Advertisement

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

  • 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 JuillardEmail author
Original Article

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.

Keywords

Trauma Cameroon Pediatric injury Pediatric surgery 

Notes

Acknowledgements

We would like to thank the Ministry of Public Health of Cameroon, the Central Hospital of Yaoundé, and all of the research assistants for their support and efforts, which made this project possible.

Funding

None.

Compliance with ethical standards

Conflict of interest

ONN, MKN, JC, IF, GM, MEM, GAE, RAD, AAH, and CJ declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    World Health Organization. Injuries and violence: the facts. Geneva: World Health Organization Press; 2010.Google Scholar
  2. 2.
    Toroyan T. Global status report on road safety. Inj Prev. 2009.  https://doi.org/10.1258/jrsm.2010.090426.Google Scholar
  3. 3.
    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.CrossRefGoogle Scholar
  4. 4.
    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.Google Scholar
  5. 5.
    Bickler SW, Rode H. Surgical services for children in developing countries. Bull World Health Organ. 2002;80:829–35.Google Scholar
  6. 6.
    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.Google Scholar
  7. 7.
    Bartlett SN. The problem of children’s injuries in low-income countries: a review. Health Policy Plan. 2002;17:1–13.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.Google Scholar
  12. 12.
    Adesunkanmi AR, Oginni LM, Oyelami AO, Badru OS. Epidemiology of childhood injury. J Trauma. 1998;44:506–12.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.Google Scholar
  16. 16.
    Wikipedia. Central Hospital of Yaoundé. Wikipedia; 2017. https://en.wikipedia.org/wiki/Central_Hospital_of_Yaound%25C3%25A9. Accessed 15 Sept 2017.
  17. 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.Google Scholar
  18. 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.Google Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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. 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. 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.CrossRefGoogle Scholar
  23. 23.
    Kobusingye OC, Lett RR. Hospital-based trauma registries in Uganda. J Trauma. 2000;48:498–502.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 25.
    Talwar S, Jain S, Porwal R, Laddha BL, Prasad P. Trauma scoring in a developing country. Singapore Med J. 1999;40:386–8.Google Scholar
  26. 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.CrossRefGoogle Scholar
  27. 27.
    Microsoft Corporation. Redmond: Microsoft Excel; 2011.Google Scholar
  28. 28.
    StataCorp. Stata Statistical Software: Release 13. College Station: StataCorp, LP; 2013.Google Scholar
  29. 29.
    Sacks D. Age limits and adolescents. Paediatr Child Health. 2003;8:577–8.CrossRefGoogle Scholar
  30. 30.
    World Health Organization. Health for the world’s adolescents: a second chance in the second decade: summary; 2014.Google Scholar
  31. 31.
    Wikipedia. Age of majority 2018. https://en.wikipedia.org/wiki/Age_of_majority. Accessed 1 May 2018.
  32. 32.
    Annuaire Statistique du Cameroun. 2013. Yaoundé: Institut National de la Statistique; 2014.Google Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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. 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.CrossRefGoogle Scholar
  36. 36.
    World Health Organization (WHO). Falls: key facts. World Heal Organization; 2018. Falls. Accessed 10 July 2018.Google Scholar
  37. 37.
    Nthumba PM. Burns in sub-Saharan Africa: a review. Burns. 2016.  https://doi.org/10.1016/j.burns.2015.04.006.Google Scholar
  38. 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.CrossRefGoogle Scholar
  39. 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.CrossRefGoogle Scholar
  40. 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.CrossRefGoogle Scholar
  41. 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.CrossRefGoogle Scholar
  42. 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.CrossRefGoogle Scholar
  43. 43.
    World Health Organization. Guidelines for essential trauma care. Geneva: World Heal Organization; 2015.Google Scholar
  44. 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.CrossRefGoogle Scholar
  45. 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. 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.Google Scholar
  47. 47.
    WHA68.15. Strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage. Geneva: World Health Organization; 2015.Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Obieze Nwanna-Nzewunwa
    • 1
  • Marquise Kouo Ngamby
    • 2
  • Jacob Cox
    • 3
  • Isabelle Feldhaus
    • 4
  • Girish Motwani
    • 1
  • Martin Ekeke Monono
    • 5
  • Georges Alain Etoundi
    • 2
  • Rochelle A. Dicker
    • 6
  • Adnan A. Hyder
    • 7
  • Catherine Juillard
    • 6
    Email author
  1. 1.Center for Global Surgical Studies, Department of Surgery, Zuckerberg San Francisco General Hospital and Trauma CenterUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Ministry of Public HealthYaoundéCameroon
  3. 3.School of MedicineJohns Hopkins UniversityBaltimoreUSA
  4. 4.Department of Global Health and PopulationHarvard T. H. Chan School of Public HealthBostonUSA
  5. 5.World Health Organization (WHO) Regional OfficeBrazzavilleRepublic of the Congo
  6. 6.Department of SurgeryUniversity of California, Los AngelesLos AngelesUSA
  7. 7.International Injury Research UnitJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations