Camila Gianella

Epidemiology of Road Traffic Incidents in Peru 1973–2008: Incidence, Mortality, and Fatality

Background The epidemiological profile and trends of road traffic injuries (RTIs) in Peru have not been well-defined, though this is a necessary step to address this significant public health problem in Peru. The objective of this study was to determine trends of incidence, mortality, and fatality of RTIs in Peru during 1973–2008, as well as their relationship to population trends such as economic growth. Methods and Findings Secondary aggregated databases were used to estimate incidence, mortality and fatality rate ratios (IRRs) of RTIs. These estimates were standardized to age groups and sex of the 2008 Peruvian population. Negative binomial regression and cubic spline curves were used for multivariable analysis. During the 35-year period there were 952,668 road traffic victims, injured or killed. The adjusted yearly incidence of RTIs increased by 3.59 (95% CI 2.43–5.31) on average. We did not observe any significant trends in the yearly mortality rate. The total adjusted yearly fatality rate decreased by 0.26 (95% CI 0.15–0.43), while among adults the fatality rate increased by 1.25 (95% CI 1.09–1.43). Models fitted with splines suggest that the incidence follows a bimodal curve and closely followed trends in the gross domestic product (GDP) per capita Conclusions The significant increasing incidence of RTIs in Peru affirms their growing threat to public health. A substantial improvement of information systems for RTIs is needed to create a more accurate epidemiologic profile of RTIs in Peru. This approach can be of use in other similar low and middle-income settings to inform about the local challenges posed by RTIs.

Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study

Background: Road injuries are the second-leading cause of disease and injury in the Andean region of South America. Adequate management of road traffic crash victims is important to prevent and reduce deaths and serious long-term injuries. Objective: To evaluate the promptness of health care services provided to those injured in road traffic incidents (RTIs) and the satisfaction with those services during the pre-hospital and hospital periods. Methods: We conducted a cross-sectional study with active surveillance to recruit participants in emergency departments at eight health care facilities in three Peruvian cities: a large metropolitan city (Lima) and two provincial cities (an urban center in the southern Andes and an urban center in the rainforest region), between August and September 2009. The main outcomes of interest were promptness of care, measured by time between injury and each service offered, as well as patient satisfaction measured by the Service Quality (SERVQUAL) survey. We explored the association between outcomes and city, type of health care facility (HCF), and type of provider. Results: We recruited 644 adults seeking care for RTIs. This active surveillance strategy yielded 34% more events than anticipated, suggesting under-reporting in traditional registries. Median response time between a RTI and any care at a HCF was 33 minutes overall and only 62% of participants received professional care during the initial “golden” hour after the RTI. After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54). This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70). Conclusions: Response time to RTIs was adequate overall, though a large proportion of RTI victims could have received more prompt care. Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.

Cobertura real de la ley de atención de emergencia y del Seguro Obligatorio contra Accidentes de Tránsito (SOAT)

(74% en Pucallpa, 34% en Ayacucho y 26% en Lima: p<0,001). De los que contaban con un seguro (SOAT u otro), pero cuya atencion no fue cubierta por este, la mayoria estuvo en Lima (70%), seguido de Ayacucho (30%) y ninguno en Pucallpa. La mayoria (94%) procedio de establecimientos publicos. Las razones incluyeron problemas administrativos (25%), vencimiento del seguro o morosidad en el pago (21%), invalidez del seguro en el establecimiento (18%), no disponibilidad de la poliza (18%), o no cobertura de las lesiones por el seguro (9%). En estos casos, los gastos fueron asumidos por el mismo paciente, familiares o parientes, el chofer o dueno del vehiculo, el servicio social del EESS, u otras personas o instituciones. Conclusiones. En este estudio se observo un gran desconocimiento de la Ley de Atencion de Emergencia, y una cobertura de atencion muy deficiente, pues casi la mitad de atenciones no fueron brindadas de acuerdo a uno o mas puntos establecidos por dicha norma. Los costos de atencion generados por el accidente de transito no fueron cubiertos por un seguro en una de cada tres victimas. Es urgente mejorar la informacion de los ciudadanos sobre sus derechos y el cumplimiento efectivo de las leyes, para lograr una cobertura universal y mas equitativa en la atencion de las victimas de accidentes de transito.