Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge

Abstract

All over the world, pediatric trauma has emerged as an important public health problem. It accounts for the highest mortality in children and young adults in developed countries. Reports from Africa on trauma in the pediatric age group are few and most have been single center experience. In many low-and middle-income countries, the death rates from trauma in the pediatric age group exceed those found in developed countries. Much of this mortality is preventable by developing suitable preventive measures, implementing an effective trauma system and adapting interventions that have been implemented in developed countries that have led to significant reduction in both morbidity and mortality. This review of literature on the subject by pediatric and orthopedic surgeons from different centers in Africa aims to highlight the challenges faced in the care of these patients and proffer solutions to the scourge.

The wrong and wounding road: Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period

“…Injuries to the head, spine and extremities predominated, 21% of patients died and one in ten survivors was permanently disabled, a finding commensurate with our own data. Compared with previous publications in SA, [3,4] little has changed with respect to mechanism of injury and outcome; of pedestrians or passengers with severe traumatic brain injury, more than half die.…”

“…[4] In SA the Arrive Alive campaign has identified a number of factors contributing to the unacceptable incidence of motor vehicle-related injuries, among which are the public attitude towards road safety, lack of effective policing, poor driving skills and road conditions, and rapid urbanisation. Compounding these problems are the social conditions of many children, of whom only 30% live with both parents, a significant risk factor for childhood injury whether deliberate or accidental.…”

“…A 10-year analysis at Red Cross War Memorial Children' s Hospital in Cape Town documented almost 70 000 injured children, of whom 40% had sustained moderate or severe trauma. [5] Furthermore, many of those who survive are permanently disabled as a result of severe traumatic brain injury, [3,4] and in the public sector have little access to adequate rehabilitation facilities. The psychological, physical and economic burdens that are imposed on the individual, the family and society are incalculable.…”

“…The extent of paediatric trauma in Africa as a whole is unknown and an appeal has been made to document the burden of this problem. [4] The limited information available suggests that motor vehicle collisions (MVCs), drowning and burns are the three commonest mechanisms causing severe injury. [3] Although falls account for the majority of childhood injuries, [5] MVCs are the major cause of severe morbidity and mortality.…”

“…[11] Africa has the dubious label of being the most dangerous place in the world for a child, [12] and prevention and political will to back up the necessary policies are the most cost-effective methods of reducing trauma-related deaths. [4] To that end, information documenting causation, morbidity and mortality are essential for planning, implementation and evaluation of preventive measures. We therefore undertook an analysis of a prospective database of paediatric admissions to a level 1 (tertiary) trauma intensive care unit (TICU) to determine the commonest causes of injury, severity of injury and outcome.…”