time and contextual effects; and content and thematic analyses, stakeholder perceptions. Results Home-, road-, school- and hospital-related childhood injuries are major but underreported. Violent injuries among youth constitute 7.3percent of total injuries, with a case fatality of 4percent. Fall and burn injuries are the greatest domestic injury risk among under-fives, while traffic, falls and sport injuries are commonest among school children. Travel, break-time activities and practical classes are most risky. Intentional injuries are skewed, peaking at 21 years; males double females‘ prevalence of victimisation. Students, casual labourers and housewives are most at risk. Teenager housewives have a higher victimisation risk. Blunt force, stabs/cuts, gunshots, and burns are the main injury mechanisms, with variations depending on location. Most prevalent intentional injuries are cuts/bites, open wounds and superficial injuries, majority are minor. The risk of home, school, and traffic injury is high, with age and contextual variations. The cumulative prevalence of school-related injury is 36.1percent, with a rate of 12.3/1000 person years. The case fatality rate of the non-intentional domestic childhood injuries is 1.1/100/year. The odds of domestic burns fall progressively from the first to the sixth year of life; after this, traffic and falls lead. At four, burn, fall and traffic injury odds approximate parity. Injury determinants include poor housing, poor supervision, and domestic energy type, school, HIV status, age and gender. The perceived drivers of injury spurts are staple food supply, social activities and competitive sports. Emergent explanations include childhood, parenting, and situational factors. Lack of guidance and counselling, hunger, intimate-partner violence (IPV), domestic violence, unsafe cooking and household chores, idleness, poor parental control, child maltreatment, corporal punishment, and unsafe storage of sharp objects are thought to cause injuries. Most stakeholders believe in prevention through education and environmental modification. Education, voluntary counselling and HIV testing and disclosure were recommended. Local treatments include sugar, cold water, bathroom sand, and urine for burn injuries; sticks, bandages, ropes, liniment and stretchers for fractures and dislocations; and raw eggs, cooking oil and milk for poisoning. Few NGOs work on injuries and violence in rural Uganda, yet injury care within the existing health facilities is not adequate. Conclusions Childhood and young adulthood injuries are common in Ugandan homes, schools, and roads with age, sex, contextual differences. Injury risk is high across Uganda with travel, practical classes, break-time activities and gardening being most risky. The determinants include maternal and child age, house condition, supervision quality, gender, school and location. Linkages are thought to exist between staple food supply, major social events, and hunting seasons and injury risk. These factors interact with individual, parental, and situational factors to pattern childhood injuries in rural Uganda. Local management strategies exist, most of them based on traditional knowledge and beliefs that may require separate quantitative evaluation. Other proposed educational interventions are based on the ineffective `victim blame template´

The effectiveness of the "Mato-Oput 5" curriculum in changing school children's attitudes towards conflict and violence, and in reducing pupil perpetrated acts of violence

Student Number : 0417597W - MSc(Med) research report - School of Public Health - Faculty of Health SciencesObjectives The study evaluated the effectiveness of the “Mato-Oput 5” curriculum in changing children’s attitudes towards conflict and violence and preventing violent acts by them; specifically, it determined attitudes differences between children exposed to and those not exposed to the intervention, and compared rates and trends of pupil-perpetrated intentional (violent) and severe intentional incidents among the children who were taught and those were not taught the curriculum. Methods and setting The study was analysis of secondary data from a community trial. The original study had been conducted in a war affected rural district in Northern Uganda in 2002. Results The intervention and control groups had comparable demographic characteristics, attitudes towards conflicts and violence, and rates of intentional and severe intentional incidents (violence) before intervention. After intervention, they remained comparable with regard to their demographic characteristics and rates and trends of intentional and severe intentional incidents. Their attitudes towards conflicts and violence, however, differed significantly, with the intervention group tending towards forgiving of offenders, and away from forceful response to provocation more than the control group. Both groups had post-intervention rate reductions in intentional incidents, and rate increments in severe intentional incidents. The pre-intervention incident rates in the intervention and control groups were 270/1000 and 370/1000 respectively, while the post-intervention rates were 190/1000 and 350/1000 respectively. Before intervention, seven in every 1000 incidents in the intervention group required school first aid or treatment in a health facility (severe incidents) as compared to 12 in every 1000 in the control group. These rates increased to 150/1000 and 160/1000 respectively after intervention. Conclusions The Mato-Oput 5 curriculum was effective in changing children’s attitudes towards conflict and violence: the intervention group tended towards forgiveness of offenders and non-forceful responses to provocation more than the control group. The rates and trends of pupil-perpetrated intentional (violent) and severe intentional incidents in the two groups of children, however, remained comparable

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

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

The effect of an overpass on pedestrian injuries on a major highway in Kampala - Uganda

Objectives: To describe the pedestrian population, their use of an overpass, and to assess pedestrian perceptions and responses to the risk of traffic crashes, determine pedestrian injuries in relation to traffic flow, and compare traffic crash and pedestrian injury rates before and after the overpass construction. Setting: The study was conducted in Nakawa trading center approximately six kilometers from the center of Kampala city on a major highway. The trading center has a busy market, small retail shops, industries, a sports stadium, offices, low cost housing estates, schools, and an estimated population of 6,226 residents, 15.1% of them students. Methodology: Pedestrian road behavior and traffic patterns were observed, and police traffic crash records reviewed, one year before and one year after overpass construction. A convenient sample of overpass and non-overpass users was interviewed to assess their perceptions of risk. Results: A total of 13,064 pedestrians were observed (male: female ratio= 2.2:1). The overall prevalence of pedestrian overpass use was 35.4%. A bigger proportion of females (49.1%) crossed on the overpass compared to males (29.2%). More children (79.7 %) than adults (27.3%) used the overpass. The majority of pedestrians (77.9%) were worried about their safety in traffic but only 6.6% thought of the overpass as an appropriate means to avoid traffic accidents. Traffic was not segregated by vehicle type. Mean traffic flow varied from 41.5 vehicles per minute between 0730-0830 hours, to 39.3 vehicles per minute between 1030-1130 hours and 37.7 vehicles per minute between 1730-1830 hours. The proportion of heavy vehicles (lorries, trailers, tankers, and tractors) increased from 3.3% of total vehicle volume in the morning to 5.4% in the evening (t = 2.847,

Pedestrian traffic injuries among school children in Kawempe, Uganda

Background: Traffic injuries are an important problem in low income countries. In Uganda road traffic is the largest single cause of injury in Kampala; pedestrians, and children are most affected. Pedestrian injury affects school children in Uganda. Objective: To determine the overall risk of pedestrian traffic injury among school children in Kawempe, Uganda. Methods: A cohort was assembled at 35 primary schools and followed for 3 terms. Ten of the schools had participated in previous injury programs, others were systematically selected. Injuries were recorded by teachers using a questionnaire. Data collected included ID, school, age, grade, gender, incident date, vehicle type, and injury outcome. Demographic characteristics are described and cumulative incidences calculated. Results: The cohort included 8,165 children (49% male) from 35 primary schools. The mean age was 9 years (Sd=2.78). Of the 35 schools, 92% were day; the others mixed day and boarding. 53 children (27girls) were involved in a traffic incident. 25% of the injuries reported were serious and warranted care in a health facility. No deaths occurred. Forty % of incidents involved commercial motorcycles, 41% bicycles, 9% cars, 8% taxis, and 2% trucks. The cumulative incidence was 0.168% each term. Over the 3 terms of the year the cumulative incidence was 0.5 ± 0.02. There were no gender differences in the cumulative incidence. Conclusion: Each school year about ½ % of Kawempe school children are involved in a traffic incident. Interventions are necessary to reduce the unacceptably high incidents of pedestrian traffic. Interventions to alleviate this situation including safer routes, teaching skills of road crossing to children as well as better regulation and road safety education to two wheelers could reduce the unacceptably high incidents of pedestrian traffic injury

Unintentional Childhood Injury Patterns, Odds, and Outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit

BACKGROUND: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. METHODS: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years). RESULTS: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. CONCLUSIONS: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention priorities could include home, road and school safety; especially dissemination and uptake of proven interventions. Burns should be focus of domestic injury prevention among under-fives. Commercial passenger motorcycles require better regulation and control

Validity and Reliability of the 3-E Tool for Evaluating the Curriculum Support Intervention in Uganda

This study determined psychometric properties of 3-ET, an instrument specifically designed to track the effects of a curriculum support intervention created to enhance the delivery of the national curriculum in a war zone in Uganda. The instrument was developed through brain storm and expert review before being committed to structural and reliability testing using Exploratory Factor analysis (EFA). The 88 variables of 3-ET were reduced to 73; five distinct sub-scales emerged. Sub-scale 1, measured core education support functions and services. Sub-scale 2, assessed aesthetics/efficiency. Sub-scale 3, focused on barriers to stakeholder participation. Sub-scale 4 measured peacefulness and gender sensitivity of learning environments. Sub-scale 5 assessed pupil participation. 3-ET has acceptable structural validity and internal consistence reliability. It can be used to test effectiveness of the REPLICA intervention. Its applicability in other conflict and non-conflict contexts needs review

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

Epidemiology of child injuries in Uganda: challenges for health policy.

Globally, 90% of road crash deaths occur in the developing world. Children in Africa bear the major part of this burden, with the highest unintentional injury rates in the world. Our study aims to better understand injury patterns among children living in Kampala, Uganda and provide evidence that injuries are significant in child health. Trauma registry records of injured children seen at Mulago Hospital in Kampala were analysed. Data were collected when patients were seen initially and included patient condition, demographics, clinical variables, cause, severity, as measured by the Kampala trauma score, and location of injury. Outcomes were captured on discharge from the casualty department and at two weeks for admitted patients. From August 2004 to August 2005, 872 injury visits for children <18 years old were recorded. The mean age was 11 years (95% CI 10.9-11.6); 68% (95% CI 65-72%) were males; 64% were treated in casualty and discharged; 35% were admitted. The most common causes were traffic crashes (34%), falls (18%) and violence (15%). Most children (87%) were mildly injured; 1% severely injured. By two weeks, 6% of the patients admitted for injuries had died and, of these morbidities, 16% had severe injuries, 63% had moderate injuries and 21% had mild injuries. We concluded that, in Kampala, children bear a large burden of injury from preventable causes. Deaths in low severity patients highlight the need for improvements in facility based care. Further studies are necessary to capture overall child injury mortality and to measure chronic morbidity owing to sequelae of injuries