Effect of wearing a helmet on the occurrence of head injuries in motorcycle riders in Benin: a case-control study

BACKGROUND: In Benin, motorcycles are the main means of transport for road users and are involved in more than half of crashes. This study aims to determine the effect of wearing a helmet on reducing head injuries in road crashes in Benin. METHODS: This case-control study took place in 2020 and focused on road trauma victims. The sample, consisting of 242 cases (trauma victims with head injuries) for 484 controls (without head injuries), was drawn from a database of traffic crash victims recruited from five hospitals across the country from July 2019 to January 2020. Four groups of independent variables were studied: socio-demographic and economic variables, history, behavioural variables including helmet use and road-related and environmental variables. To assess the shape of the association between the independent variables and the dependent variable, a descending step-by-step binary logistic regression model was performed using an explanatory approach. RESULTS: Fewer of the subjects with a head injury were wearing a helmet at the time of the crash 69.8% (95% CI = 63.6-75.6) compared to those without a head injury 90.3% (95% CI = 87.3-92.8). Adjusting for the other variables, subjects not wearing helmets were at greater risk of head injuries (OR = 3.8, 95% CI (2.5-5.7)); the head injury rating was 1.9 (95% CI = 1.2-3.3) times higher in subjects who were fatigued during the crash than among those who were not and 2.0 (95% CI = 1.2-3.3) times higher in subjects with no medical history. CONCLUSION: Failure to wear a helmet exposes motorcyclists to the risk of head injuries during crashes. It is important to increase awareness and better target such initiatives at the subjects most at risk

coloproctectomie avec anastomose colo-sus-anale pour tumeur bénigne du rectum : à propos d’un cas de bilharziome rectal

Dans l’infestation à Schistosoma haematobium, l'envahissement du rectum est  anatomiquement constant mais généralement asymptomatique. Nous rapportons l’observation d’un adulte jeune atteint d’une pseudo-tumeur bénigne du rectum due à  Schistosoma haematobium. Le patient H.D. (dossier n°14/5304/VB), âgé de vingt ans, lycéen, fut admis le 20/06/14 pour la prise en charge d’une tumeur  hémorragique du bas rectum avec anémie sévère et asthénie intense. Une recto-sigmoïdoscopie observa des lésions tumorales rectales et des biopsies furent faites. L’examen des fragments biopsiques conclut à une lésion d’aspect polypoïde avec une prolifération de cryptes normocrines et régulières faisant conclure à un polype adénomateux. Une coloproctectomie fut réalisée le 30/06/2014 avec  anastomose colo-anale, colostomie de protection sous-couvert d’une  transfusion sanguine. L’examen histologique du segment colorectal prélevé objectiva une rectocolite granulomateuse autour de nombreux oeufs de schistosomes. En effet, le patient a vécu à Pahou, un arrondissement rural marécageux du Bénin où sévit une endémie bilharzienne. Le rétablissement de la continuité digestive fut réalisé le 22/10/2014 après un contrôle radiologique  satisfaisant de l'anastomose colo-susanale. Le bilharziome rectal symptomatique est très rare et devrait attirer l’attention des chirurgiens des zones d’endémie bilharzienne devant une tumeur rectale hémorragique.Mots Clés : Bilharziome ; Rectorragie ; Tumeur ; Bénin ; ColoproctectomieIn the infestation by Schistosoma haematobium, the invasion of the rectum is constant but generally asymptomatic. We report the case of a young adult with a benign rectal pseudo-tumor caused by Schistosoma haematobium. Patient HD (record n°  14/5304/VB), twenty years old, high school student, was admitted for the treatment of a hemorrhagic tumor of the lower rectum with severe anemia and asthenia. A proctosigmoidoscopy observed rectal tumoral lesions and biopsies were made. Examination of biopsy fragments concluded to a polypoid lesion with a  proliferation of normocrineand regular crypts making thinking of adenomatous polyp. A coloproctectomy was realized on 30/06/2014 with a colo-anal anastomosis, a colostomy protection under cover by a blood transfusion. Histological examination of the colorectal segment found a granulomatous colitis around numerous  schistosoma eggs. Indeed, the patient lived in Pahou, a swampy rural district of Benin where there is aschistosomiasisendemy. The restoration of digestive  continuity was achieved on 22/10/2014 after a satisfactory radiological control of the colo-anal anastomosis. Symptomatic rectal bilharziome is very rare. It should attract the attention of surgeons in schistosomiasis endemic areas in face of  hemorrhagic rectal tumor.Keys words : bilharziome, tumor, benign, coloproctectomy