Traumatic brain injury (TBI), according to the World Health Organization, will surpass many diseases as the major cause of death and disability by the year 2020. With an estimated 10 million people affected annually by TBI, the burden of mortality and morbidity that this condition imposes on society, makes TBI a pressing public health and medical problem. The burden of TBI is manifest throughout the world, and is especially prominent in Low and Middle Income Countries which face a higher preponderance of risk factors for causes of TBI and have inadequately prepared health systems to address the associated health outcomes. Latin America and Sub Saharan Africa demonstrate a higher TBI-related incidence rate varying from 150-170 per 100,000 respectively due to RTIs compared to a global rate of 106 per 100,000. As highlighted in this global review of TBI, there is a large gap in data on incidence, risk factors, sequelae, financial costs, and social impact of TBI. This should be addressed through planning of comprehensive TBI prevention programs in LMICs through well-established surveillance systems. Greater resources for research and prioritized interventions are critical to promote evidence-based policy for TBI.

Objectives-To describe and contrast injury patterns in rural and urban Uganda. Settings-One rural and one urban community in Uganda. Methods-Community health workers interviewed adult respondents in households selected by multistage sampling, using a standardized questionnaire. Results-In the rural setting, 1673 households, with 7427 persons, were surveyed. Injuries had an annual mortality rate of 92/100 000 persons, and disabilities a prevalence proportion of 0.7%. In the urban setting 2322 households, with 10 982 people, were surveyed. Injuries had an annual mortality rate of 217/100 000, and injury disabilities a prevalence proportion of 2.8%. The total incidence of fatal, disabling, and recovered injuries was 116/1000/ year. Leading causes of death were drowning in the rural setting, and road traYc in the city. Conclusion-Injuries are a substantial burden in Uganda, with much higher rates than those in most Western countries. The urban population is at a higher risk than the rural population, and the patterns of injury diVer. Interventions to control injuries should be a priority in Uganda. (Injury Prevention 2001;7:46-50)

Background:The public health significance of injuries that occur in developing countries is now recognized. In 1996, as part of the injury surveillance registry in Kampala, Uganda, a new score, the Kampala Trauma Score (KTS) was instituted. The KTS, developed in light of the limited resource base of sub-Saharan Africa, is a simplified composite of the Revised Trauma Score (RTS) and the Injury Severity Score (ISS) and closely resembles the Trauma Score and Injury Severity Score (TRISS). Patients and Methods:The KTS was applied retrospectively to a cohort of prospectively accrued urban trauma patients with the RTS, ISS and TRISS calculated. Using ROC (receiver operating characteristics) analysis, logistic regression models and sensitivity and specificity cutoff analysis, the KTS was compared to these three scores. Results: Using logistic regression models and areas under the ROC curve, the RTS proved a more robust predictor of death at 2 weeks in comparison to the KTS. However, differences in screening performance were marginal (areas under the ROC curves were 87% for the RTS and 84% for the KTS) with statistical significance only reached for an improved specificity (67% vs. 47%; p < 0.001), at a fixed sensitivity of 90%. In addition, the KTS predicted hospitalization at 2 weeks more accurately. Conclusion:The KTS statistically performs comparably to the RTS and ISS alone as well as to the TRISS but has the added advantage of utility. Therefore, the KTS has potential as a triage tool in resource-poor and similar health care settings.

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BackgroundInjury burden is disproportionately high in low- and middle-income countries (LMICs) but the healthcare systems are least prepared to meet the challenge. Significant gaps exist in emergency care, with most preventable deaths occurring in the pre-hospital phase due to lack of emergency medical services (EMS). There are no tools to define gaps and prioritise interventions in pre-hospital care. Realising this gap, our study was conducted to: i) develop a rapid assessment tool to define the structures, resources and processes comprising EMS; ii) pilot test the tool in Kampala, Uganda; and iii) identify gaps and provide recommendations for the improvement of EMS in Uganda.MethodsThe study comprised of three phases: in Phase I rapid assessment tool was developed using the health systems framework with six building blocks; in Phase II a 3600 evaluation was performed by conducting relevant document review, objective assessment of ambulance services representing various levels of pre-hospital care and qualitative assessment through key informant interviews (KIIs) and focus group discussions (FGDs). Phase III, data analysis is underway.ResultsThe data was collected using the structured tool. Three study personnel reviewed 15 documents for the study. Three data collectors simultaneously performed 20 purposefully sampled KIIs and objective assessment. In addition, 4 FGDs will be completed by November 2015. The pilot study of the rapid assessment tool demonstrated the reliability, accuracy and completeness of the tool; further analysis after FDGs will allow us to describe the current state of EMS in Kampala. Based on the findings, context-specific interventions will be recommended.ConclusionsThere is an immediate need to understand the contextual barriers of providing systematic emergency care in LMICs. The study has successfully developed an EMS assessment tool, which will also help establish strategies for improvement of pre-hospital care in similar settings.