Three-month pattern of road traffic injuries at a Kenyan level 4 hospital

Road traffic injuries continue to exert a huge burden on the health care system in Kenya. Few studies on the pattern of road traffic injuries have been conducted in Kenya. We therefore carried out a retrospective study to determine the pattern of road traffic injuries seen in a public hospital in Naivasha district, Kenya. A retrospective study on surgical patients admitted at Naivasha District Hospital over a three month period was carried out. Eighty two percent of all patients injured in the crashes were men, and eighty percent were aged between 20-49 years. Most of the patients sustained lower limb injuries (41.5%) followed by head injuries (35.4%). Thirty one percent were pedestrians, 27.7% cyclists, 24.6% passengers and 16.9% motor vehicle drivers at the time of injury. Road traffic crashes are a growing pandemic, leading to high morbidity and mortality. Efforts need to be taken to prevent injuries, long term complications and loss of lives that are robbing communities off loved ones, bread winners and productive manpower.


Introduction
Road traffic injuries (RTIs) are a leading cause of death and disability worldwide [1]. They account for 1.3 million annual deaths and 20-50 million injuries worldwide [1]. According to the World Health Organization, 90% of these deaths occur in low and middleincome countries (LMICs), which possess less than 50% of global motor vehicles. The African region has the highest road fatality rates in the world's regions (24.1 deaths per 100,000 population), well above the global average of 18.0 deaths per 100,000, in spite of the fact that the region is the least motorized (2% of the world's vehicles) of the six world regions [2]. As such countries continue to with motorcycles accounting for close to 60%. Furthermore there has been an even bigger rise in the number of bicycles, which are being used as taxis, locally known as "boda-boda". Consequently, Kenya has an estimated death rate of 20.9 per 100,000 population (WHO 2013), which is quite high in comparison to that of the European region (10.3 per 100,000 population) [2,3]. More than 3000 annual deaths and 60% of admissions to surgical wards in Kenya occur due to RTIs [4]. Such high mortality rates, high morbidity incidences, slow recovery and high incidence of permanent sequelae account for very high medical costs and loss of productivity and gross domestic product (GDP). With the sharp rise in number of vehicles and bicycles on Kenyan roads, this incidence is expected to continue rising. Naivasha district hospital (NDH), a busy level-4 health facility in Kenya has a very high rate of RTI admissions, due to its close proximity to the busy Nairobi-Nakuru highway a major road in the country. The current study therefore aims to document the pattern of RTI admissions seen at the hospital.

Methods
A retrospective study design was employed to review records of patients admitted in the surgical wards including men and women of all ages seen at the hospital for a three-month period (September-November 2012). Data were collected using researcher-filled data questionnaires that incorporated socio-demographic pattern of the patients involved in the crashes, nature of injury and severity, circumstances that led to the injuries and modes of transport. Data

Results
Socio-demographic pattern of the patients: Eighty two percent (81.5%) of all patients injured in the crashes were men while 18.5% were women. The age range of patients seen was 3-75 years and the median was 32 years. Eighty percent (80.1%) of the affected people were between 20-49 years ( Table 1) Such statistics and those demonstrated by studies such as the current one make it imperative for interventional efforts. Such morbidities and mortalities are easier prevented than most disease associated morbidities and mortalities, and should therefore be given the highest priority in public health and in preventive efforts.
A similar study conducted at Kenyatta National Hospital, the highest level of referral and tertiary hospital in Kenya, demonstrated similar patterns with the most common injury due to RTIs being that of lower limb fractures accounting for 27%, followed by head injuries accounting for 25% of RTI admissions. The study revealed that careless driving and negligence by pedestrians are the principal causes of RTIs [5]. The probability that a pedestrian will be killed if hit by a motor vehicle increases dramatically with speed. While most vulnerable road users survive if hit by a car travelling at 30km/hr (90% chance of survival), the majority are killed if hit by a car travelling at 50 km/h (20% chance of survival). Speed regulation is therefore essential in reducing risk of mortality due to road crashes [4].

Conclusion
Road traffic injuries are a growing pandemic, leading to high morbidity and mortality. Drastic measures need to be undertaken to prevent injuries, long term complications and loss of lives that are robbing communities off loved ones, bread winners and productive manpower.