Implementation of a road traffic crash injury surveillance tool in a trauma referral hospital in Kisumu City, Western Kenya: Lessons learned from the pilot study

Abstract

Objective

Road traffic injury (RTI) is a major public health concern in Kenya with more than 13,000 deaths estimated annually. The primary objective of this study was to design and implement an injury surveillance tool for the collection of injury data, and assess the tool’s feasibility for the development of a hospital-based trauma registry in a leading Kenyan referral hospital. Secondarily, an epidemiologic profile was created to characterize RTI in the region.

Methods

An injury surveillance tool was developed and implemented, on a pilot basis, in a level 5 trauma hospital, Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), in Kisumu City, Western Kenya, for a 4-week period from 2019-07-15 to 2019-08-11. A descriptive statistical analysis summarized injury frequency counts and percentages.

Results

Over the pilot phase, 371 patients had forms completed, but 488 official injury-related hospital registrations, indicating that 117 injury patients (24%) were missed. A process evaluation of the tool implementation revealed issues in the collection protocol that required revisions, resulting in improved data form completeness rates. For the 368 cases with cause documented, the most common mechanisms of injury were RTI (46.5%; n = 171), assaults (23.9%; n = 88), and falls (14.9%; n = 55). For RTI patients, the median age was 28 years (IQR = 16) and 77% (n = 132) were males, with motorbike collision injuries (n = 91; 53.2%) the leading RTI mechanism. There were 348 injuries for 171 patients. The most common anatomical regions for RTI were the lower limb 32.8% (n = 114), upper limb (15.2%; n = 53), followed by head lacerations 8.6% (n = 30) and concussions 7.2% (n = 25). Two-thirds of patients (n = 113; 66.1%) were discharged from ED, just over a quarter (n = 46; 26.9%) were admitted to hospital and 9 patients succumbed to RTI (5.3%).

Conclusions

This injury surveillance pilot study produced the first injury dataset in Kisumu City, demonstrating the significant magnitude of RTI in Western Kenya, the leading cause of injury for the region. This dataset can be replicated in other hospitals to create an injury surveillance system for the collection of trauma data, needed for the development of countermeasures for the reduction of trauma, as well as for quality initiatives to improve patient outcomes.

Keywords:

• Road traffic injuries
• injury prevention
• injury surveillance tools
• trauma registry
• epidemiological injury profile
• global health

Acknowledgements

This project would have not been possible without the support of the Schulich School of Medicine and Dentistry, Maseno University and the study site host, Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH). An additional thank you goes to Melanie Katsivo, from the Western Global Health Office who facilitated the initial connections for this study project through her global road safety research collaborations and committees. Thank you to Dr. David Ndeti from the African Mental Health Foundation who hosted the primary author Bojana Radan, in 2018, for the initial stakeholder engagement and protocol creation phase. Thank you to Wilbroda Nancy Makunda from the JOOTRH Secretariat who facilitated ethics approval at JOOTRH and emergency department access. A special thanks to Vida Atieno Okumu, the primary research assistant during the pilot launch of this study, who contributed countless hours and translation capacity to the project. Finally, the authors would like to express their sincerest thanks to all members of the JOOTRH team, including all medical, clerical and administrative staff that contributed to this study during their working hours and hosted the Canadian research team so graciously.

Disclosure statement

The authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper to disclose.

Additional information

Funding

This work was supported by the Schulich School of Medicine and Dentistry [Student Research Opportunities Program (SROP), 2018]; the African Institute at Western University [African Institute Research Bursary, 2018]; Western University [Dr. Barry Davidson Global Opportunities Scholarship, 2019]; and by the Motor Vehicle Safety Research Team, Department of Pathology & Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University funded by Transport Canada [Contract T8056-160026/004/SS]. The Western University SROP grant, and the African Research Bursary was used for the travel expenses, accommodations and ethics approval for the lead researcher, BR, during study protocol creation in Kenya in 2018. The Dr. Barry Davidson Global Opportunities Scholarship was used for travel expenses and accommodation by the lead researcher, BR, during the study pilot implementation process in Kisumu City, 2019. Finally, the Motor Vehicle Safety Research Team funding was used to cover the administration fees for Kenyan ethics approval, project expenses such as copying and printing, and the stipend for a research assistant during study pilot implementation in Kisumu City, Kenya, 2019. Additionally, Transport Canada funding was used for conference fees and accommodation to cover the expenses for lead researcher, BR, to attend and present this research at the Canadian Global Health Conference, Ottawa, Ontario in 2019.