Article

The burden of road traffic injuries in Nigeria: Results of a population-based survey

World Health Organization, Abuja, Nigeria.
Injury Prevention (Impact Factor: 1.89). 06/2009; 15(3):157-62. DOI: 10.1136/ip.2008.020255
Source: PubMed
ABSTRACT
Mortality from road traffic injuries in sub-Saharan Africa is among the highest in the world, yet data from the region are sparse. To date, no multi-site population-based survey on road traffic injuries has been reported from Nigeria, the most populated country in Africa.
To explore the epidemiology of road traffic injury in Nigeria and provide data on the populations affected and risk factors for road traffic injury.
Data from a population-based survey using two-stage stratified cluster sampling. SUBJECTS/ SETTING: Road traffic injury status and demographic information were collected on 3082 respondents living in 553 households in seven of Nigeria's 37 states.
Incidence rates were estimated with confidence intervals based on a Poisson distribution; Poisson regression analysis was used to calculate relative risks for associated factors.
The overall road traffic injury rate was 41 per 1000 population (95% CI 34 to 49), and mortality from road traffic injuries was 1.6 per 1000 population (95% CI 0.5 to 3.8). Motorcycle crashes accounted for 54% of all road traffic injuries. The road traffic injury rates found for rural and urban respondents were not significantly different. Increased risk of injury was associated with male gender among those aged 18-44 years, with a relative risk of 2.96 when compared with women in the same age range (95% CI 1.72 to 5.09, p<0.001).
The road traffic injury rates found in this survey highlight a neglected public health problem in Nigeria. Simple extrapolations from this survey suggest that over 4 million people may be injured and as many as 200 000 potentially killed as the result of road traffic crashes annually in Nigeria. Appropriate interventions in both the health and transport sectors are needed to address this significant cause of morbidity and mortality in Nigeria.

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Available from: Catherine Juillard, Jul 30, 2014
doi:10.1136/ip.2008.020255
2009;15;157-162 Inj. Prev.
M Labinjo, C Juillard, O C Kobusingye and A A Hyder
results of a population-based survey
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The burden of road traffic injuries in Nigeria: results
of a population-based survey
M Labinjo,
1
C Juillard,
2,3
O C Kobusingye,
4
A A Hyder
5
1
World Health Organization,
Abuja, Nigeria;
2
Johns Hopkins
Bloomberg School of Public
Health, Baltimore, Maryland,
USA;
3
UCLA Department of
Surgery, Los Angeles, California,
USA;
4
World Health
Organization Regional Office for
Africa, Brazzaville, Congo;
5
International Injury Research
Unit, Department of International
Health, and Center for Injury
Research and Policy, Johns
Hopkins Bloomberg School of
Public Health, Baltimore,
Maryland, USA
Correspondence to:
Dr A A Hyder, Johns Hopkins
Bloomberg School of Public
Health, 615 North Wolfe Street,
Suite E-8132, Baltimore, MD
21205, USA; ahyder@jhsph.edu
Accepted 6 January 2009
ABSTRACT
Background: Mortality from road traffic injuries in sub-
Saharan Africa is among the highest in the world, yet data
from the region are sparse. To date, no multi-site
population-based survey on road traffic injuries has been
reported from Nigeria, the most populated country in
Africa.
Objective: To explore the epidemiology of road traffic
injury in Nigeria and provide data on the populations
affected and risk factors for road traffic injury.
Design: Data from a population-based survey using two-
stage stratified cluster sampling.
Subjects/setting: Road traffic injury status and demo-
graphic information were collected on 3082 respondents
living in 553 households in seven of Nigeria’s 37 states.
Main outcome measures: Incidence rates were
estimated with confidence intervals based on a Poisson
distribution; Poisson regression analysis was used to
calculate relative risks for associated factors.
Results: The overall road traffic injury rate was 41 per
1000 population (95% CI 34 to 49), and mortality from
road traffic injuries was 1.6 per 1000 population (95% CI
0.5 to 3.8). Motorcycle crashes accounted for 54% of all
road traffic injuries. The road traffic injury rates found for
rural and urban respondents were not significantly
different. Increased risk of injury was associated with
male gender among those aged 18–44 years, with a
relative risk of 2.96 when compared with women in the
same age range (95% CI 1.72 to 5.09, p,0.001).
Conclusions: The road traffic injury rates found in this
survey highlight a neglected public health problem in
Nigeria. Simple extrapolations from this survey suggest
that over 4 million people may be injured and as many as
200 000 potentially killed as the result of road traffic
crashes annually in Nigeria. Appropriate interventions in
both the health and transport sectors are needed to
address this significant cause of morbidity and mortality in
Nigeria.
Injuries are becoming recognised as a leading cause
of global death and disability, with road traffic
injuries (RTIs) being the greatest contributor.
1–5
Injuries due to road traffic crashes are estimated to
be the second leading cause of lost disability-
adjusted life-years (DALYs) in developing countries
by 2020.
6
Mortality due to RTI in Africa is among
the highest in the world, at 28.3 deaths per 100 000
population.
47
The economic costs associated with
RTIs in Africa were estimated to be US$3.7 billion
in 2000, translating to approximately 1–2% of each
country’s gross national product.
89
According to the World Health Organization
(WHO), RTIs ranked as the 11th leading cause of
death and the 6th leading cause of DALYs lost in
Nigeria for 2002, and constituted the leading cause
of death and DALYs lost from unintentional
injuries.
10
In the 1990s, the cost of RTIs for
Nigeria was estimated to be .US$25 million, an
amount that is thought to have greatly increased in
the past two decades.
11
Existing sources of injury
information in Nigeria include hospital data and
police records.
12–20
Although hospital data are useful
in revealing certain trends, the inferences that can
be drawn from these results are limited, as both
hospital and police data are subject to selection bias
and do not allow estimation of the population-
based impact of RTIs.
Community-based survey data for RTIs are
available for several other countries in sub-
Saharan Africa, including one from Nigeria, but
data are limited to one region of the country.
21–23
This study sought to extend the information on
RTIs in Nigeria beyond police and hospital data by
performing a larger population-based household
survey. The objectives of this study were: (1) to
estimate incidence rates for RTIs in selected parts
of Nigeria; and (2) to describe the population-based
epidemiology of RTIs, especially in terms of
gender, age and urban and rural distribution. This
study is an attempt to test methods for commu-
nity-based surveys for RTIs and to inform the
work of those involved in national and interna-
tional health in Nigeria.
METHODS
Nigeria is the most populous country in Africa,
with an estimated 126 million inhabitants, and
comprises a great diversity of climate and topo-
graphy, with a mostly rural-dwelling population.
24
It is divided into six geopolitical zones, 37 states
and multiple local government areas within each
state. The survey was conducted in early 2006 in
seven states: Lagos, Anambra, Rivers, Borno,
Plateau, Kaduna and the Federal Capital Territory.
These states range in population from 1 million
(Federal) to 9 million (Lagos) and from a per capita
household monthly income of US$7.50 and official
poverty rate of 88% (Borno) to US$36.00 and 70%
(Lagos).
25
The main rationale for the selection of
these areas was to ensure representation from each
of the six geopolitical zones in the country: South-
West, South-East, South-South, North-Central,
North-East, North-West.
The survey sample was drawn from an existing
sampling frame, the National Integrated Survey of
Households sample design, run by the National
Bureau of Statistics in Nigeria. A two-stage
stratified, cluster sampling was used, with a power
analysis for a cross-sectional survey at the 95%
confidence level. Assuming an RTI rate of 0.04, a
precision within 5%, and an average household size
Original article
Injury Prevention 2009;15:157–162. doi:10.1136/ip.2008.020255 157
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of five people, a sample size of 330 individuals (66 households)
per state was calculated. In order to account for possible low
response rates, the number of households per state was
increased to 80, yielding a total estimate of 560 households
and 2880 individuals. Four enumeration areas—two rural and
two urban—were selected randomly within each of two local
government areas in seven states, totalling eight enumeration
areas for each state. The enumeration area was the primary
sampling unit for the survey from which 10 households were
randomly selected using the existing sampling frame of the
National Bureau of Statistics. All residents of the 80 households
in each state were included in the study.
Data were collected through household interviews using
questionnaires adapted from household injury surveys pre-
viously implemented in Ghana and Uganda.
21 22
Pilot interviews
were carried out in areas not included in the survey, before the
implementation of the survey, and questions were refined on
the basis of cultural sensitivity. In each of Nigeria’s states, up to
40 languages may be spoken, therefore questionnaires were
written in English and orally translated into local languages by
the interviewers. The most commonly used languages were:
English, Yoruba, Hausa, Ijaw, Ikwere and Pidgin. The surveys
were administered by experienced local translators from the
National Bureau of Statistics. A 2-day training of master
trainers was held first, and then each master trainer conducted
a 2-day workshop to train interviewers for the field work and
translation. Quality control was achieved by designated state
coordinators via on-the-job supervision, random spot checks of
completed questionnaires, and on-site interviews ensuring
accuracy of translation.
Interviews were obtained from the head of the household,
who served as proxy respondent for people less than 18 years of
age, the legal age of adulthood in Nigeria. Demographic
information was collected for every person, including age,
gender, education, marital status, occupation and rural/urban
status. RTI was defined as any physical body damage resulting
from a motor vehicle crash, being hit by a motor vehicle, or
other transport mechanism in the past 12 months. Injuries were
categorised by severity; for the purposes of this analysis,
‘‘severe’’ injuries were defined as any injury requiring hospita-
lisation or resulting in permanent disability. Otherwise injuries
were defined as ‘‘slight’’. In addition, the mechanism of injury,
time of day, location, part of body injured, disability, treatment
and cost data were collected. During pretesting of the
questionnaire, it was found that there were negative cultural
perceptions associated with asking about a death within
30 days of the event. These cultural issues were not relevant
when death was discussed in terms of where it occurred. For
this reason, mortality from RTI was counted if a death occurred
at the scene of the crash, on arrival at the hospital, or before
discharge from the hospital only. As restricting death events to
these criteria would underestimate the number of deaths due to
RTI, this definition was felt to be a reasonable pragmatic
adjustment.
The data were entered in Epi-Info, edited and converted into
Stata 10.0 statistical software for analysis. Univariate and
bivariate analyses were performed for all demographic char-
acteristics and injury responses, and incidence rates for age,
gender, educational status and rural/urban designation were
generated. Corresponding standard errors were calculated and
multiple regression analysis was performed using a Poisson
distribution, with an adjustment for potential clustering effects
by household.
26
Multivariate logistic regression analysis was also
conducted, and the estimations were found to be robust and
consistent through both methods. Only the results of the
Poisson regression are reported here. An additional analysis was
performed that included an interaction term between age and
gender to explore potential effect modification between male
gender, which has been associated with an increased risk of RTI,
and age.
Annual numbers of events for the country were calculated
using 126 million as the total population of Nigeria, as reported
in the 2003 Demographic and Health Survey.
24
This community
survey was jointly conducted and approved by the Nigerian
Office of WHO and the Nigerian Ministry of Health.
Anonymous, secondary, deidentified data were shared with
authors at the International Injury Research Unit, Department
of International Health, Johns Hopkins University for joint
analysis.
RESULTS
The actual number of households that responded was 553,
resulting in a total of 3082 individual respondents, a household
response rate of 98.8%. Among the respondents, 50.9% were
male, 60.5% lived in urban areas, and the mean (SD) age of
study subjects was 22.5 (18) years, with the majority (36.8%) in
the 5–17-year age range. The breakdown of the survey
population was largely similar to the Nigerian population,
except for the proportion married and geographical distribution;
this study had a higher representation of urban residents, as
well as participants who responded ‘‘never married’’ (table 1).
Of the 3082 people included, 348 (11.3%) reported having any
injury in the previous 12 months, and 127 of them reported an
RTI (table 2). For all injuries, the estimated injury rate was
Table 1 Demographic data for survey sample population (n = 3082)
and Nigerian population
Survey (n = 3082) Nigeria*
Gender (%)
Male 50.91 49.64
Female 49.09 50.36
Years of age (%)
,5 14.55 16.6
5–17 36.75 53.6{
18–29 21.93
30–44 17.59 14.8
45–59 3.79 9
>60 5.4 6
Sector (%)
Rural 39.49 65.41
Urban 60.51 34.59
Education (%)
No formal education 30.18 38.4{
Pre-primary 7.04
Some primary 19.34 22.72
Completed primary 9.9 8.99
Some secondary 13.3 15.62
Completed secondary 14.28 7.64
Post-secondary 5.97 5.28
Marital status (%)
Never married 64.11 31.88
Currently married 33.1 61.53
Separated/divorced 0.75 2.57
Widowed 1.85 1.81
*From the 2003 Nigerian Demographic and Health Survey.
{Data from 2003 Demographic and Health Survey: age only available in increments of
5 years; no formal education and pre-primary only available as collapsed single
category, ‘‘no education.’’
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112.9 per 1000 population (95% CI 101.4 to 125.4), and the
estimated annual RTI rate was 41.2 per 1000 population (95%
CI 34.3 to 49.0). The rate of RTI for men of all ages was
significantly higher than that of women (table 2). The RTI rate
was higher, but not significantly so, in rural areas than urban
areas.
The mean (SD) age of people who had an RTI was 29.4 (15.9)
years, which differed significantly (p,0.001) from the mean age
of their uninjured counterparts (22.2 (18) years). The age group
with the highest reported rate of RTI was 18–44 years,
comprising 54.3% of all reported RTIs and an estimated annual
rate of 59.6 per 1000 population (95% CI 46.4 to 75.5). Five
deaths due to RTIs were reported, reflecting an annual death
rate of 1.6 per 1000 population (95% CI 0.5 to 3.8), and an
estimated case fatality ratio of 3.94% (95% CI 1.29% to 9.19%).
The most common location of RTIs was paved roads
(accounting for 72.4%), followed by at or near the home
(table 3). The lower extremities were the most commonly
injured body part (47.2%), followed by the upper extremities.
The most common road user category reported for RTIs was
motorcyclists (54.3%), with pedestrians contributing 11.8%
(table 3). Although private vehicles were the most commonly
involved single type of vehicle (37.4%), if public buses and taxis
are combined, these commercial vehicles comprised nearly half
of those involved. Seventy (55.6%) RTIs were considered
‘‘slight’’, and 53 (42.1%) were considered ‘‘serious’’ or resulted
in disability.
When not stratified by gender, membership in the 18–44-year
age group was associated with a relative risk (RR) of RTI of
2.15, and the >45-year group was associated with a relative risk
of 2.46, compared with the reference group of 0–17 years
(table 4). In an adjusted analysis (table 4), male gender was
associated with an increased risk of RTI (RR = 2.04). When an
interaction term was included for age and gender, the risk
associated with male gender was found to be limited to the
18–44-year age group (RR 2.96) compared with women in the
same age range.
Educational status was also evaluated, and people who replied
that they had ‘‘some secondary’’ schooling or had ‘‘completed
secondary’’ school contributed the greatest proportion of RTIs
(28% for each group). When compared with the reference group
of ‘‘no formal education’’ in the adjusted analysis, the group
with ‘‘some secondary’’ education had a RR for RTI of 4.09. Of
the remaining categories, the groups who responded that they
had completed ‘‘primary’’, ‘‘secondary’’ and ‘‘post-secondary’’
education were also associated with a significantly increased
risk of RTI in the adjusted analysis (table 4).
DISCUSSION
In Nigeria, a country that has been undergoing an epidemiolo-
gical transition, increasing unease regarding the contribution of
RTIs has been documented since the mid 1980s.
27–30
This paper
represents the results of one of the first multi-state household
surveys on RTIs carried out in Nigeria. Although hospital data
are valuable, it is reasonable to suspect that a large proportion of
injuries are not captured by hospital data.
23 31 32
Performing a
population-based survey in this context provides an opportu-
nity to assess RTIs that are potentially not represented in
hospital data. The estimated RTI rate in Nigeria was 41 per
1000 population, which approximates the overall RTI rate from
the community survey carried out in Uganda (38.9 per 1000
person-years), but is more than the rate reported from Tanzania
(5.98 per 1000 population).
21 33
The Tanzania study methodol-
ogy may account for this difference, as fatal RTIs or RTIs
resulting in restriction of activity lasting less than 1 day were
not included.
The age group most affected by RTI in this survey was 18–44
years, which reaffirms the findings from community surveys
performed in much of the developing world.
7 21 22 34
Also, male
Table 2 Incidence of road traffic injury (RTI) in Nigeria based on survey
data
No
All injury RTI
Number Rate/1000 Number Rate/1000
Age (years)
0–17 1502 118 78.6 34 22.6
18–44 1157 176 152.1* 69 59.6*
>45 423 54 127.7* 24 56.7*
Gender
Male 1569 217 138.3{ 89 56.7{
Female 1513 131 86.6{ 38 25.1{
Residence
Rural 1217 142 116.7 45 37
Urban 1865 206 110.5 82 44
Overall 3082 348 112.9 127 41.2
*Significant to the p,0.02 level when compared with age group 0–17 years as
reference group in a Bonferroni analysis.
{Significant to the p,0.01 level in an unadjusted bivariate analysis.
Table 3 Epidemiological characteristics of road traffic
injuries in Nigeria
Characteristic Number Proportion
Location (n = 127)
Paved road 92 72.44
Home 17 13.39
Unpaved road 14 11.02
Paved intersection 4 3.15
Body part injured (n = 127)
Lower extremity 60 47.24
Upper extremity 30 23.62
Head or neck 27 21.26
Chest 5 3.94
Abdomen 3 2.36
Spinal cord 2 1.57
Road user category (n = 127)
Motorcyclists 69 54.33
Motor vehicle users 38 29.92
Pedestrians 15 11.81
Pedal cyclists 5 3.94
Role of injured person (n = 114)
Passenger 86 75.44
Self-driver 20 17.54
Professional driver 8 7.02
Missing 13
Type of vehicle (n = 107)
Private car 40 37.38
Commercial bus or lorry 29 27.1
Other 21 19.63
Taxi 17 15.89
Missing 20
Injury severity (n = 126)
Slight 70 55.56
Serious or disability 53 42.06
Death 3 2.38
Missing 1–
Original article
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gender was associated with an increased risk of RTI in this
survey, consistent with findings from previous studies and
attributed to potential increased freedom of mobility given to
men in these settings, primarily for economic purposes.
4 35 36
However, the increased risk of RTI in men was found to be
concentrated in those aged 18–44 years. There was no
significant gender difference in risk of RTI in the 0–17-year
age group, indicating that males of this age group may not have
the same increased exposure to RTI risk as their older
counterparts.
The RTI rate in the Nigerian rural population was 37 per 1000
population per year, which is higher than that reported in the
only other community-based survey on injury carried out in
Nigeria: 25 per 1000 population per year.
23
One possible
explanation for this discrepancy is that the survey carried out
by Olawale and Owoaje
23
was restricted to one rural, homo-
geneous community, whereas that described in the present
report consisted of rural communities sampled from seven
different states throughout Nigeria. The difference may also be
due to methodological reasons, including sampling strategy and
length of recall used. The results of this survey did not show any
significant difference between RTI rates in urban and rural
Nigerian populations. In contrast, the transport-related injuries
in the Tanzanian urban population was found to be four times
that of the rural population, and, in Uganda, the urban
population was more often affected by RTIs than their rural
counterparts.
21 33
Interestingly, the RTI rates found in the rural
population in Ghana (38 per 1000 population per year) were
higher than in the urban population (22 per 1000 population per
year).
22
Motorcycle injuries accounted for more than half of RTIs
reported (54%) in this survey. Olawale and Owoaje
23
also
reported that motorcycle injuries accounted for the majority of
RTIs in their community survey. Prior hospital data reported
from Nigeria reflect a much lower contribution to RTIs by
motorcycles, ranging from 10.3% to 19%,
29 37
while, in
Tanzania, the proportion of RTIs attributable to motorcycles
was 18.7%.
33
The reason for the higher proportion of motorcycle
involvement in RTIs found in this survey merits further
exploration but may be due to an increasing use of motorcycles
in Africa.
This report represents a higher estimate of annual mortality
due to RTI than previously found for a part of Nigeria, at 1.6 per
1000 population. WHO reported 0.27 deaths due to RTI per
1000 population in 2002 using regional data.
10
The Nigerian
Federal Road Safety Commission estimated that 4519 deaths
occurred in 2005, a decrease from 5777 in 2004, yielding an
estimated mortality of 0.036 and 0.046 per 1000 population for
2005 and 2004, respectively.
38
WHO estimates are influenced by
the quality of regional data around 2000–01 and are for the
whole population of Nigeria. Road safety commissions tend to
rely on police statistics, which have been noted for under-
reporting of RTI cases in low-income countries.
39 40
The use of an English survey with translations performed by
experienced and trained interviewers has been used in Nigeria
23
and Pakistan.
34
This may have caused some misunderstanding in
respondents; however, it is likely that this would result in
under-reporting of events, and thus underestimation of rates
reported here. This study relied on a 12-month recall period,
which has been shown to result in under-reporting of less
serious injuries because of a ‘‘memory decay’’ phenomenon,
41
although severe injuries are thought to be consistently reported
up to 12 months. The net effect of this bias would result in
some underestimation of less serious RTIs, but was consistent
Table 4 Relative risk for road traffic injury (RTI) by age, gender and education status (unadjusted and
adjusted analyses), Nigeria (n = 3082)
Relative risk for RTI
Unadjusted (95% CI) p Value Adjusted (95% CI) p Value
Age (years)
0–17 Referent (RR = 1) Referent (RR = 1)
18–44 2.63 (1.75 to 3.97) ,0.001 2.15 (1.36 to 3.39) 0.001
45 and older 2.51 (1.49 to 4.23) 0.001 2.46 (1.44 to 4.18) 0.001
Gender
Female Referent (RR = 1) Referent (RR = 1)
Male 2.26 (1.54 to 3.30) ,0.001 2.04 (1.46 to 2.85) ,0.001
Urban/rural status
Rural Referent (RR = 1) Referent (RR = 1)
Urban 1.19 (0.83 to 1.71) 0.351 1.12 (0.78 to 1.61) 0.553
Education
No formal education Referent (RR = 1) Referent (RR = 1)
Pre-primary 1.07 (0.36 to 3.20) 0.902 1.53 (0.52 to 4.56) 0.441
Some primary 1.46 (0.72 to 2.96) 0.29 2.04 (0.93 to 4.49) 0.076
Completed primary 4.19 (2.20 to 7.98) ,0.001 3.3 (1.79 to 6.08) ,0.001
Some secondary 3.97 (2.15 to 7.34) ,0.001 4.09 (2.24 to 7.45) ,0.001
Completed secondary 3.7 (2.00 to 6.84) ,0.001 2.62 (1.33 to 5.15) 0.005
Post-secondary 4.42 (2.16 to 9.06) ,0.001 2.8 (1.22 to 6.44) 0.015
Age analysis with interaction term
Females 0–17 Referent (RR = 1)
Males 0–17 1.52 (0.74 to 3.12) 0.255
Females 18–44 Referent (RR = 1)
Males 18–44 2.96 (1.72 to 5.09) ,0.001
Females >45 Referent (RR = 1)
Males >45 1.11 (0.48 to 2.58) 0.811
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with the focus of the survey on consequential injuries.
However, a review of injury reports by month indicated that
44% of injuries were reported in the most recent 6 months and
the rest in the next half of the 12-month period, reflecting that
there was no sharp fall in monthly recall within the time period.
Whereas ,60% of the Nigerian population lives in rural areas,
the reverse is represented in this survey population—an artefact
of the sampling technique used in the study and an over-
representation of the urban population. This may have resulted
in the bulk of significant difference between rural and urban
RTI rates. It may have also affected the distribution of
education and marital status (table 1) in the sample used in
this study.
Initially, a fatality was defined as a death within 30 days of an
RTI, but respondents in certain parts of the surveyed areas were
very sensitive to a discussion of death in this time period during
pilot testing. As a result, the definition had to be revised to
death on the scene or in the hospital, and this may have resulted
in under-reporting of deaths in the survey. The study also
provides limited classification of injury severity and treatment
consequences for injury. Although designed to capture informa-
tion from a representation of Nigeria’s diverse geopolitical
zones, this survey is not nationally representative. Although the
sample size allows estimation of RTI incidence rates, the study
was not powered to look at disaggregated analysis by gender,
age and educational status.
This survey suggests that the morbidity and mortality caused
by RTIs in Nigeria may be much higher than previously
appreciated. Given the number of Nigerian lives that are
potentially affected and lost by RTIs on an annual basis,
improved prevention measures, prioritisation of policy mea-
sures, and further exploration of accurate methods of injury
surveillance are strongly warranted.
Acknowledgements: We thank Malecki Khayesi from WHO-Geneva, for his
assistance and kind comments on earlier drafts of this paper, and Isiaka Olarewaju, for
his guidance on the project’s preliminary statistical analysis.
Funding: The study design and data collection were funded by the Africa Regional
Office of the World Health Organization.
Competing interests: None.
Contributors: ML was responsible for the study design, survey development, data
collection and outline of paper. CJ analysed data and wrote the first draft of the paper.
OCK assisted with the study design and data collection. AAH guided the study design,
data analysis, edited all drafts, and approved the final manuscript.
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What this study adds
c The population burden of road traffic injury is high in Nigeria,
at 41 per 1000 population (95% CI 34 to 49).
c Surprisingly, motorcycle injuries comprise over half of road
traffic injuries in this sample.
c There was no significant difference in the estimated road
traffic injury rates of urban and rural populations in Nigeria.
What is already known on this topic
c Road traffic injuries are an increasing cause of death and
disability in developing countries.
c Mortality due to road traffic injuries in sub-Saharan Africa is
among the highest in the world.
Original article
Injury Prevention 2009;15:157–162. doi:10.1136/ip.2008.020255 161
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Original article
162 Injury Prevention 2009;15:157–162. doi:10.1136/ip.2008.020255
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  • Source
    • "CHY is a 500-bed tertiary care centre in Yaoundé , the capital of Cameroon, and is estimated by the Ministry of Public Health to handle over 75% of the trauma cases in the city. The survey instrument was based on the WHO Guidelines for Injury Surveillance, prior instruments used in Uganda, and our previous work done in LMICs, and was administered by trained research assistants (Supplemental File)12131415. Information on demographics, injury context and mechanism, disposition outcomes, and SES indicators, as defined by the 2004 Demographic and Health Survey (DHS) in Cameroon, was collected [16]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Injury is a significant and increasingly common cause of morbidity and mortality in sub-Saharan Africa; however, the social and economic factors underlying these trends are not well understood. We evaluated the relationship between socioeconomic status (SES) and trauma outcomes using a prospective registry of patients presenting to the largest trauma hospital in Yaoundé, Cameroon. Methods: Trauma patients (n = 2855) presenting to the emergency ward at Central Hospital, Yaoundé between April 15 and October 15, 2009 were surveyed regarding demographic and socioeconomic background, nature and severity of injuries, treatment, and disposition. A wealth score was estimated for each patient, corresponding to an SES index constructed using principle components analysis of the urban Cameroonian Demographic and Health Survey. Logistic regression was used to evaluate the effects of SES on care-seeking behaviour, injury severity, and treatment outcome. Main outcome measures:: SES wealth score, care-seeking prior to visiting hospital, injury severity, treatment outcome. Results: Patients aged 1-89 presented with road traffic injuries (59.83%), falls (7.76%), and penetrating trauma (6.16%), and had higher SES than the broader urban Cameroonian population. Within the Yaoundé sample, being in the lowest SES quintile was associated with an increased likelihood of having sought care elsewhere before presenting to the hospital (aOR = 3.28, p <. 0.001), after controlling for background and injury characteristics. Patients in the lowest SES quintile were also more likely to present with moderate/severe injuries (aOR = 4.93, p <. 0.001), and were more likely to be transferred to the operating room. Conclusions: Patients presenting to this trauma centre were wealthier than the broader community, suggesting the possibility of barriers to accessing care. Poorer patients were more likely to have severe injuries and more likely to need surgery, but were less likely to seek care from a major trauma centre immediately. Substantial differences in SES between the sample visiting the hospital and the broader community suggest a need for community-based sampling approaches in future trauma research.
    Full-text · Article · Dec 2015 · Injury
  • Source
    • "Completing the medical cause of death for external cause fatalities in accordance with ICD-10 guidelines was poorly understood and completed. However, the aggregated data from the five countries and the injury mechanisms were generally consistent with those found in similar countries101112. The high proportion of non-specified categories, referred to as 'other' and lack of information on completion of data fields in four countries highlights the lack of detailed data as is often captured in established injury surveillance systems. "
    [Show abstract] [Hide abstract] ABSTRACT: Globally, injury is the fourth major cause of death and the third leading contributor to Disability Adjusted Life Years lost due to health conditions, with the greatest burden borne by low-middle income countries (LMICs) where injury data is scarce. In the absence of effective vital registration systems, mortuaries have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish strategic injury prevention policies and programs. This evaluation sought to assess the feasibility of implementing a standardised fatal injury data collection process to systematically collect relevant fatal injury data from mortuaries. The process evaluation is described. A manual including a one page data collection form, coding guide, data dictionary, data entry and analysis program was developed through World Health Organization and Monash University Australia collaboration, with technical advice from an International Advisory Group. The data collection component was piloted in multiple mortuaries, in five LMICs (Egypt, India, Sri-Lanka, Tanzania and Zambia). Process evaluation was based on a questionnaire completed by each country's Principal Investigator. Questionnaires were completed for data collections in urban and rural mortuaries between September 2010 and February 2011. Of the 1795 reported fatal injury cases registered in the participating mortuaries, road traffic injury accounted for the highest proportion of cases, ranging from 22% to 87%. Other causes included burns, poisoning, drowning and falls. Positive system attributes were feasibility, acceptability, usefulness, timeliness, and simplicity and data field completeness. Some limitations included short duration of the pilot studies, limited injury data collector training and apparent underreporting of cases to the medico-legal system or mortuaries. The mortuary has been shown to be a potential data source for identifying injury deaths and their circumstances and monitoring injury trends and risk factors in LMICs. However, further piloting is needed, including in rural areas and training of forensic pathologists and data-recorders to overcome some of the difficulties experienced in the pilot countries. The key to attracting ongoing funding and support from governments and donors in LMICs for fatal injury surveillance lies in further demonstrating the usefulness of collected data. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Jun 2015 · Injury
  • Source
    • "As motorcyclists were at increased risk of serious injury, it is likely that motorcyclists who die at the scene are transported to the morgue rather than the hospital, suggesting that the number of deaths observed in this road user category may be underestimated. Correlation with other RTI data, such as community surveys and police and newspaper records, may clarify how much motorcycle traffic injuries contribute to morbidity and mortality in and around Yaoundé [15,19,25]. Indeed, police reports from the Yaoundé –Douala road section from 2004 to 2007 showed that 17% of RTI victims died without reaching the hospital, compared to 3% who died at the hospital and that 'motorcyclist' was the second highest road user category involved in collisions [8]. "
    [Show abstract] [Hide abstract] ABSTRACT: Background Road traffic injuries (RTIs) are a major cause of death and disability worldwide. In Cameroon, like the rest of sub-Saharan Africa, more data on RTI patterns and outcomes are needed to improve treatment and prevention. This study analyzes RTIs seen in the emergency room of the busiest trauma center in Yaoundé, Cameroon. Methods A prospective injury surveillance study was conducted in the emergency room of the Central Hospital of Yaoundé from April 15 to October 15, 2009. RTI patterns and relationships among demographic variables, road collision characteristics, injury severity, and outcomes were identified. Results A total of 1,686 RTI victims were enrolled. The mean age was 31 years, and 73% percent were male. Eighty-eight percent of road collisions occurred on paved roads. The most common user categories were ‘pedestrian’ (34%) and ‘motorcyclist’ (29%). Pedestrians were more likely to be female (p < 0.001), while motorcyclists were more likely to be male (p < 0.001). Injuries most commonly involved the pelvis and extremities (43%). Motorcyclists were more likely than other road users to have serious injuries (RR = 1.45; 95% CI: 1.25, 1.68). RTI victims of lower economic status were more likely to die than those of higher economic status. Discussion Vulnerable road users represent the majority of RTI victims in this surveillance study. The burden of RTI on hospitals in Cameroon is high and likely to increase. Data on RTI victims who present to trauma centers in low- and middle-income countries are essential to improving treatment and prevention.
    Full-text · Article · Nov 2014 · Injury
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