ORIGINAL RESEARCH ARTICLE Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy Renee Y. Hsia & Doruk Ozgediz & Milton Mutto & Sudha Jayaraman & Patrick Kyamanywa & Olive C. Kobusingye Received: 23 May 2009 /Accepted: 31 May 2010 /Published online: 20 July 2010 # Springer-Verlag London Ltd 2010 Abstract Background Despite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality. Aim To estimate the epidemiology of the injury seen in patients presenting to the government hospital in Kampala, the capital city of Uganda. Methods A secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005. Results From 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance. Conclusions Road traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development. Keywords Road traffic . Injuries . Developing country. Trauma . Uganda Introduction Injuries are responsible for an increasing share of morbidity and mortality in low- and middle-income countries (LMICs) where they currently account for 11% of the total The views expressed in this paper are those of the author(s) and not those of the editors, editorial board or publisher. R. Y. Hsia (*) Department of Emergency Medicine, University of California at San Francisco, 1001 Potrero Avenue, 1E21, San Francisco, CA 94110, USA e-mail: rhsia@post.harvard.edu D. Ozgediz Department of Surgery, University of Toronto, Hospital for Sick Children, Toronto, ON, Canada M. Mutto Injury Control Center- Uganda, Kampala, Uganda S. Jayaraman Department of Surgery, University of California at San Francisco, San Francisco, CA, USA P. Kyamanywa Department of Surgery, Faculty of Medicine, National University of Rwanda, Butare, Rwanda O. C. Kobusingye Regional Office for Africa, World Health Organization, Harare, Zimbabwe Int J Emerg Med (2010) 3:165���172 DOI 10.1007/s12245-010-0200-1

disability-adjusted life years [1]. Injuries also have an enormous socioeconomic impact both at the household and national level. There are great disparities in the prevention and care of injuries worldwide, with 1 to 2 million preventable deaths in severely injured patients and 90% of deaths from road traffic injuries occurring in low- and middle-income countries [2, 3]. Children are disproportion- ately affected as well. In sub-Saharan African children over 5, injuries account for more deaths than HIV, tuberculosis, and malaria combined [4]. Understanding the epidemiology of injury can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortal- ity. Despite the growing burden of injuries in LMICs, however, there remain limited primary epidemiologic data to guide health policy and health system development [5, 6]. Even if a health facility capable of providing quality emergency care exists, the absence of formal prehospital care in resource-constrained settings, along with multiple barriers to care such as social, educational, cultural, and financial factors, prevents access to these facilities. To improve epidemiologic surveillance of injuries in Uganda, the Injury Control Centre-Uganda established a trauma registry in 1998, after piloting and validating an instrument for data collection. This registry has been used in five Ugandan hospitals since 1998 [7, 8]. Similar registries have also been established in other countries in the region [9]. Since then, a number of injury prevention interventions such as seat belt laws in motor vehicles, helmet laws for motorcyclists, speed bumps, improved street lighting, and school and household-based interventions for children have been implemented. Efforts to improve trauma care have included trauma courses for hospital-based personnel and some first aid courses for police [10]. In addition, a national injury policy has been drafted by the Ministry of Health [11]. There has, however, been no formal epidemiologic analysis of the potential collective impact of these interventions since the trauma registry was first implemented. The goal of this study was to estimate the current epidemiology of injury in the capital city of Kampala by using data at Mulago National Referral Hospital, especially the most common causes of injury, and the prevalence of intentional and unintentional injury. Methods The database for this study was constructed from prospec- tively collected data from the Injury Control Centre- Uganda, which is a private organization that is funded by both public and private sources trained nurses, clinical officers, or doctors in the casualty (or emergency) depart- ment of the Mulago National Referral Hospital completed a one-page form (described previously in the literature [8]) on each patient presenting to the casualty department, recording information on the patient condition, status, demographics (age, sex, residence, occupation), several clinical variables (blood pressure, pulse, respiratory rate, and neurological status), as well as causes and place of injury, severity of injury, and outcome. Two weeks after initial presentation, the health care providers or records clerks completed the patient disposition from the casualty (treated and discharged from casualty, admitted, transferred to higher level facility, died in casualty, dead on arrival) as well as the disposition for those admitted (discharged, died, still in the hospital, transferred, or other). This registry was checked for accuracy by a hospital surgeon or senior doctor, and the data were entered into Excel (Microsoft, 2005), cleaned, and managed by the Injury Control Centre-Uganda. The most current full year of data available at this time is from July 2004 to August 2005. Prospective injury data were no longer recorded after 2005 due to lack of funding, and at this time, these data represent the most recent injury epidemiology seen at Mulago National Referral Hospital, a government hospital. Since 2008, efforts to restart the hospital trauma registry have been revived. All patients seen at Mulago National Referral Hospital that were recorded in the database in the 12-month period from 1 July 2004���1 August 2005 were included in the data set, which was queried for descriptive statistics of all injuries to characterize patients by age, gender, type of injury, location of injury, intent, mode of arrival, distance, injury severity, and disposition. The Kampala Trauma Score (KTS) was chosen to categorize severity of injury. This score has been validated and was revised in 2004, where previous definitions of mild, moderate, and severe injuries (which were KTS scores of 14���16, 11���13, and 11, respectively) were simplified to fit on a 10-point scale, with mild injury defined as KTS 8���10, moderate injury as KTS 5���7, and severe injury as KTS 5. This study protocol was approved by the Mulago National Referral Hospital Research Committee, the Uganda National Council of Science and Technology, and the Institutional Review Board of the University of California, San Francisco. Results From 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded. We excluded those that had no disposition from the casualty department (n=51) and those with missing values for disposition at 2 weeks (n=218), together representing 7% of our sample. A total of 3,481 records were analyzed. 166 Int J Emerg Med (2010) 3:165���172