Trends of road traffic injuries, response to the injured, and injury outcomes in mukono dIstrict.

Abstract

The effects of road traffic injuries have been more devastating in low income countries where response to the injured and public health capacity to handle the injured remains less than adequate. Mukono district where this study was done is in central Uganda, is traversed by a busy international highway serving land locked countries of Uganda, Rwanda, Burundi, a big part of the democratic republic of cong and other central African nations. Two police stations and one of five hospitals are the main agencies expected to provide emergency and other care to the injured in the district. In the period of January 2002- 1st july 2005, the district registered 460 traffic deaths which was about 7% of the national total of 7054, while recording 1,190 (4.5%) of all persons with serious traffic injuries. The figures were disproportionately high for a largely rural district which has less than 4% of the national population. This study aimed to establish trends of traffic injuries, response to injured persons, capacity available to cater for the injured and determinants of physical outcomes of traffic injuries among health facility populations in mukono district. Methods: In this cross sectional study, injured patients at health facilities were interviewed using a structured questionnaire. The health facilities were purposively selected. All police stations were included. Observation checklists and questionnaire were used to collect information on on capacities of institutions to respond to injured persons. Key informant interviews were conducted among the heads of police units and health facilities. Records on traffic injuries at police stations and health facilities were reviewed. Version 12 of SPSS computer software was used to analyse quantitative data. Data of qualitative nature were analysed manually. Results: The number of those injured in road traffic crashes over the three years under review remained high but stable. The police records had just a fraction of those actually injured in RTAs. Overall mean time between time of injury and receiving first treatment at the health facility was 3 hours 41 minutes (221 minutes). Health facilities had ambulances but did not participate in rescue of the injured at crash sites. Police lacked ambulances but participated in rescue of about 20% of those injured. The major determinants of unfavourable injury outcomes were whether someone needed blood transfusion or not, (OR 5.65, 95% CI: 1.13-28.14) whether one had sustained a limb or bone fracture or not (5.66, 95% CI: 2.59-24.36). when multivariable analysis was performed, sustaining a limb fracture was identified as the factor independently leading to unfavourable injury outcomes (AOR 6.13, 95% CI 2.66-14.11). Conclusion: The magnitude of road traffic injury is big and not well documented. Fractures sustained in RTAs are a major association with disability and/ or death should be managed more vigilantly. Blood transfusion services present a major challenge in management of the injured. Recommendations: More comprehensive documentation for injuries should be developed by the health system in order to accurately estimate the magnitude of the problem. There should be re-orientation of efforts in injury management at various levels to improve orthopaedic clinical service as well as blood replacement services. A community survey covering a wider area and conducted over a longer period would elucidate further on the factors that mainly influence injury outcome.