Vital Statistics: Estimating Injury Mortality in Kigali, Rwanda

Abstract

Background

Globally, injury deaths largely occur in low- and middle-income countries. No estimates of injury-associated mortality exist in Rwanda. This study aimed to describe the patterns of injury-related deaths in Kigali, Rwanda using existing data sources.

Methods

We created a database of all deaths reported by the main institutions providing emergency care in Kigali—four major hospitals, two divisions of the Rwanda National Police, and the National Emergency Medical Service—during 12 months (Jan–Dec 2012) and analyzed it for demographics, diagnoses, mechanism and type of injury, causes of death, and all-cause and cause-specific mortality rates.

Results

There were 2682 deaths, 57 % in men, 67 % in adults >18 year, and 16 % in children <5 year. All-cause mortality rate was 236/100,000; 35 % (927) were due to probable surgical causes. Injury-related deaths occurred in 22 % (593/2682). The most common injury mechanism was road traffic crash (cause-specific mortality rate of 20/100,000). Nearly half of all injury deaths occurred in the prehospital setting (47 %, n = 276) and 49 % of injury deaths at the university hospital occurred within 24 h of arrival. Being injured increased the odds of dying in the prehospital setting by 2.7 times (p < 0.0001).

Conclusions

Injuries account for 22 % of deaths in Kigali with road traffic crashes being the most common cause. Injury deaths occurred largely in the prehospital setting and within the first 24 h of hospital arrival suggesting the need for investment in emergency infrastructure. Accurate documentation of the cause of death would help policy-makers make data-driven resource allocation decisions.

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Acknowledgments

We would like to thank the hospitals’ administrative leaders; Department chairmen and head nurses of all the hospital wards, data analysts of the hospital statistics offices, and hospital morgue officers contributing to this study. We are also grateful for assistance and the vision of the Rwanda National Police, particularly the Commissioners of Traffic Police and Criminal Investigation Division and their staff who understood and supported this project from the outset.

Funding

Dr Jayaraman was sponsored by the Harvard Medical School Health Disparities Fellowship and by Brigham and Women’s Hospital where she was a Clinical Instructor in Surgery at the time this project was developed, funded, and conducted. Ms. Kim was a medical student at Emory University School of Medicine and was sponsored by Emory School of Medicine and Emory Global Health Institute when she conducted this project.

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Correspondence to Sudha P. Jayaraman.

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Woon Cho Kim and Jean Claude Byiringiro are co-first authors.

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Kim, W.C., Byiringiro, J.C., Ntakiyiruta, G. et al. Vital Statistics: Estimating Injury Mortality in Kigali, Rwanda. World J Surg 40, 6–13 (2016). https://doi.org/10.1007/s00268-015-3258-3

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Keywords

  • Road Traffic
  • Injury Surveillance
  • Prehospital Setting
  • Road Traffic Injury
  • Injury Death