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ORIGINAL ARTICLE  
Year : 2015  |  Volume : 8  |  Issue : 6  |  Page : 272-275
Epidemiology of admitted cases of childhood injuries in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria


Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

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Date of Web Publication20-Nov-2015
 

   Abstract 

Introduction: Injuries have become a leading cause of childhood death, and majority of these occur in developing countries. The range of injuries also varies among age groups, sex, populations and economies. Within the same population, injury pattern changes over time. Statistics of trauma from most developing countries are still not very many. To aid sound policies, documentation of trauma epidemiology from different cultures and geographies is still needful. Methodology: Hospital records of all children aged 18 years and below that presented between January 2007 and December 2011 were studied retrospectively. Results: A total of 217 patients were admitted, 125 (57.6%) males and 92 (42.4%) females. Multiple injuries occurred in 24 (11.1%) of children. Road crashes accounted for the greatest number of injuries; 109 cases (50.2%) followed by falls 60; (27.6%). Motor cycle related injuries accounted for 67 (61.5%) of the 109 road traffic injuries. The age group most commonly affected is 0-5 years accounting for 98 (45.2%) cases. Head injury was the commonest injury sustained 83 (33.9%). Majority of the injuries, 72 (66.1%) occurred in or near home. Injuries were more frequent during the weekdays 132 (60.8%) compared to the weekends 85 (39.2%). Long term functional or physical disability was seen in 62 (28.6%) of cases. Six children died giving a mortality rate of 2.8%. Conclusion: Childhood trauma rate is still high, with motorcycle related road traffic accidents constituting a major cause. Education and enforcement of road traffic regulations and limiting motorcycle transportation may help in reducing the trauma rate in children.

Keywords: Injuries, Nigeria, pediatric, trauma, unintentional

How to cite this article:
Hyginus EO, Okechukwu UJ, Victor I M, Christian OC, Anthony U. Epidemiology of admitted cases of childhood injuries in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. Ann Trop Med Public Health 2015;8:272-5

How to cite this URL:
Hyginus EO, Okechukwu UJ, Victor I M, Christian OC, Anthony U. Epidemiology of admitted cases of childhood injuries in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria. Ann Trop Med Public Health [serial online] 2015 [cited 2019 Oct 20];8:272-5. Available from: http://www.atmph.org/text.asp?2015/8/6/272/162642

   Introduction Top


Injuries have become a leading cause of deaths in childhood and a majority of these occur in developing countries. [1] The burden of intentional and unintentional injuries in developing countries is expected to continue rising with the projected rise in urbanization, motorization, communal conflicts, and natural disasters. [1],[2] Although communicable diseases are still the major cause of childhood morbidity and mortality in developing nations, trauma-related causes have been increasingly recognized as a public health issue. In low- and medium-income countries (LMIC), road traffic crashes are the second most common cause of morbidities in children aged above 9 years. [3],[4]

Several factors expose children to high risks of trauma and its consequences. These range from the lack of a safe play space, overcrowded homes, children's poor judgment of safety, caregiver's fatigue, outright carelessness, maternal depression, and alcohol abuse to nonobservance of home safety measures. [1],[5],[6],[7],[8] Also, the formulation and enforcement of child safety policies have remained a challenge in most LMIC. [6],[9]

The range of injuries also varies among age groups, sexes, populations, and economies. Within the same population, the injury pattern changes over time. Globally, road traffic crashes are the leading cause of injuries in children with an estimated 10 million injured or disabled each year. [1] Similar results are obtained in LMIC. [6],[10],[11],[12],[13],[14]

In our locality, the unprotected and unregulated use of motorcycle as a means of transportation has added to the menace. [15],[16] Absence of effective prehospital care, transportation, and intensive care management are critical factors fueling the poor outcome.

Statistics of trauma from most developing countries are still not much and the documented figures may just be the tip of the iceberg. To aid sound policies, documentation of trauma epidemiology from different cultures and geographies is needed.

Thus, we retrospectively reviewed the injured children who presented to our hospital, a tertiary center in the Southeastern part of Nigeria, with the view of understanding and documenting the local childhood injury characteristics.


   Materials and Methods Top


The hospital records of injured children below 18 years admitted to the ward, Accident and Emergency (A&E), and Children Emergency Room (CHER) of the hospital from January 2006 to December 2011 were retrospectively reviewed. Data on demography, injury mechanism, location, time of injury, and outcome were obtained and analyzed using SPSS for windows, version 17.0 (SPSS Inc. Chicago, IL).


   Results Top


There were 217 admitted trauma cases, out of whom 125 (57.6%) were males and 92 (42.4%) were females. The age range was from 1 month to 18 years with a mean age of 7.3 years. [Table 1] shows the types of injury among the different age groups.
Table 1: Injury mechanism and age groups

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Multiple injuries occurred in 24 (11.1%) children. Injuries occurred more frequently during weekdays with the number of children being 132 (60.8%) compared to weekends with the number of children being 85 (39.2%). More number of injuries occurred in the afternoon and evening (64.4%). The average time of presentation to the hospital after the injury was 151.3 h. The mean hospital stay was 52.8 days. Long-term functional or physical disability was seen in 62 (28.6%) children. Six children died, thereby making the mortality rate 2.8%.


   Discussion Top


The total number of recorded cases (217) represents only severe injuries requiring admission. Majority of the children who suffered injuries most probably did not present to the hospital; they may have sought care at the primary level care centers, numerous private hospitals, or alternative care at chemist shops or from native medical practitioners.

Similar to several reports from both Nigeria and beyond, transport-related injuries accounted for the greatest burden and was responsible for more than half of the trauma cases in our study. [1],[9],[13],[17] However, peculiar to our study was the high rate of motorcycle-related injuries. In our area, many children often walk to their school unsupervised by responsible adults. A large number of children are transported on motorcycles. On an average, a motorcyclist may carry as many as three to six children, none of whom wear a crash helmet [Figure 1]. Coupled with chaotic traffic regulation, motorcycle injuries involving children both as passengers and pedestrians were expectedly high [Table 2]. Also, as expected, head injuries are the most common type of injury [Table 3]. Transportation via motorcycles has been identified as a cause of the recent surge in road traffic injuries in parts of Nigeria. [18] Anecdotal reports have shown a reduction in road traffic injuries in states that have banned motorcycle as a means of commercial transportation. Strict enforcement of traffic regulations and proscription of commercial motorcycle transportation will most likely decrease the burden of childhood injuries from road crashes.
Figure 1: Unprotected children being transported on motorcycle

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Table 2: Road traffi c injury types and frequencies

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Table 3: Injury type and frequencies

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Unlike the data from the northern part of the country, fall is the second most common injury in our study. [19] Southeastern Nigeria has a tropical rainforest vegetation with trees that bear fruits seasonally. Majority of the injuries resulting from a fall from trees were particularly common during the season of mangoes. Fall from story buildings affected mainly children under 5 years of age. Ironically, most falls occur in the evenings when the parents are supposed to be at home. The caregiver's fatigue after the day's work may be responsible for this. The most likely explanation is that while the older child goes out to forage for fruits, the younger ones play unsupervised and are either pushed down the stairs by playmates or fall off an unprotected balcony. A more close supervision of children once they return from school by caregivers and the enforcement of provision of child safety guidelines in buildings will reduce the rate of injuries.

Burn injuries were also common and generally resulted from scald injuries from either hot water or food. These usually occurred at home during preparations for breakfast or hot water being prepared for bath.

Our study showed that injuries were most common in children in the age group of below 5 years. This age group has the combination of a poor judgment of dangerous adventures and the least defense compared to older children. Also, most of the injuries occur in and around the home [Table 4]. Minimal injury occurred while the children were in school. Again, this underscores the relative nonsupervision of children by caregivers; on returning from school, the children may have been left with househelps or just siblings.
Table 4: Site of injury and frequencies

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The rate of intentional injuries is low (5.1%) but these injuries were more common in older children. The low recorded rate in our belief was most probably due to underreporting as a result of nonpresentation to the hospital. Females were the most involved victims [Figure 2]. Cases of domestic violence against children and sexual assault are largely not often presented to hospitals except in severe cases. Most of the victims are underage housemaids abused by their employers who are often unwilling to fund their medical expenses. Also, child rape and assaults are perpetrated by close relations and thus, the children may not present due to fear of social stigmatization. Adequate parental education, counseling, and establishment of support groups will not only help in reducing the stigma but also offer practical preventive measure advice.
Figure 2: Injury mechanism and sex distribution

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In conclusion, despite the increasing interest in childhood injuries, documentation of childhood injury statistics is still needed in our environment. Continuous data generation to observe the changing trends and active implementation of preventive measures will keep the epidemic in check.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Fazlur Rahman AK, et al. World Report on Child Injury Prevention. Geneva: WHO; 2008. p. 1-7.  Back to cited text no. 1
    
2.
Rizvi N, Luby S, Azam SI, Rabbani F. Distribution and circumstances of injuries in squatter settlements of Karachi, Pakistan. Accid Anal Prev 2006;38:526-31.  Back to cited text no. 2
    
3.
Peden M, McGee K, Sharma G. The Injury Chart Book: A Graphical Overview of the Global Burden of Injuries. Geneva: World Health Organization; 2002. p. 1-76.  Back to cited text no. 3
    
4.
Mathers C. Global burden of disease among women, children, and adolescents. In: Ehiri JE editor. Maternal and Child Health. New York: Springer; 2009. p. 19-42.  Back to cited text no. 4
    
5.
Razzaka JA, Luby SP, Laflamme L, Chotani H. Injuries among children in Karachi, Pakistan -What, where and how. Public Health 2004;118:114-20.  Back to cited text no. 5
    
6.
Afukaar FK, Antwi P, Ofosu-Amaah S. Pattern of road traffic injuries in Ghana: Implications for control. Inj Control Saf Promot 2003;10:69-76.  Back to cited text no. 6
    
7.
Ruiz-Casares M. Unintentional childhood injuries in sub-Saharan Africa: An overview of risk and protective factors. J Health Care Poor Underserved 2009;20(Suppl):51-67.  Back to cited text no. 7
    
8.
Orton E, Kendrick D, West J, Tata LJ. Independent risk factors for injury in pre-school children: Three population-based nested case-control studies using routine primary care data. PLoS One 2012;7:e35193.  Back to cited text no. 8
    
9.
UNICEF: A league table of child deaths by injury in rich nations. Innocenti Report Card No.2, February 2001. UNICEF Innocenti Research Centre, Florence, Italy. Inj Prev 2001;7:166-7.  Back to cited text no. 9
    
10.
Kobusingye OC, Guwatudde D, Owor G, Lett RR. Citywide trauma experience in Kampala, Uganda: A call for intervention. Inj Prev 2002;8:133-6.  Back to cited text no. 10
    
11.
Ekenze SO, Anyanwu KK, Chukwumam DO. Childhood trauma in Owerri (south eastern) Nigeria. Niger J Med 2009;18:79-83.  Back to cited text no. 11
    
12.
Osinaike B, Amanor-Boadu S. Paediatric Trauma Admissions in a Nigerian ICU. The Internet Journal of Emergency and Intensive Care Medicine 2006;9.  Back to cited text no. 12
    
13.
Chapp-Jumbo AU, Adisa AC. Pattern of trauma among paediatric in-patients - The abia state university teaching hospital experience. Eur J Sci Res 2009;29:411.  Back to cited text no. 13
    
14.
Mohan D. Safety of Children as Motorcycle Passengers. Transportation Research and Injury Prevention Programme, Indian Institute of Technology Delhi. New Delhi 2009. p. 1-32.  Back to cited text no. 14
    
15.
Madubueze CC, Chukwu CO, Omoke NI, Oyakhilome OP, Ozo C. Road traffic injuries as seen in a Nigerian teaching hospital. Int Orthop 2011;35:743-6.  Back to cited text no. 15
    
16.
Nassir AA, Bello JO, Ofoegbu CKP, Abdul-Rahman LO, Yakub S, Solagberu BA. Childhood motorcycle-related injuries in a Nigerian city - prevalence, spectrum and strategies for control. SAJCH 2011;5:48-9.  Back to cited text no. 16
    
17.
Abantanga FA, Mock CN. Paediatric trauma: Epidemiology, prevention, and control. In: Ameh EA, Bickler SW, Lakhoo K, Nwomeh BC, Poenaru D, editors. Paediatric Surgery: A Comprehensive Text for Africa. Seattle: Global HELP Organization; 2012. p. 157-63.  Back to cited text no. 17
    
18.
Okeniyi JA, Oluwadiya KS, Ogunlesi TA, Oyedeji OA, Oyelami OA, Oyedeji GA, et al. Motorcycle injury: An emerging menace to child health in Nigeria. Internet J Pediatr Neonatol 2004;5.  Back to cited text no. 18
    
19.
Oboirien M. Pattern of paediatric trauma in Sokoto, North West Nigeria. Afr J Paediatr Surg 2013;10:172-5.  Back to cited text no. 19
[PUBMED]  Medknow Journal  

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Correspondence Address:
Ekwunife Okechukwu Hyginus
Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1755-6783.162642

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