Dan K Kisitu1, Lauren E Eyler2, I Kajja3, G Waiswa3, T Beyeza4, Isabelle Feldhaus2, Catherine Juillard2, Rochelle A Dicker5. 1. Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda. 2. Center for Global Surgical Studies, Department of Surgery, San Francisco General Hospital, University of California-San Francisco, San Francisco, California. 3. Department of Orthopaedics, Makerere University College of Health Sciences, Kampala, Uganda. 4. Department of Orthopedic Surgery, Mulago National Referral and Teaching Hospital, Kampala, Uganda. 5. Center for Global Surgical Studies, Department of Surgery, San Francisco General Hospital, University of California-San Francisco, San Francisco, California. Electronic address: rochelle.dicker@ucsf.edu.
Abstract
BACKGROUND: Musculoskeletal injuries are a major public health problem in low-income countries like Uganda. Patterns of musculoskeletal injuries presenting to district hospitals are unknown. Our pilot orthopedic trauma registry establishes a framework for broader district hospital injury surveillance. MATERIALS AND METHODS: We interviewed and examined patients presenting to Mityana, Entebbe, and Nakaseke hospitals with musculoskeletal injuries from October 2013 to January 2014. We compared patient and Demographic and Health Survey population demographics and determined predictors of delayed presentation for care. RESULTS: Men, adults, and individuals with postsecondary education were more common among patients than in the Demographic and Health Survey population. Common causes included road traffic injuries (48.5%) and falls (25.1%). Closed, simple fractures comprised 70% of injuries. Compared to the self-employed, subsistence farmers (odds ratio [OR] = 2.99, 95% confidence interval [CI] = 1.15-7.91), motorcycle taxi drivers (OR = 10.50, 95% CI = 1.92-64.57), and preschool children (OR = 4.24, 95% CI = 1.05-17.39) were significantly more likely to be delayed to care after adjustment for covariates. Subsistence farmers were more likely than other occupations to seek care from traditional bonesetters (23% versus 7%, P = 0.001). All patients who visited bonesetters were delayed to hospital care. CONCLUSIONS: Policies for trauma systems strengthening must address the needs of underserved groups and involve all stakeholders, including bonesetters. Research should address reasons for delayed care among subsistence farmers, motorcycle taxi drivers, and preschool children. Injury surveillance at district hospitals facilitates evidence-based resource allocation and should continue in the form of an Ugandan national trauma registry.
BACKGROUND:Musculoskeletal injuries are a major public health problem in low-income countries like Uganda. Patterns of musculoskeletal injuries presenting to district hospitals are unknown. Our pilot orthopedic trauma registry establishes a framework for broader district hospital injury surveillance. MATERIALS AND METHODS: We interviewed and examined patients presenting to Mityana, Entebbe, and Nakaseke hospitals with musculoskeletal injuries from October 2013 to January 2014. We compared patient and Demographic and Health Survey population demographics and determined predictors of delayed presentation for care. RESULTS:Men, adults, and individuals with postsecondary education were more common among patients than in the Demographic and Health Survey population. Common causes included road traffic injuries (48.5%) and falls (25.1%). Closed, simple fractures comprised 70% of injuries. Compared to the self-employed, subsistence farmers (odds ratio [OR] = 2.99, 95% confidence interval [CI] = 1.15-7.91), motorcycle taxi drivers (OR = 10.50, 95% CI = 1.92-64.57), and preschool children (OR = 4.24, 95% CI = 1.05-17.39) were significantly more likely to be delayed to care after adjustment for covariates. Subsistence farmers were more likely than other occupations to seek care from traditional bonesetters (23% versus 7%, P = 0.001). All patients who visited bonesetters were delayed to hospital care. CONCLUSIONS: Policies for trauma systems strengthening must address the needs of underserved groups and involve all stakeholders, including bonesetters. Research should address reasons for delayed care among subsistence farmers, motorcycle taxi drivers, and preschool children. Injury surveillance at district hospitals facilitates evidence-based resource allocation and should continue in the form of an Ugandan national trauma registry.
Authors: Daniel K Kisitu; Nathan N O'Hara; Gerard P Slobogean; Andrea L Howe; Piotr A Blachut; Peter J O'Brien; David J Stockton Journal: J Orthop Trauma Date: 2022-09-01 Impact factor: 2.884
Authors: Dan K Kisitu; Lauren E Eyler; Isaac Kajja; Gonzaga Waiswa; Titus Beyeza; David R Ragland; Isabelle Feldhaus; Catherine Juillard; Rochelle A Dicker Journal: Inj Epidemiol Date: 2016-12-05