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East and Central African Journal of Surgery
Association of Surgeons of East Africa and College of Surgeons of East Central and Southern Africa
ISSN: 1024-297X EISSN: 2073-9990
Vol. 13, Num. 1, 2008, pp. 73-76
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East and Central African Journal of Surgery, Vol. 13, No. 1, March-April 2008, pp. 73-76
Road Traffic Injuries
at Kigali University Central Teaching Hospital, Rwanda.
E. Twagirayezu, R. Teteli, A.
Bonane, E. Rugwizangoga,
Kigali University Teaching
Hospital, Kigali, Rwanda.
Correspondence
to: Dr. E Twagirayezu, Email: emmanuel.twagirayezu@chukigali.org
Code Number: js08012
Background: Injury and deaths due to road
traffic crashes are a major public health problem in developing countries. More than 3000 people die on the world's
roads every day. Tens of millions of people are injured or disabled every year.
Children, pedestrians, cyclists and the elderly are among the most vulnerable
of road users. More than 85% of all deaths and 90%
of disability adjusted life years lost from road traffic injuries occur in
developing countries. Road traffic injuries in developing countries
particularly affect the productive (working) age group (15-44 years) and
children. Among children aged 0-4 and 5-14 years, the number of
fatalities per 100 000 population in low income countries was about six
times greater than in high income countries in 1998. Police data for
Rwanda has revealed a decline in the number of road traffic accidents. This
reduction in number of RTA has been attributed to the vigilance of Traffic
Police, This study was aimed at determining the
pattern of road traffic injuries seen at Kigali.
Methods: This was a retrospective
descriptive study done at Kigali Central University Teaching Hospital in the
Department of Emergence and in the Trauma hospitalization wards. Records of all
cases of road traffic injuries were retrieved and studied.Data collected was
filled in a standard form in which data obtained was recorded. Parameters
studied included the age, sex, place of residence, province of origin, means of
transport used.
Results: Of the 1101 road traffic
accident victims, 558 (50.7%) were in the 16 to 30 age group. Only 7.2% of the
cases were aged 46 years and above with only 21 (1.9%) being above 60 years.
Table 3 shows the socio-demographic findings among patients with road traffic
injuries seen at Kigali University Teaching Hospital (CHUK). There was a
predominance of males accounting for 78.7% with a male to female ratio of
3.7: 1. Most patients (90.2% were residents of Kigali city. Most patients came
to CHUK without going through the established referral systems (Table 4). The
commonest injuries were wound and contusions (54.7%), lower limb injuries
(41.9%) and head injury (29.4%). There were 103 deaths (9.4% mortality rate).
Fifty eight (56.3%) of the deaths occurred before arrival to hospital
Introduction
Road traffic injuries (RTI)
constitute a major but neglected public health problem and y have a significant
adverse effect on the economy and health services of many countries. The WHO
found that 1.2 million people are killed each year and about 50 million are
injured over the world1. Statistics available in come from Rwanda
Police registers and give only the number of injured people but do not say
anything about diagnosis and importance of the trauma2. Before the
invention of vehicles, injuries on the road were rare and involved animals,
pedestrians and trolleys among others. With the invention of vehicles
(cars, buses, motorcycles, etc) road traffic injuries increased. According to
available information, the first accident involving a bicycle was registered in
New York on 30 may 1896. The first death of a pedestrian knocked by a vehicle was on 17
August 1896. By 1997, 25 million people had been killed in road traffic
accidents (RTA). In 2002, 1.18 million died of RTI, giving an average of 3242
deaths per day. Road traffic injuries accounted for 2.1% of all deaths and were
the 11th cause of deaths worldwide. Among deaths registered in
2002, 90% were in developing countries1.
Apart from causing deaths, RTA
account for injuries in 20-50 Million people annually. Since 60s –
70s the mortality rate in developed countries has declined. For
example, in 1975-1998 in the North America, deaths due to RTA decreased by 27%
for a population of 100.000 inhabitants in USA, and in Canada the decrease were
63%. However, in the developing countries, the rates have been on the increased11,8.9 for instance by 243% in China and by 44% in Malaysia10.
Police data for Rwanda has
revealed a decline in the number of road traffic accidents. This reduction in
number of RTA has been attributed to the vigilance of Traffic Police (Table 1).
Table 2 shows the causes of road traffic accidents as reported by the Police2. The
number of victims of road traffic accidents decreased by 650 (16%) in
2005 compared to 2004 and by 800 (19%) in 2004 compared to 2003. According
to the police, carelessness was the leading cause of RTA in Rwanda followed by
over speeding and wrong manoeuvres. This study was aimed at analyzing the
cases of RTI treated at CHUK in Rwanda.
Patients
and Methods
This was a retrospective
descriptive study done at CHUK in the Department of Emergence and in the Trauma
hospitalization wards. It covered all the RTI victims who consulted Emergence
department from 1st Jan. to 31st Dec.2005. The data was
collected from the patients’ registers of emergence department, admission,
files of emergence department and hospitalization files in surgery and
intensive care unit.
Data collected was filled in a
standard form in which data obtained was recorded. Parameters studied included
the age, sex, place of residence, province of origin, means of transport used
at the time of accident, loss of consciousness (LOC) on arrival; type of
lesion, findings on clinic examination, treatment received, place of
hospitalization, evolution and duration of hospitalization, were included.
Results
Of the 1101 road
traffic accident victims, 558 (50.7%) were in the 16 to 30 age group. Only 7.2%
of the cases were aged 46 years and above with only 21 (1.9%) being above 60
years. Table 3 shows the socio-demographic findings among patients with road
traffic injuries seen at Kigali University Teaching Hospital (CHUK). There was
a predominance of males accounting for 78.7% with a male to female ratio of
3.7: 1. Most patients (90.2%) were residents of Kigali city. Most patients came
to CHUK without going through the established referral systems (Table 4). Only
about a third (32.2%) of the patients were hospitalized. Among hospitalized
patients, 50.3% spent between 8 -30 days.
Table
1. Rwanda Police
Statistics of 2002 – 2005 Road Traffic Accident
|
2002 |
2003 |
2004 |
2005 |
Accidents |
3930 |
4210 |
4063 |
3410 |
Severe |
1221 |
963 |
955 |
735 |
Not severe |
2709 |
3247 |
3008 |
2675 |
Day |
3045 |
3191 |
2995 |
2517 |
Night |
885 |
1019 |
1078 |
893 |
Injured |
3227 |
3392 |
3206 |
2856 |
Dead |
416 |
385 |
323 |
267 |
Total |
15433 |
16407 |
15628 |
13353 |
Table 2. Causes of RTA in Rwanda According to 2002 – 2005 Police data.
Cause |
2002 |
2003 |
2004 |
2005 |
Overspeeding |
780 |
749 |
560 |
447 |
Drunkardness |
238 |
114 |
114 |
81 |
Carelessness |
1920 |
2458 |
2398 |
1894 |
Wrong manoeuvres |
432 |
408 |
595 |
648 |
Machanical problems |
300 |
202 |
154 |
136 |
Poor roads |
56 |
53 |
49 |
34 |
Rains (slipperly roads) |
30 |
11 |
9 |
5 |
Lack of sign posts |
12 |
8 |
2 |
3 |
Other |
162 |
207 |
182 |
162 |
Total |
3930 |
4210 |
4063 |
3410 |
Table
3. Socio –Demographic
Characteristics
Characteristics (N = 1101) |
Frequency |
% |
Age |
|
|
0 – 15years |
226 |
20.5 |
16 – 30 |
558 |
50.7 |
31 – 45 |
238 |
21.6 |
46 – 60 |
58 |
5.3 |
60 |
21 |
1.9 |
|
|
|
Sex |
|
|
Male |
866 |
78.7 |
Female |
235 |
21.3 |
|
|
|
Residence |
|
|
Kigali City |
993 |
90.2 |
Other Provinces |
108 |
9.8 |
Table 4;.Distribution According to the Place of Origin
Origin (N= 1101 |
Frequency |
% |
Referral hospital (KFH) |
4 |
0.3 |
District Hospital |
57 |
5.2 |
Health Center |
13 |
1.2 |
Police |
33 |
3 |
Direct Admission |
982 |
89.2 |
Not specific |
12 |
1.1 |
Table 5. Type of Transport
Causing the accident
Type of transport |
Frequency |
% |
Bicycle |
54 |
10.3 |
Motocycle / motobike |
159 |
30.5 |
Motor car |
212 |
40.7 |
Minibus |
79 |
15.2 |
Bus |
14 |
2.7 |
Lorry |
3 |
0.6 |
Total |
521 |
100 |
Table
6. Distribution According
to the Type of Lesions Sustained
Type of Lesion |
Frequency |
% |
Wounds and contusions |
602 |
54.7 |
Monotrauma (N= 666) |
666 |
60.5 |
Head |
196 |
29.4 |
Upper limbs |
96 |
14.4 |
Lower limbs |
279 |
41.9 |
Abdomen |
60 |
9 |
Thorax |
9 |
1.3 |
Vertebral Column |
7 |
1 |
Pelvis |
19 |
2.8 |
Polytrauma (N = 38) |
38 |
3.4 |
Abdomen + Limbs |
4 |
10.5 |
Abdomen + Thorax |
3 |
7.8 |
Head + Thorax |
3 |
7.8 |
Head + Abdomen |
13 |
34.2 |
Head + Limbs |
11 |
28.9 |
Head + Vertebral Column |
1 |
2.6 |
2 lesions |
3 |
7.8 |
Regarding the
time of the accident, 733 (66.6%) occurred during the day, 215 (19.5%) at night
and in 153 (13.5), the time was not specified. The
type of transport involved in the accident was not specified in 579 (52.6%)
case and was known in 521. In 16.7%, the victims were pedestrians. Motcycles
and motor cars accounted for 30.5% and 40.7% among those whose form of
transport was known (Table 5). Only about a third (32.2%) of the patients
were hospitalized.. Among hospitalized patients, 50.3% spent between 8 -30
days. The commonest injuries were wound and contusions (54.7%), lower limb
injuries (41.9%) and head injury (29.4%).
There were 103
deaths giving a 9.4% mortality rate. Fifty eight (56.3%) of the deaths occurred
before arrival to hospital.
Discussion
Our study confirmed that young
adults in their prime of life are most commonly sustain road traffic injuries.
The average in our study was 25.7 years with a peak in the 16 – 30 years group. In their studies on road traffic accidents,
Bikandou3 in Brazzaville in Congo and Hoekman et al4 in Niger found an average age 24.8 years and 26.3 years
respectively. Romao et al5 in Mozambique in a study on RTA, found
the 25 – 38 years age group to be most commonly affected. Odero et6 al in Kenya found a peak in the 15 – 44 age group.
The male to female sex ratio in
this review was 4 : 1. The preponderance of males has been reported from
elsewhere. The male to female sex has ranged from 2:1 in Brazzavile3 to 5: 1 in Mozambique5. Sheng Yong7 in china recorded a
male to female sex ratio of 4: 1. In our study, the
male to female sex ratio was 4: 1. The reason male predominance is probably
because males are more mobile with active participation in transport
activities. The finding that 66.6% of road traffic injuries were sustained
during the day was in agreement with the Rwanda National Police statistics2.
Similar findings were reported by Andrews, Kobusingye and Lett8 in
Uganda.
Only 32.2% of
our patients were hospitalized with an average hospital stay of 7 days. In
their study, Odero et al6 in Kenya reported a hospitalization rate
of 31% which is much higher than the 5.6% reported by Bikandou et al3 in Brazzaville. Rossi et al9 in Italy. Wounds and contusions were
found in 54.7% of our cases which was comparable with the 50.98% reported in
Brazzaville Congo and the 50% recorded in Italy3,9. Head injury as a
single entity was recorded in 29.45 of cases which was higher than that
reported in Congo (9.82%) and in Mozambique (11.8%)3,5. Limbs are
commonly traumatized in road traffic accidents and were involved in 56.3% of
our patients with a predominance of lower limbs trauma (41.9%). This figure is
high compared to the others. Limb trauma was reported in 42.3% of children
involved in RTA in Gabon10 and in 48% of children in Ivory Coast11.
In Brazzaville limb trauma was observed in only 18.05% of cases3.
Our high figure of limb trauma
is attributable to the large number of pedestrians in Kigali city, which
include children. It ought to be stressed that with Rwanda being hilly, the
mechanical state of vehicles should be perfect with a reliable braking system.
Splenic rupture was sustained in
40% of the 9% cases that had abdominal injury. Pelvic fractures were seen in
2.8% of our cases. Raouf et al10 in Gabon had 16.4% frequency of
abdominal injury, higher than the 8.5% reported in Brazzaville3. The
high frequency of splenic rupture is most likely attributable to splenomegaly
secondary to endemic malaria.
Thoracic Trauma
occurred in1.3% which is lower than that of 3.46% reported by Bikandou
et al3 and 11.2% by Raouf et al10. This lower incidence
in Rwanda may be due to strictness of Rwanda Traffic Police to use of safety
belts2. Only 1% of our cases sustained spinal injury.
A large
number (18.6%) of the patients in CHUK stayed in hospital for over 30 days. The
overwhelming numbers of patients with few surgeons makes patients wait for a
long time before operation, except emergences. Our results show that 91.6% of
our RTA cases made a good progress. The overall mortality was 9.4%. Most deaths
occurred at the site of accident, on the way to the hospital or soon after
admission to the emergency unit. The overall death rate in our series was lower
than that reported by Hoekman et al4 of 15.6% and 15.1% by Rossi et
al9.
In our study history of loss of
consciousness (GCS 9) in motorcycle accidents was recorded in 55% which was
comparable with the 51.2% reported by Hoekman et al4.
Patients with
Glasgow coma scale of below 9 had 82.9% mortality rate. Hoekman et al4 recorded 46.9% mortality among their cases scoring GCS of less than 9. Although
patients aged 60 years and above accounted for only 1.9%, in our study, they
contributed 23.8% of the deaths. This increased mortality among the elderly was
also found by Rossi et al9 but those who were over 70 years of age..
Conclusion:
- The youth (16-30 years)in the most productive
(active) age were most commonly involved in RTA. And accounted for 50.7%of
the cases.
- Males were predominantly affected (78.7%).
- Motorcycles and cars were the major causes of
accidents on the roads.
- The majority (56.3%) of the deaths occurred
before arrival to hospital.
- Prognosis depends largely on LOC on arrival.
- RTI were associated with long hospital stay beds
(16-30days) and over.
References
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road traffic injury prevention. Geneva 2004.
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Rwanda national
Police statistics on RTA 2002-2005.
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Bikandou et al. : Profil des
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Djia, : Les traumatisés dus aux accidents motorisés : un
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© 2008 East and Central African Journal of Surgery
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