Epidemiology and Outcome of Gunshot Injuries in a Civilian Population in West Africa

Abstract

Background and Objectives: Gunshot injuries (GSI) were first reported in West Africa following the Nigerian civil war of [1967][1968][1969][1970]. Recent wars within and around the West African subregion have further encouraged easy access to sophisticated and locally manufactured firearms. This report examines the epidemiology and management of GSI in an urban settlement in West Africa. Patients and Methods: GSI data was collected prospectively for 24 months beginning September 1999: age, sex, velocity of gunshot, circumstances of GSI, whether accidental or intentional, and by whom (self-inflicted, police, armed robbers, and others via riots and/or students' secret cult activities), region(s) affected, operative interventions, and outcome of care. Results: 107 GSI patients were seen, comprising 99 males and eight females (M : F ratio = 16.8 : 1), 79 of whom (73.8%) were analyzed comprising 71 males and eight females (M : F ratio = 9 : 1); mean age 29.9 ± 13.0 years (range 5-75 years). Intentional GSI occurred in 66 cases (83.6%) -45 from armed robbers (57.0%), the others from police gunshots, assaults, religious/communal riots, and cultists. No suicide-related GSI were recorded. Accidental GSI occurred in 13 (16.5%) -eight from hunters and five from the police. 16 of the 79 (20.3%) were high-velocity gunshots. The regions affected were extremities 29 (35.7%), multiple regions 23, chest twelve, abdomen eight, head six, and neck one. 13 deaths (16.5%) occurred, all before surgical intervention -twelve in the emergency room because of late reporting and lack of blood transfusion. Ten of the deaths (76.9%) resulted from gunshots to either the chest or abdomen. 27 patients (34.2%) were successfully treated, eleven of whom had operations, while the majority (39 patients, 49.4%) was discharged against medical advice to traditional healers for bullet extraction. Conclusion: Wars in West Africa have caused a high incidence of GSI in peace times through armed robbery. Suicide-related GSI is rare in Nigeria unlike in many developed countries. Only every fifth GSI is a result of a high-velocity gunshot. Mortality determinants are the region of GSI and injury-arrival time. The logistics in the emergency room leading to unacceptable deaths requires an overhaul. Half of GSI victims discharged themselves to native healers for extraction of pellets, portraying the beliefs of patients about GSI.

Gun Violence in Nigeria: A Focus on Ethno-Religious Conflict in Kano

“…No deaths occurred among the 12 patients injured by SALW, but many were left with disabilities (66%). As with other studies, most victims of SALW were males (7,19). Their median hospital stay was 21 days.…”

“…Amnesty International and other organizations have consistently called for action to end indiscriminate police use of SALW (15). A 2003 study in Ilorin found that after armed robbery, the police were the second most common cause of injuries due to SALW (19).…”

“…The ammunition will likely end up in the hands of the general public, as government supplies are the only reliable source in Nigeria (10). As a minimum, issuing plastic bullets rather than live ammunition may prevent a number of deaths and serious injuries (19).…”

The emerging trend in the epidemiology of gunshot injuries in the emergency department of a Nigerian tertiary hospital in a State without formal prehospital emergency medical services

“…[16][17][18]26] Hospital rates of trauma admissions resulting from GSIs have been reportedly variable in Nigeria depending on the socio-economic, religious, cultural, and political activities in the locality. [13,21,27] The reported hospital rates were 4.5%, [13] 3.6%, [21] and 3.8% [27] in some Nigerian studies. Studies have also described the sites of GSIs to involve head and neck, [10] oro-facial region, [28] upper extremities, [29] chest, [30] and lower extremities.…”

Autopsy Review of Gunshot Deaths in A South Eastern Tertiary Hospital of NIGERIA FROM 2008-2012

“…16 wars in and around west African region have increased easy acquisition to sophisticated and locally manufactured firearms leading to increased incidence of gunshot injuries in peace times through armed violence. 17 This study is taken to document our experience and associated consequences with respect to morbidities due to gunshot injuries in order to advance ways of curbing the growing trends. Materials and Method: A cross-section of all autopsies done from 2008-2012 was evaluated and that due to gunshot deaths were extracted from the medico-legal (coroner) files.…”