Seema Kacker1, David Bishai2, Georges Alain Etoundi Mballa3, M E Monono4, Eric B Schneider5, Marquise Kouo Ngamby3, Adnan A Hyder6, Catherine J Juillard7. 1. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. 2. Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. 3. Cameroon Ministry of Health, PO Box 4282, Yaoundé, Cameroon. 4. World Health Organization, Africa Regional Office, Brazzaville, Congo. 5. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 6. Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. 7. Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, CA, USA. Electronic address: Catherine.Juillard@ucsf.edu.
Abstract
INTRODUCTION: Injury is a significant and increasingly common cause of morbidity and mortality in sub-Saharan Africa; however, the social and economic factors underlying these trends are not well understood. We evaluated the relationship between socioeconomic status (SES) and trauma outcomes using a prospective registry of patients presenting to the largest trauma hospital in Yaoundé, Cameroon. METHODS: Trauma patients (n=2855) presenting to the emergency ward at Central Hospital, Yaoundé between April 15 and October 15, 2009 were surveyed regarding demographic and socioeconomic background, nature and severity of injuries, treatment, and disposition. A wealth score was estimated for each patient, corresponding to an SES index constructed using principle components analysis of the urban Cameroonian Demographic and Health Survey. Logistic regression was used to evaluate the effects of SES on care-seeking behaviour, injury severity, and treatment outcome. MAIN OUTCOME MEASURES: SES wealth score, care-seeking prior to visiting hospital, injury severity, treatment outcome. RESULTS: Patients aged 1-89 presented with road traffic injuries (59.83%), falls (7.76%), and penetrating trauma (6.16%), and had higher SES than the broader urban Cameroonian population. Within the Yaoundé sample, being in the lowest SES quintile was associated with an increased likelihood of having sought care elsewhere before presenting to the hospital (aOR=3.28, p<0.001), after controlling for background and injury characteristics. Patients in the lowest SES quintile were also more likely to present with moderate/severe injuries (aOR=4.93, p<0.001), and were more likely to be transferred to the operating room. CONCLUSIONS: Patients presenting to this trauma centre were wealthier than the broader community, suggesting the possibility of barriers to accessing care. Poorer patients were more likely to have severe injuries and more likely to need surgery, but were less likely to seek care from a major trauma centre immediately. Substantial differences in SES between the sample visiting the hospital and the broader community suggest a need for community-based sampling approaches in future trauma research.
INTRODUCTION: Injury is a significant and increasingly common cause of morbidity and mortality in sub-Saharan Africa; however, the social and economic factors underlying these trends are not well understood. We evaluated the relationship between socioeconomic status (SES) and trauma outcomes using a prospective registry of patients presenting to the largest trauma hospital in Yaoundé, Cameroon. METHODS: Trauma patients (n=2855) presenting to the emergency ward at Central Hospital, Yaoundé between April 15 and October 15, 2009 were surveyed regarding demographic and socioeconomic background, nature and severity of injuries, treatment, and disposition. A wealth score was estimated for each patient, corresponding to an SES index constructed using principle components analysis of the urban Cameroonian Demographic and Health Survey. Logistic regression was used to evaluate the effects of SES on care-seeking behaviour, injury severity, and treatment outcome. MAIN OUTCOME MEASURES: SES wealth score, care-seeking prior to visiting hospital, injury severity, treatment outcome. RESULTS: Patients aged 1-89 presented with road traffic injuries (59.83%), falls (7.76%), and penetrating trauma (6.16%), and had higher SES than the broader urban Cameroonian population. Within the Yaoundé sample, being in the lowest SES quintile was associated with an increased likelihood of having sought care elsewhere before presenting to the hospital (aOR=3.28, p<0.001), after controlling for background and injury characteristics. Patients in the lowest SES quintile were also more likely to present with moderate/severe injuries (aOR=4.93, p<0.001), and were more likely to be transferred to the operating room. CONCLUSIONS: Patients presenting to this trauma centre were wealthier than the broader community, suggesting the possibility of barriers to accessing care. Poorer patients were more likely to have severe injuries and more likely to need surgery, but were less likely to seek care from a major trauma centre immediately. Substantial differences in SES between the sample visiting the hospital and the broader community suggest a need for community-based sampling approaches in future trauma research.
Authors: Kevin J Blair; Michael de Virgilio; Fanny Nadia Dissak-Delon; Lauren Eyler Dang; S Ariane Christie; Melissa Carvalho; Rasheedat Oke; Mbiarikai Agbor Mbianyor; Alan E Hubbard; Alain Mballa Etoundi; Thompson Kinge; Richard L Njock; Daniel N Nkusu; Jean-Gustave Tsiagadigui; Rochelle A Dicker; Alain Chichom-Mefire; Catherine Juillard Journal: BMJ Glob Health Date: 2022-01
Authors: Joongsik Jeong; Yun Jeong Kim; So Yeon Kong; Sang Do Shin; Young Sun Ro; Dae Han Wi; Sang Chul Kim; Kyong Min Sun; Suhee Kim; Sola Kim; Saee Byel Kang; Louis Joss Bitang; Bonaventure Hollong; Lee Wallis Journal: Afr J Emerg Med Date: 2022-01-20