Crash characteristics and injury patterns among commercial motorcycle users attending Kitale level IV district hospital, Kenya

Introduction Motorcycle users involved in crashes are likely to die or be severely injured due to high frequency of head, chest and leg injuries. We carried out a descriptive cross sectional study to determine crash characteristics and injury patterns among motorcycle users attending Kitale district hospital, Kenya. Methods Motorcycle trauma patients were recruited between 1st August 2013 and 31stOctober 2013. Data collection was done using a pre-tested, coded questionnaire. Frequencies mean (SD) and chi-square was employed in the analysis. Analysis was done using SPSS V.20. Results were considered significant at α = 0.05. Results Motorcycle trauma patients formed 39.4% of all road traffic injuries. Males constituted 69.8%, females 30.2% and mean age was 30(±13) years. Riders accounted for majority of injury patients (45%), passengers (38.8%) and pedestrians (15.9%). Mechanism of motorcycle crash was involving motorcycle versus vehicle (45.6%). Riders suffered severe injuries compared to passengers (χ2=129.936, p < 0.001). Head injury patients were assessed as having Glasgow coma scale (GCS) of 70% 9-12, 26% GCS of 13-15 and 7% GCS of 3-8. Injuries sustained by victims included head and neck injury 40%, lower extremity injury 39.9% and chest injury 8.2%. Riders without helmets during the crash sustained head injuries (χ2=111.352, p < 0.001). Conclusion Head injuries and lower extremity injuries accounted for the major proportion of injuries sustained by motorcycle users. Non helmet use was associated with increased risk of head injuries. Morbidity can be mitigated by encouraging use of protective gear like helmets.


Introduction
Globally it is estimated that, 1.2 million people are killed in road crashes each year and as many as 50 million are injured [1]. With increasing modernization in many developing countries, road traffic deaths are increasing and traffic deaths are projected to become the third most important health problem by the year 2020 [2]. Motorcycle Injuries constitute a major but neglected emerging public health problem in developing countries and contribute significantly to the overall Road Traffic Injuries [1]. Motorcycle Injuries are among the leading causes of disability and deaths and the main victims are the motorcyclists, passengers and pedestrians in their young reproductive age group [3,4]. The problem is increasing at a fast rate in developing countries due to rapid motorization and other factors [5]. The motorcycle, commonly called "bodaboda" in Uganda and Kenya [5, 6] and "Okada" in Nigeria [4,7] has recently become increasingly popular in Kenya as a means of commercial transport. Their operation is characterized by non-helmet use by riders and passengers, passenger overload and lack of valid licensing among riders. Over speeding, reckless driving, lack of law enforcement and possible use of alcohol and drugs also characterise commercial motorcycle operations [8]. The scarcity of existing data on commercial motorcycle injuries in this environment despite morbidity and mortality resulting from motorcycle crashes necessitate a further look into the causative factors influencing the occurrence of such crashes. Studying the morbidity pattern of these motorcyclists will reveal the burden of the problem, as deaths and injuries due to road traffic crashes have not really been seen as a matter of public health importance. We carried out a descriptive cross sectional study of commercial motorcycle injuries presenting at Kitale district hospital to determine prevalence, severity and injury patterns among these patients.

Methods
This was a descriptive cross-sectional study of patients with commercial motorcycle crash injuries of all age groups and gender presenting at the Accident and Emergency (A&E) department of Kitale level IV District Hospital. Kitale town is located at high Agricultural potential area of Trans-Nzoia County with an estimated population of 200,000. Kitale level IV district hospital provides Accident and Emergency services and its Government sponsored.
On arrival at the hospital, 240 (64.7%) patients with head injury were assessed as having Glasgow coma scale of between 9-12 moderate injury and 29 (7.8%) was between 3-8 severe injuries.
Majority of the patients were treated as in-patients 317 (85.7%).
Among those treated as outpatients, 38 (73.1%) were done minor surgery and 201 (63.8%) had major surgery. Hundred and forty seven (39.9%) had head and neck injuries and a similar proportion were injured in the lower extremity ( Table 3). Majority of the riders who did not wear helmets at the time of crash suffered head injuries 89 (85.6%). Riders who wore helmets at the time of crash had no head injury 62 (98%) and this was statistically significant (χ 2 =111.352, P<0.001) ( Table 3).

Discussion
In this study the prevalence of Commercial Motorcycle crashes was in agreement with studies conducted in other developing countries.  [13]. High occurrences of motorcycles crashes among this group have been attributed to a wide range of activities engaged in by this class of people. They represent the active group that partake in high risk-taking activities such as recklessness riding, over-speeding and overloading their motorcycles, riding under the influence of alcohol and riding without wearing any protective gears. Males are more often exposed to traffic as drivers; they travel longer distances to work and are more often involved in use of automobile as leisure activities [14].
The commonest anatomical/site of injury were head and neck and lower extremities. The findings are similar to a study in Tehran, which documented that the commonest musculoskeletal injury was fracture of the tibia comprising almost 50% of cases [15]. Previous studies in Nigeria have shown that limb and head injuries are the commonest causes of morbidity and mortality in motorcycle injuries [7]. From a safety perspective a helmet is the most important part of a motorcycle. Its use has been shown to be 72% effective at reducing the incidence of head injuries [16]. In this study larger proportion of head injuries occurred among riders who did not wear Higher percentage of severe cases was among the motorcycle riders. However in a study of road traffic injuries in Western Maharashtra, no positive correlation existed between category of road user and severity of injury [17]. This could be attributed to differences in areas of study as well measurement scales of the study variable. Our study findings are subject to some limitations.
We did not collect information from the first hospital the patient attended, it is possible that this would bias the interpretation of injuries sustained. Patients with minor injuries and never sought treatment were never captured. Pre hospital deaths were also not captured. In some instances it was impossible to corroborate independently the information provided by victims.