Solagberu Ba

Motorcycle Injuries in a Developing Country and the Vulnerability of Riders, Passengers, and Pedestrians

At a Nigerian university hospital, none of the motorcyclists who presented over a 12 month period had been wearing a helmet, and of the eight patients who died, seven had head injuries. Of the five collision types described, the rate of motorcycle-other vehicle collisions was highest at 40.6%, while the motorcycle-pedestrian rate was 23.4%. Measures to prevent these collisions might reduce overall crashes by 64%; in addition, helmet law should be enforced.

Clinical Spectrum of Trauma at a University Hospital in Nigeria

AbstractBackground and Objectives: Data on trauma in Nigeria requires updating just as trauma care needs coordination and organization. This study was done to examine the clinical spectrum of trauma and to propose measures for organization of trauma care. Patients and Methods: A 2-year prospective report of an ongoing trauma research is presented. Data obtained from September 1999 to December 2000) include name, age, sex, presenting diagnosis at the accident and emergency (A and E) unit, injury-arrival time, ode of transportation of patients to the hosptial, and the outcome of care. Results: Trauma patients comprised 2,913 of the 4,164 (70.0%) surgical patients seen in the A and E but 129 of 171 deaths (75.4%). Types of trauma were lacerations (585 patients, 20.1%), fractures (542, 18.7%), head injury (250, 8.6%), multiple injuries (249, 8.6%), burns (159, 5.5%), and others. Road traffic accidents (RTA) occurred in 1,816 patients (62.3%), falls in 308, assaults in 258, burns in 159, home accidents in 122, gunshot injuries in 107, industrial accidents in 73, and foreign body injuries in 70. There was no pre-hospital care. Transport to the A and E was done by relations, the police and a few Good Samaritans. Most of the patients reached the hospital in < 6 h. Common mortalities were from head injury (37 patients, 28.7%), multiple injuries (35, 27.1%), fractures (12, 9.3%), and burns (9, 7.0%). Of 106 deaths with timed records, 22 (20.7%), 56 (53.0%) and 28 (26.3%) occurred in 0–1 h, > 1–24 h and > 24 h, respectively. Conclusions: The spectrum of trauma is predominantly RTA-related, hence, trauma care organization would include prevention of RTA, organization of pre-hospital care aimed at transport time of < 2h, training volunteers from the populace and the police as emergency medical services technicians for resuscitation during transport and getting patients to hospital in optimal state, and an enhanced in-hospital care by designation and categorization of hospitals. These strategies, including continuous trauma research and funding, would go a long way in reducing mortalities from trauma, especially from RTA.

Long bone fractures treated by traditional bonesetters: a study of patients' behaviour.

This is a study of 295 patients (23.1% of 1278 patients with long bone fractures) who had visited the traditional bonesetter (TBS). The initial idea of visiting TBS was mooted by an external person in 75% of cases, whereas to discharge from TBS was usually the patients idea. The reasons for a patient to opt for a TBS are explored.

Pedestrian Injuries in the Most Densely Populated City in Nigeria—An Epidemic Calling for Control

Objectives: Since the first pedestrian road fatality of 1896, pedestrians still remain vulnerable, with fatalities in Africa being 55% of global statistics. Many previous reports from Nigeria have emphasized passengers and drivers over pedestrians; this study was done in the most densely populated Nigerian city with no previous publication exclusively dedicated to pedestrians—the megacity has been projected by the World Bank to be the third largest in the world by 2015 (after Tokyo and Mumbai), so the study results would aid injury control and reduce morbidity and mortality. Methods: This is a one-year prospective study on pedestrians attending the surgical emergency room of the busiest referral hospital in Lagos, Nigeria, detailing age, sex, occupation, regions injured, injury mechanism, incident vehicles, highway collisions, and immediate outcomes. Results: Some 702 pedestrians were seen, including 494 (70%) males with overall peak incidence in the third decade, but the peak incidence among females is lower and in the first decade. Common injuries sustained were to the head (40%), lower limbs (35%), upper limbs (9%), multiple regions (6%), pelvis (3%), and others (7%). Gender differences also were noted—the predominant injury location in males was the head, followed by lower limbs; the opposite was true for females, though both regional injuries were fewer in females than in males. Students were 20% of the entire pedestrians, with nearly half of them injured by a motorcycle. The mechanism of injury included crossing a highway (63%), walking along the pavement (17%), standing by a bus stop (12%), at a shop/house (5%), and others (3%). However, 76% injuries occurred on highways, 22% on inner city roads, and 2% elsewhere. Vehicles included motorcycles (33%), cars (27%), buses (22%), trucks (6%), tricycles (2.4%), and other (9%). Overall fatality was 10% and about half were due to being knocked down by buses and cars. Conclusions: This study suggests a high incidence and significant underreporting of pedestrian injuries. A reduction in morbidity and mortality is possible (from head and lower limb injuries) by traffic calming techniques in crossing the highway, especially injuries due to being struck by motorcycles, cars, and buses.

Non-trauma surgical emergencies in adults: Spectrum, challenges and outcome of care

Introduction Significant deaths of between 21% and 38% occur from non-trauma surgical conditions in the accident and emergency room. Access to emergency surgical care is limited in many developing countries including Nigeria. We aimed to study the spectrum of non-trauma surgical emergencies, identify challenges in management and evaluate outcomes. Methods A one year prospective cohort study of all non-trauma emergencies in adults seen at the surgical emergency room of LASUTH from 1st October, 2011 to 30th September, 2012 was conducted. Data was analyzed using SPSS version 15.0. Results Of a total of 7536 patients seen, there were 7122 adults. Those with non-trauma conditions were 2065 representing 29% of adult emergencies. Age ranged between 15 and 97 years and male to female ratio was 1.7:1. Acute abdomen (30%), urological problems (18%) and malignancies (10%) were the most common. Among 985 patients requiring admission only 464 (47%) were admitted while the remaining 53% were referred to other centers. Emergency surgical intervention was carried out in 222 patients representing 48% of admitted patients. There were 12 (24%) non-trauma deaths in the emergency room. They were due to acute abdomen and malignancies in half of the cases. Conclusion Facilities for patients needing emergency care were inadequate with more than half of those requiring admission referred. Attention should be paid to the provision of emergency surgical services to the teeming number of patients seen on yearly basis in the Teaching Hospital.

Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care

Introduction Injuries are the third most important cause of overall deaths globally with one-quarter resulting from road traffic crashes. Majority of these deaths occur before arrival in the hospital and can be reduced with prompt and efficient prehospital care. The aim of this study was to highlight the burden of road traffic injury (RTI) in Lagos, Nigeria and assess the effectiveness of prehospital care, especially the role of Lagos State Ambulance Service (LASAMBUS) in providing initial care and transportation of the injured to the hospital. METHODS A three-year, retrospective review of road traffic injured patients seen at the Surgical Emergency Room (SER) of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigeria, from January 1, 2012 to December 31, 2014 was conducted. Parameters extracted from the Institution Trauma Registry included bio-data, date and time of injury, date and time of arrival in SER, host status, type of vehicle involved, and region(s) injured. Information on how patients came to the hospital and outcome in SER also were recorded. Results were analyzed using Statistical Package for Social Sciences (SPSS; IBM Corporation; Armonk, New York USA) version 16. RESULTS A total of 23,537 patients were seen during the study period. Among them, 16,024 (68.1%) had trauma. Road traffic crashes were responsible in 5,629 (35.0%) of trauma cases. Passengers constituted 42.0% of the injured, followed by pedestrians (34.0%). Four wheelers were the most frequent vehicle type involved (54.0%), followed by motor cycles (30.0%). Regions mainly affected were head and neck (40.0%) and lower limb (29.0%). Less than one-quarter (24.0%) presented to the emergency room within an hour, while one-third arrived between one and six hours following injury. Relatives brought 55.4%, followed by bystanders (21.4%). Only 2.3% had formal prehospital care and were brought to the hospital by LASAMBUS. They also had significantly shorter arrival time. One hundred and nine patients (1.9%) died in the emergency room while 235 bodies were brought in dead. CONCLUSION Less than three percent among the victims of road crashes had formal prehospital care and shorter hospital arrival time. Current facilities for emergency prehospital care in Lagos are inadequate and require improvement. Training lay first-responders, who bring the majority of the injured to hospital, in basic first-aid may improve prehospital care in Lagos. Ibrahim NA , Ajani AWO , Mustafa IA , Balogun RA , Oludara MA , Idowu OE , Solagberu BA . Road traffic injury in Lagos, Nigeria: assessing prehospital care. Prehosp Disaster Med. 2017;32(4):424-430.

Childhood motorcycle-related injuries in a Nigerian city - prevalence, spectrum and strategies for control

The use of motorcycles is becoming increasingly popular in Nigeria because of poor public and private transportation systems. Motorcycle crashes account for a disproportionate share of the deaths and disabilities that result from road traffic accidents. We undertook a prospective descriptive study of all children aged 15 years or under with motorcycle-related injuries (MCRIs) who presented at the emergency room of the University of Ilorin Teaching Hospital over a period of 3 years. Children with ophthalmic injuries and those who died before reaching the hospital were excluded. Over the study period, 40 of a total of 440 patients admitted with MCRIs were children (9.0%). Twenty-seven children (67.5%) were injured as pedestrians, 11 (27.5%) as passengers and 2 (5%, young adolescents) as riders. One 3-year-old child was admitted to the intensive care unit with severe head injury and died. Prevention of MCRIs in children should be a priority in our setting. Public campaigns should clearly highlight the risk of injury to this age group, and poor safety practices with regard to children should be specifically targeted. With the motorcycle gaining popularity as a mode of transportation in our cities and communities, the importance of teaching our youth about correct safety behaviour such as helmet use, and parents on the danger of letting their children cross roads alone, cannot be over-emphasised.

PA 02-5-2551 Epidemiology of injuries at a teaching hospital in nigeria: a 15-year review

Injuries constitute a large proportion of the emergency surgical patient load in most hospitals. It constitutes a major public health threat and is the leading cause of death in persons aged between 1 and 44 years, accounting for up to 72% of deaths in some age groups (e.g. 15–24 years). The effect of injury as a public health burden is particularly felt in low and middle-income countries that experience 90% of the global mortality from injury. In 2010, 5.1 million deaths resulted from injuries surpassing the cumulative mortality from the more prominent public health concerns in LMICs (HIV-AIDS, malaria, and tuberculosis at 3.8 million deaths). Over a 15 year period from February 2000 to January 2015, all patients that presented to the surgical emergency of a University Teaching Hospital were enrolled into a prospective observational study to observe the patterns of presentation and epidemiology. Data was collected at presentation and analysis was done at the end of the 15 year period. A total of 17,0677 patients were admitted via the surgical emergency ward over the period. Most of the patients were young adults (47.1%) with an average age at presentation of 32.38 (s.d 19.2). 11 779 patients (69%) presented to the hospital following trauma while the remaining 31% presented with other surgical emergencies. Road traffic crashes accounted for the vast majority of the injuries (59.6%) while falls and assaults accounted for 9.8% and 7.2% respectively. Occupational injuries and sports injuries were relatively rare, accounting for only 1.2% and 0.4% of cases respectively. Injuries constitute a large proportion of the emergency surgical health care demands in this environment. Road traffic injuries continue to account for majority of injuries presenting to the hospitals with young adult males being the main victims.

Emergency Medical Services Outcome Assessment in Lagos, Nigeria: Review of Cases of ''Brought in Dead'' Patients

Abstract BACKGROUND: This study sets out to establish a database of BID patients presenting at the Lagos State University Teaching Hospital (LASUTH). METHOD: A retrospective study of consecutive ‘’Brought in Dead‘’ (BID) patients seen from April to November 2011 at the surgical emergency room of the Lagos State University Teaching Hospital (LASUTH) was done using a validated questionnaire. RESULTS: A total of 144 BID patients were seen during the study period. There were 112 males or 78% and 32 females or 22% of the total (M:F=3:1). The age group with the largest number of victims was the 31-40 age groups; and there were 37 patients (30.8% of 120 cases captured under age group). Trauma also accounted for 104 patients (72.2%) with 52 (36.1%, 50% of trauma cases) of these caused by Road traffic injuries (RTI), and Gunshot injuries accounting for 21 (14.6%, 20.2% of trauma cases). Among the Trauma BID cases from RTI, 4-wheeled vehicles accounted for 20 cases (19.2%, 40% of RTI), whilst motor cycle injuries accounted for 12 cases (11.5%, 24% of RTI). CONCLUSION: The study shows that road traffic injuries and gunshot injuries, accounted for 70% of BID cases presenting at LASUTH. Majority of cases of RTI are from 4 wheeler vehicles (40%) and motorcycles (24%).

Sustaining a vehicle: A voice and a platform for trauma research in Africa - The second coming of the African Journal of Trauma

The re‐emergence of African Journal of Trauma with a reconstituted Editorial Board and better journal management should see the Journal fulfilling its dreams Africa is known to those who live and breathe Africa. Time and again, many untrue beliefs have been held and promoted about Africa due to inadequate research. At one point, Brain tumors were said to be rare in Africans; this was until research done by Nigeria’s first Neurosurgeon, Prof. E. Latunde Odeku, revealed the true picture–brain tumors were not a rarity. Africa is also “known” to those who do not live or breathe it and herein lays the possibility of inadequate representation or outright misrepresentation. However, trauma is a global phenomenon with variability in geographical locality, socio‐economics of the countries affected, age, gender, tribe, and race.[1‐4] We, at African Journal of Trauma primarily aim to promote the dissemination of trauma research from Africa while improving the visibility of Africa’s trauma and trauma care.