Injuries among children and young adults in Uganda : epidemiology and prevention

Abstract

Injuries are a major morbidity and mortality cause among children and young adults worldwide. Previous Ugandan studies were limited in scope and biased towards severe adulthood injuries in referral care.

Aims and Objectives: This study explored the epidemiology of childhood and young adulthood injuries in Uganda: specifically their extent, pattern, distribution, risk and determinants, and stakeholder perceptions their regarding prevention and control.

Methods: Cross-sectional survey was used to describe unintentional domestic injury patterns and determinants among under-fives; facility-based surveillance, to determine the distribution, characteristics, and outcomes of violent injuries among 13-23-year-olds and all injuries among under-13s; cohort design, to explore the extent, nature and determinants of school-related risk; FGDs and KIIs, to explore stakeholder perceptions of prevention. Chi-square tests were used to evaluate categorical differences, t-tests, quantitative differences, odds ratios, associations, survival and multi-level modelling, time and contextual effects; and content and thematic analyses, stakeholder perceptions.

Results: Home-, road-, school- and hospital-related childhood injuries are major but underreported. Violent injuries among youth constitute 7.3percent of total injuries, with a case fatality of 4percent. Fall and burn injuries are the greatest domestic injury risk among under-fives, while traffic, falls and sport injuries are commonest among school children. Travel, break-time activities and practical classes are most risky. Intentional injuries are skewed, peaking at 21 years; males double females‘ prevalence of victimisation. Students, casual labourers and housewives are most at risk. Teenager housewives have a higher victimisation risk. Blunt force, stabs/cuts, gunshots, and burns are the main injury mechanisms, with variations depending on location. Most prevalent intentional injuries are cuts/bites, open wounds and superficial injuries, majority are minor. The risk of home, school, and traffic injury is high, with age and contextual variations. The cumulative prevalence of school-related injury is 36.1percent, with a rate of 12.3/1000 person years. The case fatality rate of the non-intentional domestic childhood injuries is 1.1/100/year. The odds of domestic burns fall progressively from the first to the sixth year of life; after this, traffic and falls lead. At four, burn, fall and traffic injury odds approximate parity. Injury determinants include poor housing, poor supervision, and domestic energy type, school, HIV status, age and gender. The perceived drivers of injury spurts are staple food supply, social activities and competitive sports. Emergent explanations include childhood, parenting, and situational factors. Lack of guidance and counselling, hunger, intimate-partner violence (IPV), domestic violence, unsafe cooking and household chores, idleness, poor parental control, child maltreatment, corporal punishment, and unsafe storage of sharp objects are thought to cause injuries. Most stakeholders believe in prevention through education and environmental modification. Education, voluntary counselling and HIV testing and disclosure were recommended. Local treatments include sugar, cold water, bathroom sand, and urine for burn injuries; sticks, bandages, ropes, liniment and stretchers for fractures and dislocations; and raw eggs, cooking oil and milk for poisoning. Few NGOs work on injuries and violence in rural Uganda, yet injury care within the existing health facilities is not adequate.

Conclusions: Childhood and young adulthood injuries are common in Ugandan homes, schools, and roads with age, sex, contextual differences. Injury risk is high across Uganda with travel, practical classes, break-time activities and gardening being most risky. The determinants include maternal and child age, house condition, supervision quality, gender, school and location. Linkages are thought to exist between staple food supply, major social events, and hunting seasons and injury risk. These factors interact with individual, parental, and situational factors to pattern childhood injuries in rural Uganda. Local management strategies exist, most of them based on traditional knowledge and beliefs that may require separate quantitative evaluation. Other proposed educational interventions are based on the ineffective ‘victim blame template‘.