Epidemiology of transport-related injuries in Ghana

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Abstract

To better elucidate the incidence, characteristics, and consequences of transport-related injuries in a less developed country in Africa, we undertook an epidemiologic survey in Ghana. A total of 21 105 persons were surveyed, in both an urban area (Kumasi, n=11 663) and a rural area (Brong-Ahafo, n=9442). In the preceding year, a total of 656 injuries were reported in the urban area and 928 injuries reported in the rural area. Transport-related mechanisms accounted for 16% of all injuries in the urban and 10% of all injuries in the rural area. The annual incidence of transport-related injuries was almost identical in the two settings, 997/100 000 persons in the urban area and 941/100 000 in the rural area. In both settings, transport-related injuries were more severe than other types of injuries in terms of mortality, length of disability, and economic consequences. In the urban area, the most common transport-related mechanisms were either to passengers involved in crashes of mini-buses or taxis (29%) or to pedestrians struck by these vehicles (21%). In the rural area, the most common transport-related mechanisms were bicycle crashes. The second most common rural mechanisms were motor vehicle crashes, which were the most severe and which involved commercial (83%) rather than private vehicles. Prevention strategies need to be different from those in developed countries and should target commercial drivers more than private road users.

Introduction

During the preceding 200 years, industrialized countries experienced an epidemiologic transition in which the incidence of infectious diseases declined, with decreases in infant mortality rates and increases in life expectancy. Accompanying these changes, however, were increases in other diseases, primarily degenerative diseases of older age and injury. Currently, in most industrialized societies, injury is the leading cause of years of potential life lost. Transport-related injuries are usually the pre-eminent cause of such injury-related deaths in most locations (Smith and Barss, 1991, The World Bank, 1993).

Most low income countries (LICs) are going through a similar epidemiologic transition currently, with declines in the childhood infectious diseases which had been the leading causes of mortality. This has been due to the successes of public health efforts by groups such as the World Health Organization. At the same time however, rates of injury-related death and disability are increasing. Injury is currently a leading cause of death among older children and adults in most LICs. As in industrialized countries, a leading contributor to such losses are transport-related mechanisms. The World Health Organization estimates that, with current epidemiologic trends, the years of life lost due to infectious diseases and due to injuries will be equal worldwide by the year 2020. The largest contributor to injury-related losses is projected to be transport-related. Moreover, transport-related injuries alone are projected to be the second leading cause of years of life lost worldwide by the year 2020 (Murray and Lopez, 1996).

Despite this burgeoning problem, little attention has been paid to injuries in the setting of LICs in terms of research efforts or organized prevention programs. Efforts to combat the problem of injuries in LICs are hampered by restrictions of financial resources and also by lack of adequate data. Many LICs can afford to spend only $5–10 per capita per year for health (The World Bank, 1994), compared to $3000 for the USA. In light of such limitations, prevention emerges as the most cost effective strategy to decrease the toll of death and disability from injuries. However, adequate data is often lacking to address where prevention priorities should be placed or to design effective prevention strategies.

The nature of injuries in LICs needs to be better understood. Their overall societal burden also needs to be elucidated to ascertain how great a priority should be placed on them. The relative contribution of specific mechanisms needs to be assessed in order to address prevention priorities.

The usual data sources which would provide such information in developed countries include vital statistic registries, police reports, and health care records. All of these data sources are of limited value in many LICs, especially those in Africa. Vital registry data are usually incomplete, with a minority of the deaths of any cause being reported to the governments (Smith and Barss, 1991). Crash statistics are rudimentary, if available at all. In Ghana, such statistics are collected from police records by the Building and Roads Research Institute (Ross Silcock Partnership, 1990). The process takes 3–4 years between time of crash and the availability of collated data for statistical analysis. An uncertain percent of crash events are reported to the police. Finally, many injured persons do not receive formal health care, rendering health care records an incomplete source of information as well (Forjuoh et al., 1995, Mock et al., 1997).

Due to such difficulties with existing data sources, we undertook a primary epidemiologic survey of transport-related injuries in Ghana. We sought to more directly determine the incidence, characteristics, economic consequences, and outcomes of such injuries in both an urban area and a rural area of this nation. By so doing, we hoped to provide information which: (i) would indicate the relative importance of transport-related injuries compared to other injuries; and (ii) would be useful in the design of prevention strategies.

Section snippets

Method

The study setting was the West African nation of Ghana. This nation has a population of 17 000 000 and a per capita gross national product of $325. The urban area studied was the Kumasi Metropolitan Area in the Ashanti Region. This city, with a population of 650 000, is the second largest city in Ghana and the economic center of the northern two thirds of the nation. The rural area studied included all or portions of four contiguous districts of the Brong-Ahafo Region: Berekum; Jaman; Wenchi;

Denominator surveyed

Data were obtained on 11 663 individuals in 262 separate sites in Kumasi and on 9442 individuals living in 160 separate sites in the rural area. In the rural area, the communities in which the people lived were classified according to access to motorized transport:

  • 1.

    (most access) paved road, n=2745 (29%);

  • 2.

    major unpaved road, indicating at least daily motorized transport, n=5209 (55%);

  • 3.

    minor unpaved road, indicating an unpaved road with less than daily motorized transport or footpath access only, n

Discussion

Given limitations of existing data sources for injury in LICs, community based surveys represent a method to obtain more accurate information on all injuries, including transportation-related mechanisms. This was the goal of the current study. Although this methodology offers advantages to existing data sources, it also has its own limitations. These must be addressed before drawing any inferences from the data. First, the study relied on self reports by respondents. There was no way to

Conclusions

Transport-related injuries account for a significant proportion of all injuries in this African country. This pertains especially to urban populations, but also to a rural area which has limited distances of paved roads. In both locations, transport-related injuries are among the most significant injuries in terms of mortality, length of temporary disability, potential for long term disability, and economic consequences. In terms of prevention efforts, the mechanisms of injury are fundamentally

Acknowledgements

This study was funded by an American Association for the Surgery of Trauma/Davis and Geck Research Scholarship. Portions of the paper were presented at the 40th (1996) and 41st (1997) Annual Meetings of the Association for the Advancement of Automotive Medicine.

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