|Year : 2017 | Volume
| Issue : 2 | Page : 171-174
Childhood injuries in a teaching hospital setting, Nnewi, South-East Nigeria
Anthony Ifeanyi Ugezu, CC Ihegihu, NC Chukwuka, CU Ndukwu, RO Ofiaeli
Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
|Date of Web Publication||14-Nov-2017|
Anthony Ifeanyi Ugezu
Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State
Background: Injuries resulting from accidents are of the most common cause of morbidity, mortality, and disability in childhood. Injuries in children are global problem occurring in all countries of the world. Aim: The aim of this study is to determine the pattern of injuries sustained during childhood and to recommend appropriate preventive measures. Materials and Methods: This is a hospital-based retrospective study, which comprised patients aged 18 years and below who presented with injuries at Nnamdi Azikiwe University Teaching Hospital, Nnewi, between January 2012 and December 2016. Patients with burn injury were excluded from the study. This is because the authors did not manage burn cases. Patients with incomplete records were excluded from the study. Results: Four hundred and twenty-nine patients' case records were reviewed. These patients sustained 549 injuries. Twenty-eight patients had multiple injuries. Their ages ranged from 1 day to 18 years with a mean age of 8.01 ± 2.2 years. 46.9% of the patients were 4–12 years of age. More males were affected than females with a ratio of 1.4:1. 48.2% of the patients sustained their injuries along the roads. Road traffic accidents were the leading cause of injury (48.2%) followed by falls (21.7%), with birth trauma accounting for 9.1% of cases. Fracture was the most common injury sustained accounting for 321 cases (58.4%) with 28.2% being open/compound. The time of these injuries occurs more in the morning and afternoon of the day. Conclusion: The prevention of these childhood injuries would involve public health education on identification of child hazards and safety measures. There is a need for legislation to outlaw certain activities such as street trading and hawking of wares/goods by children which exposes them to injuries. There is also a need to improve road designs by including zebra crossing and speed breaks on roads to curtail the magnitude of these injuries. Enforcement of road safety measures is also important.
Keywords: Children, injuries, pattern, prevention
|How to cite this article:|
Ugezu AI, Ihegihu C C, Chukwuka N C, Ndukwu C U, Ofiaeli R O. Childhood injuries in a teaching hospital setting, Nnewi, South-East Nigeria. Trop J Med Res 2017;20:171-4
|How to cite this URL:|
Ugezu AI, Ihegihu C C, Chukwuka N C, Ndukwu C U, Ofiaeli R O. Childhood injuries in a teaching hospital setting, Nnewi, South-East Nigeria. Trop J Med Res [serial online] 2017 [cited 2018 Dec 15];20:171-4. Available from: http://www.tjmrjournal.org/text.asp?2017/20/2/171/218221
| Introduction|| |
Malnutrition and infectious diseases are known to be the common causes of morbidity and mortality in children in developing countries including Nigeria. However, trauma is becoming a major killer of children in developing countries as infection and malnutrition are being controlled. In fact, trauma has been described as a “neglected disease of modern” Nigeria and a “hidden, disease of epidemic proportion.” This trend can be attributed to industrialization, modernization, as well as increase in the rate of violence in the society. Injuries, especially the accidental ones, are fast taking over as the leading causes of disability and deaths in Nigeria.
These injuries are sustained both within and outside the home. These injuries can be accidental, child abuse, or occasionally intentional. The causes of these injuries are varied and include road traffic accidents (RTAs), falls, firearms, sports, and assaults.,,,,,, Falls occur on ground level while running or playing. There are falls from beds at home, school, or on the farm. There are falls from a significant height from mango trees, multistorey buildings, or stairs. The severity of the injuries sustained ranges from minor bruises to fractures, severe soft tissue damage, and even loss of parts of the body., Again, the effects of these childhood injuries are usually far reaching not only on the involved child but also on the parent or guardian and the socioeconomic condition of the country. The child suffers pain, both emotional and physical distress, time off school, the parents or guardians lose income where the nation loses man hours.
The treatment of these injuries ranges from nonoperative methods to operative methods. The outcome of treatment is quite satisfactory but still depends on some variables. These include severity of injury, time of presentation, associated injuries, and availability of emergency medical services (EMSs), However, there is a need to prevent these injuries as their effects on national economy are enormous.
| Materials and Methods|| |
This is a hospital-based retrospective study of children aged 18 years and below, who presented with injuries at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra state, between January 2012 and December 2016. Patients with burns and those with incomplete records were excluded from the study.
The demographic data, cause of injuries, the pattern of injuries, investigations done, and treatment offered were analyzed using Statistical Package for Social Sciences Version 17 (SPSS Inc., Chicago, Illinois, USA).
| Results|| |
A total of 429 patients were included in the study. The mean age of the patients was 8.01 ± 2.2 years (range 1 day to 18 years; [Figure 1]).
There were 249 (58.0%) males and 180 (42.0%) females with a ratio of 1.4:1. The age group 7–9 years was the largest proportion of patients constituting 210% of injured patients.
RTAs was the leading cause of injury (48.2%) followed by falls (21.71%), with birth trauma accounting for 9.1% of cases [Table 1].
Roads was the most common place of injury (222, 51.7%) followed by the home, which accounted for 93 (21.7%) cases [Table 2].
These injuries occurred more in the morning and afternoon periods of the day accounting for 65.8% of cases.
Fracture was the most common injury sustained accounting for 321 (58.4%) cases with 99 cases (28.2%) being compound fractures [Table 3].
Twenty-eight (6.5%) patients had more than one anatomic injury.
There were 21 (4.9%) mortalities. Three hundred and sixty patients (83.9%) were discharged from the hospital after completion of treatment while 48 (11.2%) patients signed against medical advice.
| Discussion|| |
Childhood injuries are becoming a major cause of mortality and morbidity in developing countries. The risks of these injuries are increased due to child lack of knowledge, fear to avoid dangerous situations, and poor judgmental skills.
Several factors have been identified to influence childhood injuries. These include sex, age, behavior, and environment. All these factors were noted to play a significant role in this study.
The mean age of patients in this study was 8.01 ± 2.2 years, with more than 46.9% between the ages of 4–12 years. This is in keeping with results of other studies.,, The relationship between age and type of injury in this study showed that RTA and fall are more common among the age group 4–12 years.
Males constituted 58% of the injured in this study. This is because of their adventurous tendencies, dangerous games, and impulsive act. This is similar to report from other studies from developed and developing countries.,,,,,,,,
RTA is the leading cause of childhood injury in this study. This is similar to several studies from developed and developing countries.,,
Injuries involving motorcycles constituted a significant proportion of the injuries in this study. This is because motorcycles are more common means of transportation in our community and in other developing countries.
The road was most common place of injury accounting for 222 (51.7%) cases and the school was the least common place of injury (3, 0.7%). These patients sustained injuries as motor vehicle occupants, motorcycle passengers, and pedestrians. This can be attributed to poverty, illiteracy, and culture. These children are often left to play alone, go to school unaccompanied, and engage in hawking of goods on the street and highways to support their family.
In contrast to our findings, the study by Adesunkanmi et al. showed that the home was the most common place of injury.
Again, walkways and zebra crossing are sometimes not provided on the roads. And, where they are provided, laws about use of them are not enforced.
Falls occurred in 93 (21.7%) patients; 57 (58.8%) patients fell while on a level ground either running or playing. This is similar to other studies.,
Falls occur on ground level while running or playing. There are falls from beds at home, school, or on the farm. There are falls from a significant height from mango trees, multistorey buildings, or stairs.
This is in contrast to other studies where falls was the most common cause of injury.,,,,
Birth trauma caused injuries in 39 (9.1%) of the patients in our study, as against 4.2% in a previous study at Lagos Nigeria., This can be attributed to early detection of these injuries and improved awareness of parents on the need to seek early medical attention in hospital.
In our study, extremity injuries were the most commonly injured part followed by head injury. Fractures accounted for 58.4% of injuries. Morbidity was high in those who sustained fractures and mortality was higher in those patients who sustained head injuries. Many studies have shown that head injury is the most common cause of death among childhood injured patients.,
The overall mortality in this study was 4.9% but the morbidity, cost of treatment, loss of man hours and burden on the patients, parents/guardian, and the national economy cannot be overemphasized.
Nearly 11.2% of cases were discharged against medical advice. The outcome of these injuries was very good in 83.9% of cases.
Motor vehicular-related injuries are the leading cause of death for the United States children aged 5–19 years. These injuries accounted for 24.0% of deaths from all causes in this age group and for most unintentional injury-related deaths.
RTAs and falls have been widely reported as the main causes of childhood injuries in the developing countries.,,,, This is in agreement with the findings in our study.
Injury prevention includes strategies on many levels such as education, enforcement of laws on road safety, and engineering.
There is a need to increase public health education regarding childhood injury management, early transportation, and prompt accessibility of hospital care.
- Health education on injury prevention, increasing awareness of child safety acts both at home and outside the home is advocated
- There is a need to avoid drinking and driving or over-speeding on street roads
- The enforcement of laws on road safety measures such as wearing of helmets and use of child safety seat will help reduce these injuries
- Street trading and hawking of wares/goods by children should be abolished by legislation and enforced by the government agencies
- Engineers should provide better designs of roads with zebra crossing, speed breaks, walkways, and bridges on the major highways
- Provision of adequate and prompt EMSs, establishment of trauma care centers with rehabilitation facilities for these children and provision of children intensive care units in tertiary health-care centers is very important to reduce mortality.
| Conclusion|| |
Childhood injuries are most common in the 4–12 years age group.
The most common cause is RTAs. The extremity is mostly affected but head injuries cause more mortality. The prevention of these childhood injuries would involve public health education on identification of childhood hazards and adequate safety measures. Early presentation and adequate management are recommended.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bensard DD, Beaver BL, Besner GE, Cooney DR. Small bowel injury in children after blunt abdominal trauma: Is diagnostic delay important? J Trauma 1996;41:476-83.
Ngim NE, Yinusa W, Fadero PE. Injuries in children: The lagos experience. Niger J Orthop Trauma 2005;4:54-61.
Adeyemi-Doro HO. Trends in trauma care in Nigeria. Afr J Trauma 2003;1:35-8.
Ball DJ, King KL. Playground injuries: A scientific appraisal of popular concerns. J R Soc Health 1991;111:134-7.
Adesunkanmi AR, Oginni LM, Oyelami AO, Badru OS. Epidemiology of childhood injury. J Trauma 1998;44:506-12.
Shanon A, Bashaw B, Lewis J, Feldman W. Nonfatal childhood injuries: A survey at the Children's Hospital of Eastern Ontario. CMAJ 1992;146:361-5.
Jones NE. Prevention of childhood injuries. Part I: Motor vehicle injuries. Pediatr Nurs 1992;18:380-2.
Hu X, Wesson D, Kenney B. Home injuries to children. Can J Public Health 1993;84:155-8.
Gedlu E. Accidental injuries among children in North-West Ethiopia. East Afr Med J 1994;71:807-10.
Bienefeld M, Pickett W, Carr PA. A descriptive study of childhood injuries in Kingston, Ontario, using data from a computerized injury surveillance system. Chronic Dis Can 1996;17:21-7.
Adesunkanmi AR, Oginni LM, Oyelami OA, Badru OS. Road traffic accidents to African children: Assessment of severity using the injury severity score (ISS). Injury 2000;31:225-8.
Karbakhsh M, Zargar M, Zarei MR, Khaji A. Childhood injuries in Tehran: A review of 1281 cases. Turk J Pediatr 2008;50:317-25.
Esin IA, Alabi S, Lawal OA. Childhood injuries in a tertiary institution in North East Nigeria. Afr J Paediatr Surg 2013;10:367-70.
] [Full text]
Tandon T, Shaik M, Modi N. Paediatric trauma epidemiology in an urban scenario in India. J Orthop Surg (Hong Kong) 2007;15:41-5.
Zargar M, Sayyar Roudsari B, Shadman M, Kaviani A, Tarighi P. Pediatric transport related injuries in Tehran: The necessity of implementation of injury prevention protocols. Injury 2003;34:820-4.
Hulme P. Mechanisms of pediatric trauma at a rural hospital in Uganda. Rural Remote Health 2010;10:1376.
Walker PJ, Cass DT. Paediatric trauma: Urban epidemiology and an analysis of methods for assessing the severity of trauma in 598 injured children. Aust N
Z J Surg 1987;57:715-22.
Adesunkanmi AR, Oseni SA, Badru OS. Severity and outcome of falls in children. West Afr J Med 1999;18:281-5.
Smith GS, Barss P. Unintentional injuries in developing countries: The epidemiology of a neglected problem. Epidemiol Rev 1991;13:228-66.
Oyemade GA, Oluwole S. The pattern of fractures in an African community. Niger Med J 1978;8:21-4.
Yousefzadeh S, Hemmati H, Alizadeh A, Karimi A, Ahmadi M, Mohammadi H. Pediatric unintentional injuries in North Iran. Iran J Pediatr 2008;18:267-71.
Lasi S, Rafique G, Peermohamed H. Childhood injuries in Pakistan: Results from two communities. J Health Popul Nutr 2010;28:392-8.
Agran PF, Winn DG, Anderson CL. Surveillance of pediatric injury hospitalizations in Southern California. Inj Prev 1995;1:234-7.
Constan E, de la Revilla E, Fernández G, Casado IM, Jover I, Bolaños J. Children's accidents treated at health centers. Aten Primaria 1995;16:628-30, 632.
Shokunbi T, Olurin O. Childhood head injury in Ibadan: Causes, neurologic complications and outcome. West Afr J Med 1994;13:38-42.
Vane DW, Shackford SR. Epidemiology of rural traumatic death in children: A population-based study. J Trauma 1995;38:867-70.
[Table 1], [Table 2], [Table 3]