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European Journal of Trauma and Emergency Surgery

Published in:

01-12-2020 | Original Article

Epidemiology and cost of pediatric injury in Yaoundé, Cameroon: a prospective study

Authors: Obieze Nwanna-Nzewunwa, Marquise Kouo Ngamby, Jacob Cox, Isabelle Feldhaus, Girish Motwani, Martin Ekeke Monono, Georges Alain Etoundi, Rochelle A. Dicker, Adnan A. Hyder, Catherine Juillard

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2020

Abstract

Purpose

Unintentional injury is the leading cause of death among children aged 10–19 years and over 95% of injury deaths occur in low- and middle-income countries (LMICs). As patterns of injury in the pediatric population may differ from those in adults, risks specific to children in LMICs need to be identified for effective injury prevention and treatment. This study explores patterns of pediatric injury epidemiology and cost in Yaoundé, Cameroon to inform injury prevention and resource allocation.

Methods

Pediatric (age < 20 years) trauma patient data were collected at the emergency department (ED) of Central Hospital of Yaoundé (CHY) from April through October 2009. Univariate, bivariate, and multivariate analyses were used to explore injury patterns and relationships between variables. Regression analyses were conducted to identify predictors of receiving surgical care.

Results

Children comprised 19% (544) of trauma cases. About 54% suffered road traffic injuries (RTIs), which mostly affected the limbs and pelvis (37.3%). Half the RTI victims were pedestrians. Transportation to CHY was primarily by taxi or bus (69.4%) and a preponderance (71.1%) of the severely and profoundly injured patients used this method of transport. Major or minor surgical intervention was necessary for 17.9% and 20.8% of patients, respectively. Patients with an estimated injury severity score ≥ 9 (33.2%) were more likely to need surgery (p < 0.01). The median ED cost of pediatric trauma care was USD12.71 [IQR 12.71, 23.30].

Conclusions

Injury is an important child health problem that requires adequate attention and funding. Policies, surgical capacity building, and health systems strengthening efforts are necessary to address the high burden of pediatric injuries in Cameroon. Pediatric injury prevention efforts in Cameroon should target pedestrian RTIs, falls, and burns and consider school-based interventions.

World Health Organization. Injuries and violence: the facts. Geneva: World Health Organization Press; 2010.

Toroyan T. Global status report on road safety. Inj Prev. 2009. https://doi.org/10.1258/jrsm.2010.090426.CrossRefPubMed

Juillard C, Etoundi Mballa GA, Bilounga Ndongo C, Stevens KA, Hyder AA. Patterns of injury and violence in Yaounde Cameroon: an analysis of hospital data. World J Surg. 2011;35:1–8. https://doi.org/10.1007/s00268-010-0825-5.CrossRefPubMed

Bickler SW, Sanno-Duanda B. Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia. Bull World Health Organ. 2000;78:1330–6.PubMedPubMedCentral

Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. 2002;80:829–35.PubMedPubMedCentral

Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Rahman AF et al, editors. World report on child injury prevention. Geneva: World Health Organization; 2008.

Bartlett SN. The problem of children’s injuries in low-income countries: a review. Health Policy Plan. 2002;17:1–13.CrossRef

Chichom-Mefire A, Fokou M. Epidemiology of paediatric injury in low income environment: value of hospital based data prior to the institution of a formal registration system. Afr J Paediatr Surg AJPS. 2013;10:265–70. https://doi.org/10.4103/0189-6725.120909.CrossRefPubMed

Kiser MM, Samuel JC, Mclean SE, Muyco AP, Cairns BA, Charles AG. Epidemiology of pediatric injury in Malawi: burden of disease and implications for prevention. Int J Surg. 2012;10:611–7. https://doi.org/10.1016/j.ijsu.2012.10.004.CrossRefPubMed

10.

de Sousa Petersburgo D, Keyes CE, Wright DW, Click LA, Macleod JBA, Sasser SM. The epidemiology of childhood injury in Maputo, Mozambique. Int J Emerg Med. 2010;3:157–63. https://doi.org/10.1007/s12245-010-0182-z.CrossRefPubMed

11.

Mariam A, Sadik M, Gutema J. Patterns of accidents among children visiting Jimma University Hospital, south west of Ethiopia. Ethiop Med J. 2006;44:339–45.

12.

Adesunkanmi AR, Oginni LM, Oyelami AO, Badru OS. Epidemiology of childhood injury. J Trauma. 1998;44:506–12.CrossRef

13.

Abantanga FA, Mock CN. Childhood injuries in an urban area of Ghana a hospital-based study of 677 cases. Pediatr Surg Int. 1998;13:515–8. https://doi.org/10.1007/s003830050387.CrossRefPubMed

14.

Zwi KJ, Zwi AB, Smettanikov E, Söderlund N, Logan S. Patterns of injury in children and adolescents presenting to a South African township health centre. Inj Prev J Int Soc Child Adolesc Inj Prev. 1995;1:26–30.CrossRef

15.

Mwaura LW, Katsivo MN, Amuyunzu M, Muniu E. Childhood accidents in an urban community in Kenya. East Afr Med J. 1994;71:506–9.PubMed

16.

Wikipedia. Central Hospital of Yaoundé. Wikipedia; 2017. https://en.wikipedia.org/wiki/Central_Hospital_of_Yaound%25C3%25A9. Accessed 15 Sept 2017.

17.

Nwanna-Nzewunwa OC, Kouo Ngamby M, Shetter E, Etoundi Mballa GA, Feldhaus I, Monono ME, et al. Informing prehospital care planning using pilot trauma registry data in Yaoundé, Cameroon. Eur J Trauma Emerg Surg. 2018. https://doi.org/10.1007/s00068-018-0939-2.CrossRefPubMed

18.

Kacker S, Bishai D, Mballa GAE, Monono ME, Schneider EB, Ngamby MK, et al. Socioeconomic correlates of trauma: an analysis of emergency ward patients in Yaoundé. Cameroon Inj. 2016;47:658–64. https://doi.org/10.1016/j.injury.2015.12.011.CrossRef

19.

Juillard CJ, Stevens KA, Monono ME, Mballa GAE, Ngamby MK, McGreevy J, et al. Analysis of prospective trauma registry data in Francophone Africa: a pilot study from Cameroon. World J Surg. 2014;38:2534–42. https://doi.org/10.1007/s00268-014-2604-1.CrossRefPubMed

20.

Weeks SR, Juillard CJ, Monono ME, Etoundi GA, Ngamby MK, Hyder AA, et al. Is the Kampala Trauma Score an effective predictor of mortality in low-resource settings? A comparison of multiple trauma severity scores. World J Surg 2014;38. https://doi.org/10.1007/s00268-014-2496-0.

21.

Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O. Injury surveillance guidelines. WHO 2001:1–91. https://doi.org/10.1007/s13398-014-0173-7.2.

22.

Hyder AA, Sugerman DE, Puvanachandra P, Razzak J, El-Sayed H, Isaza A, et al. Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study. Bull World Health Organ. 2009;87:345–52.CrossRef

23.

Kobusingye OC, Lett RR. Hospital-based trauma registries in Uganda. J Trauma. 2000;48:498–502.CrossRef

24.

Labinjo M, Juillard C, Kobusingye OC, Hyder AA. The burden of road traffic injuries in Nigeria: results of a population-based survey. Inj Prev J Int Soc Child Adolesc Inj Prev. 2009;15:157–62. https://doi.org/10.1136/ip.2008.020255.CrossRef

25.

Talwar S, Jain S, Porwal R, Laddha BL, Prasad P. Trauma scoring in a developing country. Singapore Med J. 1999;40:386–8.PubMed

26.

McLellan BA, Koch JP, Wortzman D, Rogers C, Szalai J, Williams D. Early identification of high-risk patients using the “estimated” injury severity score and age. Accid Anal Prev. 1989;21:283–90.CrossRef

27.

Microsoft Corporation. Redmond: Microsoft Excel; 2011.

28.

StataCorp. Stata Statistical Software: Release 13. College Station: StataCorp, LP; 2013.

29.

Sacks D. Age limits and adolescents. Paediatr Child Health. 2003;8:577–8.CrossRef

30.

World Health Organization. Health for the world’s adolescents: a second chance in the second decade: summary; 2014.

31.

Wikipedia. Age of majority 2018. https://en.wikipedia.org/wiki/Age_of_majority. Accessed 1 May 2018.

32.

Annuaire Statistique du Cameroun. 2013. Yaoundé: Institut National de la Statistique; 2014.

33.

Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21:459–68. https://doi.org/10.1093/heapol/czl029.CrossRefPubMed

34.

The World Bank. Official exchange rate (LCU per US$, period average). Cameroon. 2009. https://data.worldbank.org/indicator/PA.NUS.FCRF?locations=CM. Accessed 1 May 2018.

35.

Whiteside LK, Oteng R, Carter P, Amuasi J, Abban E, Rominski S, et al. Non-fatal injuries among pediatric patients seeking care in an urban Ghanaian emergency department. Int J Emerg Med. 2012;5:36. https://doi.org/10.1186/1865-1380-5-36.CrossRefPubMedPubMedCentral

36.

World Health Organization (WHO). Falls: key facts. World Heal Organization; 2018. Falls. Accessed 10 July 2018.

37.

Nthumba PM. Burns in sub-Saharan Africa: a review. Burns. 2016. https://doi.org/10.1016/j.burns.2015.04.006.CrossRefPubMed

38.

Hyder AA, Chandran A, Khan UR, Zia N, Huang C-M, de Ramirez SS, et al. Childhood unintentional injuries: need for a community-based home injury risk assessments in Pakistan. Int J Pediatr 2012;2012:203204.CrossRef

39.

Tiska MA. A model of prehospital trauma training for lay persons devised in Africa. Emerg Med J. 2004;21:237–9. https://doi.org/10.1136/emj.2002.002097.CrossRefPubMedPubMedCentral

40.

Callese TE, Richards CT, Shaw P, Schuetz SJ, Issa N, Paladino L, et al. Layperson trauma training in low- and middle-income countries: a review. J Surg Res. 2014;190:104–10. https://doi.org/10.1016/j.jss.2014.03.029.CrossRefPubMed

41.

Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, et al. Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World J Surg. 2009;33:2512–21. https://doi.org/10.1007/s00268-009-0180-6.CrossRefPubMed

42.

Nwanna-Nzewunwa OC, Christie SA, Carvalho M, Motwani, Delon GD, Ngamby FN, Mballa MKE, Nsongoo GA, Saidou P, Mekolo A, Dicker D, Juillard RC. Analysis of a National Trauma Registry in Cameroon: implications for prehospital care strengthening. Panam J Trauma Crit Care Emerg Surg. 2018;7:133–42.CrossRef

43.

World Health Organization. Guidelines for essential trauma care. Geneva: World Heal Organization; 2015.

44.

Mock CN, Tiska M, Adu-Ampofo M, Boakye G. Improvements in prehospital trauma care in an African country with no formal emergency medical services. J Trauma. 2002;53:90–7.CrossRef

45.

The World Bank. Official exchange rate (LCU per US$, period average). Cameroon; 2009. https://data.worldbank.org/indicator/PA.NUS.FCRF?locations=CM. Accessed 1 May 2018

46.

Institut National de la Statistique. République du Cameroun, Enquête Démographique et de Santé et à Indicateurs Multiples (EDS-MICS) 2011. Yaoundé: Institut National de la Statistique; 2012.

47.

WHA68.15. Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage. Geneva: World Health Organization; 2015.

Title: Epidemiology and cost of pediatric injury in Yaoundé, Cameroon: a prospective study
Authors: Obieze Nwanna-Nzewunwa
Marquise Kouo Ngamby
Jacob Cox
Isabelle Feldhaus
Girish Motwani
Martin Ekeke Monono
Georges Alain Etoundi
Rochelle A. Dicker
Adnan A. Hyder
Catherine Juillard
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2020
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-019-01104-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Epidemiology and cost of pediatric injury in Yaoundé, Cameroon: a prospective study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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