Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care

Ibrahim, Nazir; Ajani, Abdul Wahab O; Mustafa, Ibrahim; Balogun, Rufai A; Oludara, Mobolaji; Idowu, Olufemi Emmanuel; Solagberu, Babatunde A

doi:10.1017/s1049023x17006410

Cited by 38 publications

(38 citation statements)

References 20 publications

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“…The motorcycle was a common mode of travel for women, especially in remote areas as well as areas prone to significant traffic. However, it is important to bear in mind that beyond the risk posed by these two-wheelers to pregnant women, at least 30% of road traffic accidents have been attributed to them [40]. It was, therefore, good to find that women in our study perceived the tricycle as a safer alternative.…”

Section: Discussionmentioning

confidence: 75%

Reaching health facilities in situations of emergency: qualitative study capturing experiences of pregnant women in Africa’s largest megacity

et al. 2020

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Background The consequences of delays in travel of pregnant women to reach facilities in emergency situations are well documented in literature. However, their decision-making and actual experiences of travel to health facilities when requiring emergency obstetric care (EmOC) remains a ‘black box’ of many unknowns to the health system, more so in megacities of low- and middle-income countries which are fraught with wide inequalities. Methods This in-depth study on travel of pregnant women in Africa’s largest megacity, Lagos, is based on interviews conducted between September 2019 and January 2020 with 47 women and 11 of their relatives who presented at comprehensive EmOC facilities in situations of emergency, requiring some EmOC services. Following familiarisation, coding, and searching for patterns, the data was analysed for emerging themes. Results Despite recognising danger signs, pregnant women are often faced with conundrums on “when”, “where” and “how” to reach EmOC facilities. While the decision-making process is a shared activity amongst all women, the available choices vary depending on socio-economic status. Women preferred to travel to facilities deemed to have “nicer” health workers, even if these were farther from home. Reported travel time was between 5 and 240 min in daytime and 5–40 min at night. Many women reported facing remarkably similar travel experiences, with varied challenges faced in the daytime (traffic congestion) compared to night-time (security concerns and scarcity of public transportation). This was irrespective of their age, socio-economic background, or obstetric history. However, the extent to which this experience impacted on their ability to reach facilities depended on their agency and support systems. Travel experience was better if they had a personal vehicle for travel at night, support of relatives or direct/indirect connections with senior health workers at comprehensive EmOC facilities. Referral barriers between facilities further prolonged delays and increased cost of travel for many women. Conclusion If the goal, to leave no one behind, remains a priority, in addition to other health systems strengthening interventions, referral systems need to be improved. Advocacy on policies to encourage women to utilise nearby functional facilities when in situations of emergency and private sector partnerships should be explored.

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Section: Discussionmentioning

confidence: 75%

Reaching health facilities in situations of emergency: qualitative study capturing experiences of pregnant women in Africa’s largest megacity

et al. 2020

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“…Most of the victims were young males in their most productive prime of life, the economic life-wires of most homes in sub-Saharan Africa. Most are from the low-income economic strata of the population, a group well-documented to bear the greatest proportion of the global RTI burden ( 8 , 10 , 13 , 14 , 22 , 23 ). This fact has well-known significant debilitating implications for a nation’s human capital base.…”

Section: Discussionmentioning

confidence: 99%

“…Although a global phenomenon, RTI burdens in general, and RTI-related fatalities in particular, exert their highest tolls in the low middle-income countries (LMIC) of the world ( 1 , 5 – 7 ). It is particularly more so in the African region ( 1 , 8 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical Epidemiology of Head Injury from Road-Traffic Trauma in a Developing Country in the Current Era

Adeleye

Ogun

2017

Front. Neurol.

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ObjectivesAfrica and other Asian low middle-income countries account for the greatest burden of the global road-traffic injury (RTI)-related head injury (HI). This study set out to describe the incidence, causation, and severity of RTI-related HI and associated injuries in a Nigerian academic neurosurgical practice.MethodsThis is a retrospective cross-sectional analysis of RTI-related HI from a prospective HI registry in an academic neurosurgery practice in Nigeria.ResultsAll-terrain RTI accounted for 80.6% (833/1,034) of HI over a 7-year study period. All age groups were involved, mean 33.06 years (SD 18.30), mode 21–30, 231/833 (27.7%). The male:female ratio was 631:202, ≈3:1. The road trauma occurred exclusively from motorcycle-and motor-vehicle crash (MCC/MVC), MCC caused 56.8% (473/833) of these; the victims were vulnerable road users (VRU) in 74%, and >90% belong in the low socioeconomic class. Using the Glasgow Coma Scale grading, the HI was moderate/severe in 52%; loss of consciousness occurred in 93%, the Abbreviated Injury Severity-head > 3 in 74%, and computed tomography (CT) Rotterdam score > 3 in 52%. Significant extracranial injuries occurred in many organ systems, 421/833 (50.5%) having Injury Severity Score (ISS) > 25. Surgical lesions included extensive brain contusions in 157 (18.8%); acute extradural hematoma in 34 (4.1%); acute subdural hematoma in 32 (3.8%); and traumatic intracerebral hemorrhage in 27 (3.2%), but only 97 (11.6%) received operative care for various logistic reasons. The in-hospital outcome was good in 71.3% and poor in 28.7%; the statistically significant (p < 0.001) determinants of this outcome profile were the severity of the HI, the CT Rotterdam score, and the ISS.ConclusionIn this study from Nigeria, RTI-related HI emanates from significant trauma to vulnerable road users and are caused exclusively by motorcycles and motor vehicles.

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“…With regard to the second finding, our study showed that LASAMBUS attended to less than half of the RTA calls that it received. Similarly, a 2017 single-institution study revealed that, of all the RTAs that came into the emergency department of a tertiary health facility, the Lagos State University Teaching Hospital (LASUTH), less than 3% were brought in by LASAMBUS [22].…”

Section: Discussionmentioning

confidence: 99%

Lagos state ambulance service: a performance evaluation

Venkatraman

Odusola

Malolan

et al. 2020

Eur J Trauma Emerg Surg

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Objectives The mortality rate from road traffic accidents (RTAs) in Nigeria is almost double that of the USA. In Nigeria, the first emergency medical services (EMS) system was established in March 2001, The Lagos State Ambulance Service (LASAMBUS). The objectives of this study are to (1) determine the burden of RTAs in Lagos, (2) assess RTA call outcomes, and (3) analyze LASAMBUS's response time and causes for delay. Methodology We reviewed completed LASAMBUS intervention forms spanning December 2017 to May 2018. We categorized the call outcomes into five groups: I. Addressed Crash, II. No Crash (False Call), III. Crash Already Addressed, IV. Did Not Respond, and V. Other. We further explored associations between the (1) causes for delay and outcomes and (2) response times and the outcomes. Results Overall, we analyzed 1352 intervention forms. We found that LASAMBUS did not address 53% of the RTA calls that they received. Of this, Outcome II. No Crash (False Call) accounted for 26% and Outcome III. Crash Already Addressed accounted for 22%. Self-reported causes for delay were recorded in 180 forms, representing 13.7% of the RTA burden. Traffic congestion accounted for 60% of this distribution. Conclusion LASAMBUS response rates are significantly lower than response rates in high-income countries such as the USA and lead to increased RTA mortality rates. Eliminating causes for delay will improve both LASAMBUS effectiveness and RTA victims' health outcomes. Changing the public perception of LASAMBUS and standardizing LASAMBUS' contact information will aid this as well.

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Road Traffic Injury in Lagos, Nigeria: Assessing Prehospital Care

Cited by 38 publications

References 20 publications

Reaching health facilities in situations of emergency: qualitative study capturing experiences of pregnant women in Africa’s largest megacity

Reaching health facilities in situations of emergency: qualitative study capturing experiences of pregnant women in Africa’s largest megacity

Clinical Epidemiology of Head Injury from Road-Traffic Trauma in a Developing Country in the Current Era

Lagos state ambulance service: a performance evaluation

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