Anne Abio’s research while affiliated with University of Turku and other places

Background: We assessed the impact of rural trauma team development course (RTTDC) on clinical processes and patient outcomes of motorcycle-accident related neurological and/or musculoskeletal injuries in selected Ugandan hospitals. Methods: Trial design: Two arm, parallel, multiperiod, cluster randomized controlled trial. Participants: Trauma care frontliners, and patients aged 2-80 years at three intervention and three control Ugandan hospitals (1:1 allocation). Randomization: Hospitals were randomly allocated to intervention or control using permuted block sequences. Blinding: Patient-participants and outcome assessors were blind to allocation. Intervention arm: 500 trauma care frontliners received RTTDC; patients received standard care. Control arm: Patients received standard care without RTTDC for staff. Primary outcomes: Time from accident to admission and from referral to discharge. Secondary outcomes: 90 day mortality and morbidity related to neurological and/or musculoskeletal injuries. We followed the CONSORT guidelines for cluster randomized trials. Results: We analyzed 1003 participants (501 intervention, 502 control). The intervention arm had a shorter median prehospital time (1hr; IQR=0.50, 2.00) and referral to discharge interval (median 2hrs; IQR=1.25, 2.75) vs. [(2hrs; IQR=1.50, 4.00) mean difference 1.13hrs, p<0.0001 and (4hrs; IQR=2.50, 4.10), mean difference 1.39hrs, p<0.0001 in the control], respectively. The 90 day mortality was more than halved in the intervention (5%, 24/457) vs. (13%, 58/430) in the control arm (p<0.0001). Fewer participants in the intervention group had unfavorable Glasgow Outcome Scale scores (9%, 42/457) vs. (20%, 87/430), p<0.0001. No difference was found in musculoskeletal injury morbidity outcomes (p=0.567). Interpretation: Rural trauma team development training improved organizational time efficiency and clinical outcomes for neurological injuries without negatively impacting musculoskeletal injury morbidity outcomes.

Introduction The objective of this study was to examine the factors linked to all-cause mortality and morbidity from neurological and musculoskeletal injuries in motorcycle accidents. Methods The study was part of a two-armed, parallel, multi-period, cluster-randomized controlled trial of 1003 motorcycle crash victims. Morbidity was assessed using various scoring systems, and mixed effects regression models were employed for analysis. Results 90-day all-cause mortality was 9.2% (82/887). Factors associated with mortality included referral-to-discharge >1 hour [OR 4.215 (1.802-9.858), p =.001), Kampala Trauma Score (KTS) ≤6 [OR 7.696 (1.932-30.653), p =.004], GCS 9-12 [OR 3.432 (1.194-9.870), p =.022], GCS ≤8 [OR 6.919 (2.212-21.645), p =.001], intra-axial lesions [OR 78.647 (9.871-626.587), p <.001], extra-axial lesions [OR 11.933 (1.386-102.750), p =.024], skull fracture [OR 11.366, (1.197-107.977), p =.034], and decompressive craniotomy (DC) [OR 0.260 (.095-.706), p =.008). A proportion of 14.5% had unfavourable Glasgow Outcome Scale (1-3); associated factors included increasing age [OR 1.02, (1.013-1.045, p <.001], multiple injuries [OR 4.559 (1.185-17.531), p=.027], KTS 7-8 [OR 2.755 (1.285-5.906), p=.009], KTS ≤6 [OR 7.551 (2.815-20.255), p=.001], GCS 9-12 [OR 4.07 (1.901-8.719), p=.001], GCS ≤8 [OR 13.779 (5.643-33.645), p <.001], and DC [OR 0.149 (.075-.295), p <.001]. Factors associated with unfavourable patient-reported musculoskeletal outcomes included being married [OR 1.984 (1.322–2.976), p =.001], multiple injuries [OR 1.762, (1.001–3.100), p =.049], and enrolment after the onset of the COVID-19 pandemic [OR 2.095 (1.199–3.659), p=.009]. Conclusions The key determinants of mortality and adverse neurological and musculoskeletal injury outcomes observed in this study are essential for establishing core outcome sets in future research and predictive models. Summary of the Key Messages Existing Knowledge: Motorcycle crashes in low- and middle-income countries represent significant public health issues, exacerbated by low helmet usage and insufficient trauma care resources. Study Contributions: This MOTOR trial ancillary study investigated factors associated with all-cause mortality and morbidity from motorcycle crashes, emphasizing neurological and musculoskeletal injuries as critical targets for enhancing rural trauma care systems. Implications for Research, Practice, and Policy: Our findings indicate that the anatomical nature, multiplicity and severity of injuries, referral-dispatch intervals, operative interventions, and COVID-19-related social conditions significantly influence injury outcomes. These factors may serve as a foundational outcome set for benchmarking future clinical trials and trauma registries.

Background Intimate partner violence (IPV) during pregnancy is a global issue of public health importance. Due to the low rates of help-seeking in response to IPV, research on survivors’ help-seeking behaviors is scarce, particularly within low- and middle-income countries (LMICs). The present study provides a cross-national evidence of informal and formal help-seeking patterns among pregnant women experiencing IPV. Methods This study made use of population-based data from the Demographic and Health Surveys (DHS) Program from 54 LMICs, collected between 2005 and 2020 (N = 359,027). Applying bivariate and multivariable analyses, the present study examined IPV survivors’ help-seeking distributions and associations with individual, partner, family, and community factors. Results Only half of survivors sought help in response to IPV during pregnancy with wide regional and national variations, mainly from informal support networks (including family, neighbors, and friends), and rarely from formal institutions (including legal, socio-cultural, and medical services). Evidence shows that help-seeking behaviors were associated with IPV survivors’ age and educational attainment, survivors’ employment status and earnings compared to their partners, survivors’ consumption of mass media, intimate partner’s age and education, spouse’s alcohol consumption and controlling behaviors, survivors’ wealth index, place of residence, and health-seeking barriers, among others. Conclusion Practitioners are encouraged to consider the study’s outcomes when designing interventions and support for survivors seeking help in response to IPV during pregnancy. Strong advocacy and action are needed, including fostering survivors’ educational attainment, diminishing pregnant women’s social and financial dependencies on their intimate partners, promoting pre- and peri-natal health care, informing survivors about help, and increasing gender equality by engaging women and men equally within the whole community.

Background Childhood bullying has been classified as a major public health concern by WHO, with negative effects on the health education and social outcomes of both bullies and victims. There is no current Kenyan data on the prevalence of face-to-face bullying and cyberbullying co-occurring in the same cohort of youth and how they are associated with different aspects of suicidality and socio-demographic characteristics. This study aims to fill these gaps in the Kenyan situation so as to inform current policy and practice. Methodology This cross-sectional study involved 2,652 students from ten secondary schools in Kenya, selected from three regions representing different levels of public funded schools and socioeconomic spaces. The outcome variable was derived from the questionnaire which asked students questions related to self-harm, suicide thoughts, plans, and attempts. Predictor variables were based on response on experience of bullying in school, out of school, at home, and cyberbullying. Other variables such as gender, age, family background, and class were also collected from the self-reported questions. Data were analyzed using SPSS version 25, with descriptive summary statistics and chi-square tests used to examine variables, and logistic regression analysis used to determine the associations between suicidality and experience of bullying. Results The mean age was 16.13 years. More than half of the participants were male, with the largest proportion living in rural areas. Face-to-face bullying was more prevalent than cyberbullying, with 82% of participants experiencing bullying and 68% experiencing it almost daily in the past six months. Both face-to-face bullying and cyberbullying were associated with suicidal thoughts, plans, and attempts. Predictors of suicidal attempts included being bullied outside of school and being a victim of group bullying, while being bullied every day and being bullied by adult men were predictors of suicidal attempts in cyberbullying. Conclusion There is a high prevalence of face-to-face bullying both in and outside schools. There is also a high prevalence of cyberbullying. Both face-to-face and cyberbullying are associated with suicidality in Kenyan high school students.

Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008–2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24–65 years was 5.2% (95% CI: 4.6–5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18–64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6–2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.

Background This retrospective study clarified patients´ psychiatric morbidity in IPV-related facial fractures; in particular, their additional psychiatric care. We hypothesized that patients in need of additional support can be identified, allowing overall care processes to be improved. Methods Patients’ age, sex, anamnestic psychiatric disorders, history of substance abuse, and psychiatric interventions were recorded, as well as the perpetrator, location, time of day, assault mechanism, fracture type, treatment, and associated injuries. Results In all, 807 adult patients were included in the study. Of these, 205 patients (25.4%) had anamnestic psychiatric disorders that were associated independently with female sex (OR 1.95, 95% CI 1.12, 3.41; p = 0.019) or history of substance abuse (OR 5.82, 95% CI 4.01, 8.46; p < 0.001). Patients with anamnestic psychiatric disorder were more likely to be subjected to severe violence, with an increased risk for combination fractures (OR 2.51, 95% CI 1.30, 4.83; p = 0.006). Of all patients, 61 (7.6%) received a psychiatric intervention within the first 12 months. The most common reasons for intervention were anxiety/fear and psychotic symptoms, surfacing within one month in 57% of patients. Anamnestic psychiatric disorders (OR 2.00, 95% CI 1.04, 3.82; p = 0.036), severe mental illnesses (OR 2.45, 95% CI 1.04, 5.77; p = 0.040), and use of an offensive weapon (OR 2.11, 95% CI 1.11, 4.02; p = 0.023) were the strongest independent predictors of psychiatric intervention. Conclusions Our results emphasize the need for more structured treatment protocols for patients sustaining IPV injury. Special attention is recommended for patients with anamnestic psychiatric disorders, severe mental illnesses, and those assaulted with an offensive weapon.

Intimate Partner Violence (IPV) is a global problem of public health importance, which can be found across all social layers and cultural backgrounds worldwide. Angola is still an under-explored country in the context of domestic violence and was therefore chosen as our focus of interest. Our study’s goal was to identify the socio-demographic determinants of IPV in Angola. We used nationally representative data from female respondents of the 2015 Angolan Demographic and Health Surveys (DHS). Simple bivariate and multiple logistic regression analyses were used to assess the relationship between the experience of IPV and the women’s’ individual and contextual characteristics. Out of the 7,699 respondents, 3,070 (41.1%) reported having experienced at least one form of violence by their partners, with physical violence being more prevalent (32.5%) than emotional (27.7%) and sexual violence (7.2%). The partner’s use of alcohol, the respondent’s tendency to hurt her partner, her having witnessed her father beating her mother and being the first wife showed significantly higher odds of experiencing one or more types of IPV, whereas being older than the partner appears to have protective effects. Our findings reflect the widespread prevalence rates of violence against women in African countries. Future intervention programs should focus on women with risky background characteristics to help decrease domestic abuse in Angola. Our results indicate to focus on young women who have witnessed domestic violence in childhood, those whose partners use alcohol and those who tend to physically hurt their partners themselves. It is also recommended to intensify future research on the effects of co-wives on a relationship since first wives were found to have a higher risk of being physically abused by their partners.

Purpose Violence within extended kinship contexts remains understudied. This study sought to estimate the prevalence of physical violence perpetrated by in-laws. Methods Demographic and Health Surveys’ data collected between 2011 and 2020 were utilized. Data for females and males were derived from 47 and 10 countries respectively. We estimated the prevalence of being physically hurt by mothers-in-law, fathers-in-law and other in-laws against participating females (n=420 020) and males (n=71 629) separately. Results The pooled prevalence for in-law perpetrated physical violence against female respondents was 0.38% (95% CI 0.34, 0.42). The prevalence of violence from mothers-in-law was 0.18% (95% CI 0.15, 0.21), fathers-in-law was 0.11% (95% CI 0.09, 0.13) and other in-laws 0.20% (95% CI 0.17, 0.23). The pooled prevalence of in-law violence against male respondents was 0.56%; (95% CI 0.45, 0.71), and from mothers-in-law was 0.08%; (95% CI 0.05, 0.13), fathers-in-law was 0.05%; (95% CI 0.03, 0.09) and other in-laws was 0.51%; (95% CI 0.39, 0.66). Among individual countries, the highest prevalence among females and males was recorded in Afghanistan at 4.07% (95% CI 3.30, 5.02) and in Mozambique at 2.24%; (95% CI 1.56, 3.20) respectively. Conclusion Violence by in-laws affects both men and women in varying degrees across different countries. The data indicate that it is possible for one individual to experience violence perpetrated by more than one extended family member. Given the paucity of research in this area, it is hoped that the results may stimulate further inquiry into relevant contextual and social variables which influence in-law violence.

Background and Aim Injuries are among the leading causes of mortality worldwide. There exists a paucity of nationally representative injury data from the sub‐Saharan African region on the nature of injuries outside of road traffic contexts. The aim of this study was to estimate the prevalence of nonfatal unintentional injuries that occurred outside of the traffic environment among persons aged 15–54 years in Kenya. Methods We used the 2014 Kenyan Demographic Health Survey data to estimate the prevalence of nonfatal unintentional injuries and their injury mechanisms. Binary logistic regression was used to estimate the odds of unintentional injuries and associated factors. Results Injury prevalence was three times higher among males (27.56%) compared to females (8.25%). The highest prevalence for females and males respectively was among those aged 15–19 years (9.80%) and (31.18%), rural residents (8.45%) and (30.05%) and those who consumed alcohol (18.13%), and (31.39%). For both females and males, the most frequent injuries were cuts (4.95%; 18.15%) and as result of falls (3.29%; 8.92%) respectively. Burns were more prevalent among females (1.65%) compared to males (0.76%). Among males, the demographic and contextual factors associated with nontraffic unintentional injuries were residing in a rural area (OR 1.33, 95% CI 1.14, 1.56), primary education (OR 2.02, 95% CI 1.48, 2.76), a higher wealth index (second quintile OR 1.41, 95% CI 1.19, 1.67) and consuming alcohol (OR 1.49, 95% CI 1.32, 1.69). Females who had completed primary, secondary (OR 2.43, 95% CI 1.92, 3.08) or higher education had higher odds of unintentional injuries. Conclusion The findings mirror prior literature highlighting the clustering of demographic and behavioral factors which underlie predisposition to injuries outside of the traffic environment. Future nationally representative studies would benefit from deeper inquiry into and measurement of injury severity and health care utilization to inform strategic policy‐relevant research.