Annals of African Medicine Annals of African Medicine Society ISSN: 1596-3519 Vol. 5, Num. 3, 2006, pp. 149-152

Annals of African Medicine, Vol. 5, No. 3, 2006, pp. 149-152

Epidemiology of Accident Deaths in Jos, Nigeria (1996-2000)

¹B. M. Mandong, ¹J. K. A. Madaki, ¹A. Z. Mohammed, ²A. T. Kidmas and ¹G. O. Echejoh

¹Department of Pathology, and ²Surgery, Jos University Teaching Hospital, Jos, Nigeria
Reprint requests to: Dr. B. M. Mandong, P. O. Box 887, Jos, Plateau State, Nigeria, E-mail: mafala2004@yahoo.com

Code Number: am06034

Abstract

Background:Accidents are common events in our society and have contributed significantly to causes of morbidity and mortality in most hospitals. In our environment accidents are fast becoming the commonest cause of death. Only few cases of these accidents are reported to the corona for investigation.
Methods: Records of deaths from January 1996- December 2000 reported to the corona for autopsies from two major Hospitals in Jos city were analyzed.  Those related to accidents were retrieved and studied. Information from the Police regarding causes of accidents was also extracted.  Data on the deceased such as age, sex, and nature of injury were also collated.  Police reports on the contributing factors to accidents were also analysed.
Results:A total of 270 cases of deaths were reported to the corona for autopsies out of which 122 (45%) were accident deaths. One hundred and three (86%) cases were males while 19 cases were females.  Two-thirds of deaths (60%) were in the productive age group of 21—40 years.  Multiple fractures long bones without head injury accounted for 37.7% of deaths, followed by head/upper spinal injuries 24.6%, crushed body injuries 22%, while, intra-abdominal organ injuries which accounted for 15.6%.  Analysis of types of accidents showed that vehicle, motorcycle, airplane crash and pedestrian accidents accounted for 59.8%, 20.5%, 10.7% and 9.0% respectively.  Information from the Police on motor vehicle accidents, records showed that 50% of the accidental events were due to dangerous driving under the influence of alcohol.
Conclusion:Accident death in our environment appears to affect mostly men in the productive and reproductive age groups.  However measures that regulate vehicle speed on the road and alcohol intake by drivers may reduce more than half of such deaths.

Key words:Accidental deaths, epidemiology

Résumé

Introduction :Des accidents sont des événements ordinaires dans notre société et ils ont contribué d’une manière significative à des causes de la morbidité et mortalité dans la plupart des hôpitaux.  Dans notre milieu des accidents deviennent de plus en plus la cause la plus ordinaire de la mort.  Quelques cas seulement de ces accidents sont rapportés au Corona pour des enquêtes.
Méthodes : Dossiers des morts du janvier 1996 – décembre 2000 rapportés à Corona pour des autopsies venant de deux Hôpitaux principaux à Jos ont été analysés.  Ceux ayant rapport aux accidents ont été retrouvés et étudiés.  Des informations d’après la Police pour ce qui est des causes des accidents était également notées.  Les données sur les décès telles que âge, sexe, et la nature de la blessure ont été également notés.  Des rapports de la part de la Police sur des facteurs qui provoquent les acidents ont été également étudiés.
Résultats : Un nombre total de 270 cas ont été rapportés à  Corona pour des autopsies parmi lesquels 122 soit 45% étaient  des morts à travers des accidents.  Cent trois soit 86% cas étaient du sexe masculin tandis que 19 étaient du sexe féminin.  Deux tiers des morts soit 60% était dans la trance d’âge productif 21 – 40 ans.   Fractures multiples os long sans blessure dans la tête constituent  37,7% des morts, suivi par tête/blessures spinales supérieure 24,6%, blessures impliquant le corps écrasé 22%, tandis que des blessures des organes intra-abdominal qui constituent 15,6%.  L’analyse des types des accidents a montré que véhicule, motocyclette, accident d’avion et accident pédestre constituent 59,8%, 20,5%, 10,7% et 9,0% respectivement.  Des informations de la part de la Police sur des accidents à travers des véhicles, les dossiers ont montré que 50% des événements accidentels étaient attribuables à la conduite dangereuses sur l’empire de la boisson.
Conclusion :La  mort à travers des accidents dans notre milieu semble de toucher des hommes en particulier dans la tranche d’âge productif et reproductif.  Toutefois ; des demarches qui contrôlent la vitesse des véhiclules dans la route et la consommation de la boisson par des chauffeurs peuvent baisser plus d’un moitie de telles morts.

Mot clés : morts accidentielles, épidémiologie

Introduction

Deaths resulting from trauma sustained from various types of accidents continue to be a serious public health problem.^{1, 2} Medico-legal deaths refer to deaths in suspicious circumstances which require an inquest from the Corona.  A Corona in such cases is either a judge or a magistrate empowered by law to investigate the cause of death.   Deaths resulting from accidents account for the major cause of mortality in both developed and developing countries.^{1, 3}

Studies from various part of Africa including Nigeria have shown that road traffic accidents are on the increase and are responsible for the high rate of deaths in most cities of Nigeria and other African cities.^1-7  In some teaching hospitals in Nigeria, trauma from accidents is responsible for more than sixty percent of surgical admissions^5,6 .  Causes of accident deaths in our environment include road traffic accidents, drowning in mining ponds, airplane crash, falls from trees, fire outbreaks and occasionally train accidents.

The objectives of the study are to determine the pattern of deaths that resulted from accidental events, the types of injuries sustained the possible contributing factors and to make suggestions on possible preventive strategies.

This retrospective study was a 6 year review carried out in two hospitals namely Jos University Teaching Hospital (JUTH) and Plateau State Specialist Hospital (PSSH), all located in the city of Jos. These hospitals have the services of resident pathologists. All corona requests for autopsies were referred to either of the hospitals from neighbouring states of Bauchi, Benue, Taraba, Nasarawa, Southern Kaduna and Plateau states.  Records of all accident deaths reported to the corona between January1996- Dec 2000 were retrieved from the two hospitals.  Information on age, sex, type of accidents, mechanism of injury and possible cause of death was collected and analysed.

There were two hundred and seventy medico legal autopsies recorded in both hospitals. One hundred and twenty two cases were due to accidents and accounted for 45.2% of all medico legal autopsies.  In the 122 cases of accident deaths, 103 were males and 19 were females giving a male to female ratio of 5:1.

Table 1 shows the age distribution of patients.  The least age was less than 1 yr while the oldest case was 60 years.  The highest proportion of deaths occurred in the age range 21-40 years and accounted for 59.9%.  Children less than 10 years were the least affected accounting for 4.9%.  The aged (those >50years) accounted for 10.9% of cases.  Table 2 shows types of accidents responsible for mortality.  Motor vehicle accidents accounted for the highest proportion of deaths (59.8%) and reported deaths were only the occupants of the vehicles.  This was followed by motor cycle accidents 20.5%, airplane crash accidents 10.7% and Pedestrian accidents 9.0%.  Pedestrian cases were either those knocked down by a cyclist or a motor vehicle.  Table 3 shows types of injuries sustained at death. Multiple fractures of bones without head injury accounted for 37.7% followed by head/upper spinal injuries 24.6%, crushed body injuries 22% and intra-abdominal organ injuries which accounted for 15.6%.There were a total of twenty fatal accidents in our records out of only ten were retrieved from police records.

Information from the Police showed that 10 (50%) of the accidental events from motor vehicle were due to dangerous driving under the influence of alcohol. Other contributing factors included brakes failure accounting for 4 (20 %), and head on collision due to bad condition of roads 6 (30 %).

Table 2: Type of accidents        

Table 3: Types of injuries sustained in the 122 accidental deaths

Though accident constitutes a major cause of death in our environment   only a small proportion of the cases are reported to the corona for investigation In the 5 years review only 270 cases of medico legal autopsies were carried out in these two major health institutions. The proportion of deaths was highest in the younger age group of 21-40 years and occurred predominantly in males. This group represents the economically active age and portrays an economic lost both to the family and the Nation. This is because this age group travels widely in search of means of livelihood and people in this group are more likely to be involved in accidents.

Fifty nine percent of deaths were due to motor vehicle accidents involving the occupants. This type of accident is responsible for the highest cause of deaths in our society.^{3, 4} The causes of accidents resolved around three factors; human, vehicle and road^{3, 12}.  These factors are not mutually exclusive in Nigeria in the causation of road traffic accidents.  In most developing countries roads are poorly maintained.  Also there is inadequate observation of traffic regulations.  These irregularities are responsible for most of the accidents recorded.  Most cars in Nigeria are fairly used and their life spans have been shortened by the time they arrived Nigeria. These used cars constitute a threat to the life and health of citizens of the Country.  Driving under the influence of alcohol and other dangerous drugs has been a major cause of accidents in Nigeria.^{7, 8}

Absence of ambulance services on our high ways and lack of prompt medical attention to accidents victims are contributors to the high death rate in accidents.^{2, 4,9,10}

Motor cycle use is becoming popular with Nigerians as it has become a cheaper and easier means of transportation in most cities. Most cyclist do not use protective head crash helmet. Accidents with unprotected and exposed body might be responsible for the high rate of fatality in motor cycle accidents.^{7, 8}

Pedestrian accidents are not uncommon, and occur most commonly in children. In this study it occurred in children below the age of 10 years. In most cities of Nigeria pedestrians signs are either absent or not observed by pedestrians or drivers and this has been responsible for high rate of fatality pedestrian accidents.^{8- 10}

Airplane accidents are global problem and are not frequent. First recorded plane accident in Nigeria was recorded in the 1960s and a number of cases have occurred in the past two decades. The plane crash victims in this study involved a military administrator and his aids.

High rate of death is attributed to delay and in adequate medical attention, which in our environment is characterized by practically non existent pre hospital services. A study of trauma victims in Lagos Nigeria showed that 94% arrived the hospital in public or private vehicles with only 6% transported by ambulance.^{4, 9, 10} Prevention of accidents death will include proper road construction and maintenance, observation of road sign and speed limits.

There is the need for legislation that would compel motorist to be trained and issue with appropriate licencing agents and to discourage motorist driving under the influence of drugs and alcohol. These processes will require public enlightenment and education.

From the foregoing it is clear that accidents are responsible for high proportion of deaths in our environment. Improvement in the quality of Nigerian roads, proper highway patrol by law-enforcement agents will reduce road accidents. Also prompt medical attention to accidents victims and availability of ambulance services in our highways will also reduce mortality rate.

References

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