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Understanding the Burden of Pediatric Traumatic Injury in Uganda: A Multicenter, Prospective Study
Hannah S Thomas1, Adupa Emmanuel2, Peter Kayima3
1Institute for Global Health Sciences, University of California, San Francisco, California; Division of Urology, University of Toronto, Toronto, Canada.
Insights
Pediatric trauma in Uganda is primarily caused by falls and road traffic accidents, leading to significant abdominal injuries. Data supports training general surgeons for pediatric emergency care due to workforce shortages.
Area of Science:
- Global Health
- Pediatric Surgery
- Trauma Surgery
Background:
- Traumatic injuries cause 8 million childhood deaths globally each year.
- Uganda lacks comprehensive data on pediatric trauma burden, hindering resource allocation and surgical workforce planning.
- This study addresses the critical need for data on non-adolescent pediatric trauma in Uganda.
Purpose of the Study:
- To determine the burden of non-adolescent pediatric trauma in Uganda.
- To identify common injury mechanisms and outcomes.
- To inform surgical workforce planning and resource allocation.
Main Methods:
- A descriptive review of prospective pediatric surgical databases from four Ugandan hospitals (Mulago, Mbarara, Soroti, Lacor) between 2012-2019.
- Inclusion criteria: all clinical encounters involving trauma in non-adolescent pediatric patients.
- Primary outcome: distribution of injury mechanisms; Secondary outcomes: operative intervention and clinical outcomes.
Main Results:
- A total of 693 pediatric trauma patients were analyzed.
- The majority were male (63%) with a median age of 5 years.
- Common injury mechanisms included falls (16.2%) and road traffic crashes (14.7%), frequently resulting in abdominal trauma (29.4%) and long-bone fractures (27% in available data).
Conclusions:
- Falls and road traffic crashes are the leading causes of pediatric trauma in Uganda, often resulting in abdominal injuries.
- High rates of surgical intervention (55%) with a 95% recovery to discharge rate were observed.
- Findings support training adult general surgeons for pediatric emergency care to address workforce deficits and resource variability.
Introduction:
Traumatic injury is responsible for eight million childhood deaths annually. In Uganda, there is a paucity of comprehensive data describing the burden of pediatric trauma, which is essential for resource allocation and surgical workforce planning. This study aimed to ascertain the burden of non-adolescent pediatric trauma across four Ugandan hospitals.
Methods:
We performed a descriptive review of four independent and prospective pediatric surgical databases in Uganda: Mulago National Referral Hospital (2012-2019), Mbarara Regional Referral Hospital (2015-2019), Soroti Regional Referral Hospital (SRRH) (2016-2019), and St Mary's Hospital Lacor (SMHL) (2016-2019). We sub-selected all clinical encounters that involved trauma. The primary outcome was the distribution of injury mechanisms. Secondary outcomes included operative intervention and clinical outcomes.
Results:
There was a total of 693 pediatric trauma patients, across four hospital sites: Mulago National Referral Hospital (n = 245), Mbarara Regional Referral Hospital (n = 29), SRRH (n = 292), and SMHL (n = 127). The majority of patients were male (63%), with a median age of 5 [interquartile range = 2, 8]. Chiefly, patients suffered blunt injury mechanisms, including falls (16.2%) and road traffic crashes (14.7%) resulting in abdominal trauma (29.4%) and contusions (11.8%). At SRRH and SMHL, from which orthopedic data were available, 27% of patients suffered long-bone fractures. Overall, 55% of patients underwent surgery and 95% recovered to discharge.
Conclusions:
In Uganda, non-adolescent pediatric trauma patients most commonly suffer injuries due to falls and road traffic crashes, resulting in high rates of abdominal trauma. Amid surgical workforce deficits and resource-variability, these data support interventions aimed at training adult general surgeons to provide emergency pediatric surgical care and procedures.
