Epidemiology of paediatric injuries in Rwanda using a prospective trauma registry

R T Petroze, A N Martin, E Ntaganda, P Kyamanywa, E St-Louis, S K Rasmussen, J F Calland, J C Byiringiro, R T Petroze, A N Martin, E Ntaganda, P Kyamanywa, E St-Louis, S K Rasmussen, J F Calland, J C Byiringiro

Abstract

Background: Child survival initiatives historically prioritized efforts to reduce child morbidity and mortality from infectious diseases and maternal conditions. Little attention has been devoted to paediatric injuries in resource-limited settings. This study aimed to evaluate the demographics and outcomes of paediatric injury in a sub-Saharan African country in an effort to improve prevention and treatment.

Methods: A prospective trauma registry was established at the two university teaching campuses of the University of Rwanda to record systematically patient demographics, prehospital care, initial physiology and patient outcomes from May 2011 to July 2015. Univariable analysis was performed for demographic characteristics, injury mechanisms, geographical location and outcomes. Multivariable analysis was performed for mortality estimates.

Results: Of 11 036 patients in the registry, 3010 (27·3 per cent) were under 18 years of age. Paediatric patients were predominantly boys (69·9 per cent) and the median age was 8 years. The mortality rate was 4·8 per cent. Falls were the most common injury (45·3 per cent), followed by road traffic accidents (30·9 per cent), burns (10·7 per cent) and blunt force/assault (7·5 per cent). Patients treated in the capital city, Kigali, had a higher incidence of head injury (7·6 per cent versus 2·0 per cent in a rural town, P < 0·001; odds ratio (OR) 4·08, 95 per cent c.i. 2·61 to 6·38) and a higher overall injury-related mortality rate (adjusted OR 3·00, 1·50 to 6·01; P = 0·019). Pedestrians had higher overall injury-related mortality compared with other road users (adjusted OR 3·26, 1·37 to 7·73; P = 0·007).

Conclusion: Paediatric injury is a significant contributor to morbidity and mortality. Delineating trauma demographics is important when planning resource utilization and capacity-building efforts to address paediatric injury in low-resource settings and identify vulnerable populations.

© 2019 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.

Figures

Figure 1
Figure 1
Age demographics of injured paediatric patients WHO age categories are used to describe distribution of 3010 paediatric patients in the Rwanda Injury Registry, 2011–2015.
Figure 2
Figure 2
Disposition of 2928 injured paediatric patients The disposition was not available for 82 patients. *The high care unit had the availability of oxygen. †Referrals were to a higher level of care (the private hospital in the country or the military hospital). OR, operating room; ED, emergency department.
Figure 3
Figure 3
Causes of injury in 2982 paediatric patients in Rwanda, May 2011 to July 2015 The mechanism of injury was missing for 28 children. *Includes choking (1 patient), near‐drowning (3), electrical injury (2), sexual assault (2) and non‐specified (27). RTA, road traffic accident.

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