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Driver yield and safe child pedestrian crossing behavior promotion by a school traffic warden program at primary school crossings: A cluster-randomized trial

Abstract

Objective: To determine the effect of a school traffic warden program on increasing driver yield and safe child pedestrian crossing behavior in Kampala, Uganda.

Methods: We designed and implemented a school traffic warden program in specific school zones in Kampala, Uganda. We randomly assigned 34 primary schools in Kampala, in a 1:1 ratio, using a computer-generated randomization sequence, to control or intervention arms in a cluster randomized trial. Each school in the intervention group received one trained adult traffic warden stationed at roads adjacent to schools to help young children safely cross. The control schools continued with the standard of care. We extracted and coded outcome data from video recordings on driver yield and child crossing behavior (defined as waiting at the curb, looking both ways for oncoming vehicles, not running while crossing, and avoiding illegal crossing between vehicles) at baseline and after 6 months. Using a mixed effect modified Poisson regression model, we estimated the prevalence ratio to assess whether being in a school traffic warden program was associated with increased driver yield and safe crossing behavior.

Results: A higher proportion of drivers yielded to child pedestrians at crossings with a school traffic warden (aPR 7.2; 95% CI 4.42–11.82). Children were 70% more likely to demonstrate safe crossing behavior in the intervention clusters than in control clusters (aPR 1.7; 95% CI 1.04–2.85). A higher prevalence was recorded for walking while crossing (aPR 1.2; 95% CI 1.08–1.25) in the intervention clusters.

Conclusion: The school traffic warden program is associated with increased driver yield and safe child pedestrian crossing behavior, i.e., stopping at the curb, walking while crossing, and not crossing between vehicles. Therefore, the school traffic warden program could be promoted to supplement other road safety measures, such as pedestrian safety road infrastructure, legislation, and enforcement that specifically protects children in school zones.

 


 

Child pedestrian crossing behaviour and associated risk factors in school zones: a video-based observational study in Kampala, Uganda
Jimmy Osuret, Ashley Van Niekerk, Olive Kobusingye, Lynn Atuyambe, Victoria Nankabirwa

ABSTRACT
Background: Pedestrian crashes, often occurring while road crossing and associated with crossing behaviour, make up 34.8% of road casualties in Uganda. This study determined crossing behaviour and associated factors among child pedestrians around primary schools in
Kampala, Uganda.
Methods: We conducted a cross-sectional study in 2022 among 2100 primary school children. Data on their crossing behaviour were collected using video recordings from cameras staged at the crossing points of 21 schools. We estimated prevalence ratios (PR) with their corresponding 95% CIs using a modified Poisson regression model for the association between unsafe behaviour and the predictors.
Results:  The prevalence for each of 5 unsafe child pedestrian behaviour was 206 (25.8%) for crossing outside the crosswalk, 415 (19.8%) for failing to wait at the kerb, 238 (11.3%) for failing to look for vehicles, 361 (17.2%) for running and 235 (13%) for crossing between vehicles. There was a higher likelihood of crossing outside the crosswalk when an obstacle was
present (adjusted PR (aPR) 1.8; 95% CI 1.40 to 2.27) and when children crossed alone (aPR 1.5; 95% CI 1.13 to 2.06). Children who crossed without a traffic warden (aPR 2; 95% CI 1.40 to 2.37) had a significantly higher prevalence of failing to wait at a kerb.
Conclusion: These findings reveal the interaction between child pedestrians, vehicles and the environment at crossings. Some factors associated with unsafe child pedestrian behaviour were the presence of an obstacle, crossing alone and the absence of a traffic warden.
These findings can help researchers and practitioners understand child pedestrian crossing behaviour, highlighting the need to prioritise targeted safety measures.

 


Lifejackets or just jackets? Seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda

Jeff Agenonga, Abel Wilson Walekhwa, John Bosco Isunju, Olive Kobusingye

ABSTRACT

Objectives. Upon immersion in water, a cascade of human physiological responses is evoked, which may result in drowning death. Although lifejackets are over 80% effective in preventing drowning, many people in lakeside fishing communities in Uganda shy away from wearing them because of active distrust in the quality of the lifejackets on the local market. No study has determined the veracity of these claims. This study determined the seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda.

Methods: Using a within-person repeated assessment design, we tested 22 new lifejacket samples obtained from landing sites of Lake Albert, Uganda. We conducted water entry, righting, floatation stability and minimum buoyancy performance tests.

Results: All the lifejacket samples failed the minimum buoyancy functional requirements test; the average buoyancy was 80 N (SD 13). Only 4% of the lifejackets passed the righting test within 5 s. For floatation stability, 45% of the lifejackets sank earlier than 48 h of placement in water and also failed water entry tests by getting dislodged from the wearer.

Conclusion: The lifejackets sold at the landing sites of Lake Albert do not meet minimum seaworthiness functional requirements. The government should regulate the quality of lifejackets on the local market.

 


Developing, implementing, and monitoring tailored strategies for integrated knowledge translation in five sub-Saharan African countries

Kerstin Sell, Nasreen S. Jessani, Firaol Mesfin, Eva A. Rehfuess, Anke Rohwer, Peter Delobelle, Bonny E. Balugaba, Bey-Marrié Schmidt, Kiya Kedir, Talitha Mpando, Jean Berchmans Niyibizi, Jimmy Osuret, Esther Bayiga-Zziwa, Tamara Kredo, Nyanyiwe Masingi Mbeye & Lisa M. Pfadenhauer

ABSTRACT

Background: Integrated knowledge translation (IKT) through strategic, continuous engagement with decision-makers represents an approach to bridge research, policy and practice. The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA +), comprising research institutions in Ethiopia, Malawi, Rwanda, South Africa, Uganda and Germany, developed and implemented tailored IKT strategies as part of its multifaceted research on prevention and care of non-communicable diseases and road traffic injuries. The objective of this article is to describe the CEBHA + IKT approach and report on the development, implementation and monitoring of site-specific IKT strategies.

Methods: We draw on findings derived from the mixed method IKT evaluation (conducted in 2020–2021), and undertook document analyses and a reflective survey among IKT implementers. Quantitative data were analysed descriptively and qualitative data were analysed using content analysis. The authors used the TIDieR checklist to report results in a structured manner.

Results: Preliminary IKT evaluation data (33 interviews with researchers and stakeholders from policy and practice, and 31 survey responses), 49 documents, and eight responses to the reflective survey informed this article. In each of the five African CEBHA + countries, a site-specific IKT strategy guided IKT implementation, tailored to the respective national context, engagement aims, research tasks, and individuals involved. IKT implementers undertook a variety of IKT activities at varying levels of engagement that targeted a broad range of decision-makers and other stakeholders, particularly during project planning, data interpretation, and output dissemination. Throughout the project, the IKT teams continued to tailor IKT strategies informally and modified the IKT approach by responding to ad hoc engagements and involving non-governmental organisations, universities, and communities. Challenges to using systematic, formalised IKT strategies arose in particular with respect to the demand on time and resources, leading to the modification of monitoring processes.

Conclusion: Tailoring of the CEBHA + IKT approach led to the inclusion of some atypical IKT partners and to greater responsiveness to unexpected opportunities for decision-maker engagement. Benefits of using systematic IKT strategies included clarity on engagement aims, balancing of existing and new strategic partnerships, and an enhanced understanding of research context, including site-specific structures for evidence-informed decision-making.


Nasreen S. Jessan, Peter Delobelle, Bonny Enock Balugaba, Talitha Louisa Mpando, Firaol Mesfin Ayele, Seleman Ntawuyirushintege, Anke Rohwer

ABSTRACT

Integrated Knowledge Translation (IKT) is a key strategy for contextualising, tailoring, and communicating research for policy and practice. In this viewpoint, we provide examples of how partners from five countries in sub-Saharan Africa used IKT to advance interventions for curbing non-communicable diseases in their contexts and how these strategies were magnified during the COVID-19 pandemic in some cases. The stories highlight the importance of deliberate and reinforced capacity building, authentic relationship enhancement, adaptable and user-informed stakeholder engagement, and agile multi-sectoral involvement.

 


 

Peer-led training improves lifejacket wear among occupational boaters: Evidence from a cluster randomized controlled trial on Lake Albert, Uganda

Frederick Oporia, Simon P. S. Kibira, Jagnoor Jagnoor, Olive Kobusingye, Fredrick Edward Makumbi, John Bosco Isunju, Fred Nuwaha

Abstract

Background: The burden of drowning among occupational boaters in low and middle-income countries is highest globally. In Uganda, over 95% of people who drowned from boating-related activities were not wearing lifejackets at the time of the incident. We implemented and evaluated a peer-led training program to improve lifejacket wear among occupational boaters on Lake Albert, Uganda.

Methods: We conducted a two-arm cluster randomized controlled trial in which fourteen landing sites were randomized to the intervention and non-intervention arm with a 1:1 allocation ratio. In the intervention arm, a six-month peer-to-peer training program on lifejacket wear was implemented while the non-intervention arm continued to receive the routine Marine Police sensitizations on drowning prevention through its community policing program. The effect of the intervention was assessed on self-reported and observed lifejacket wear using a test of differences in proportions of wear following the intention to treat principle. The effect of contamination was assessed using mixed effect modified Poisson regression following the As Treated analysis principle at 95% CI. Results are reported according to the CONSORT statement–extension for cluster randomized trials.

Results: Self-reported lifejacket wear increased markedly from 30.8% to 65.1% in the intervention arm compared to the non-intervention arm which rose from 29.9% to 43.2%. Observed wear increased from 1.0% to 26.8% in the intervention arm and from 0.6% to 8.8% in the non-intervention arm. The test of differences in proportions of self-reported lifejacket wear (65.1%– 43.2% = 21.9%, p-value <0.001) and observed wear (26.8%– 8.8% = 18%, p-value <0.001) showed statistically significant differences between the intervention and non-intervention arm. Self-reported lifejacket wear was higher among boaters who received peer training than those who did not (Adj. PR 1.78, 95% CI 1.38–2.30).

Conclusion: This study demonstrated that peer-led training significantly improves lifejacket wear among occupational boaters. The government of Uganda through the relevant ministries, and the Landing Site Management Committees should embrace and scale up peer-led training programs on lifejacket wear to reduce drowning deaths.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0292754

 

 

Development and validation of an intervention package to improve lifejacket wear for drowning prevention among occupational boaters on Lake Albert, Uganda

Frederick Oporia1, Fred Nuwaha1, Olive Kobusingye1,2, Jagnoor Jagnoor3, Fredrick Edward Makumbi4, John Bosco Isunju1, Simon P S Kibira5

Correspondence to Frederick Oporia, Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala 7072, Uganda; foporia@musph.ac.ug

Abstract

Background Occupational drowning is a growing public health concern globally. The human cost of fishing is highest in sub-Saharan Africa. Although lifejackets prevent drowning, the majority of boaters in Uganda do not wear them. We developed and validated a peer-to-peer training manual to improve lifejacket wear among occupational boaters on Lake Albert, Uganda.

Methods The intervention was developed in three stages. In stage one, we conducted baseline studies to explore and identify aspects of practices that need to change. In stage two, we held a stakeholder workshop to identify relevant interventions following the intervention functions of the behaviour change wheel (BCW). In stage three, we developed the content and identified its implementation strategies. We validated the intervention package using the Content Validity Index for each item (I-CVI) and scale (S-CVI/Ave).

Results Seven interventions were identified and proposed by stakeholders. Training and sensitisation by peers were unanimously preferred. The lowest I-CVI for the content was 86%, with an S-CVI/Ave of 98%. This indicates that the intervention package was highly relevant to the target community.

Conclusion The stakeholder workshop enabled a participatory approach to identify the most appropriate intervention. All the proposed interventions fell under one of the intervention functions of the BCW. The intervention should be evaluated for its effectiveness in improving lifejacket wear among occupational boaters.

http://dx.doi.org/10.1136/ip-2022-044840

 


Where are pedestrians injured and killed on Kampala city’s road network?

Esther Bayiga Zziwa, Olive Kobusingye, David Guwatudde

School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

Road traffic crashes are a threat to walkers in cities in the global south. It is important for us to know where these crashes frequently occur as well as gain an in-depth understanding of the traffic generators around these sites. Kampala city has experienced many changes over time, and as a result, the crash sites could have changed over time. Pedestrian crashes in cities cluster in specific places than others on a road network known as black spots. It is important to know and update the current black spots as well as reassess the circumstances surrounding these crash sites. This study utilized 5-year traffic crash data (2015–2019) to map and categorize pedestrian black spots in Kampala city, Uganda, by road location type, as well as the nature of activity happening around. A total of 1,095 unique crash locations emerged from the data. Based on the criteria of locations with at least 10 serious or fatal crashes in 5 years, 46 locations were identified as black spots. The bulk (48%) of serious and fatal pedestrian black spots were junctions, especially those with traffic lights, while 74% of these black spots were around places with commercial land use. Whereas implementation of appropriate interventions at black spots is a general well-proven method for reducing the number and severity of crashes at these sites on the road network, the measures taken to treat accident black spots vary from place to place dependent on the unique local circumstances and risk factors. The draft black spot list serves as a basis for further investigation and analysis of the local risk factors surrounding serious and fatal pedestrian crashes in low-income settings as a key step in generating appropriate interventions.

https://doi.org/10.3389/frsc.2022.838186

 


Cluster analysis of the spatial distribution of pedestrian deaths and injuries by parishes in Kampala city, Uganda

Esther Bayiga Zziwa 1Milton Mutto 1David Guwatudde 2

 

PMID: 37093962

DOI: 10.1080/17457300.2023.2204490

Abstract

Studies on pedestrian deaths and injuries at the urban level in Africa mostly provide overall aggregated figures and do not examine variation in the sub-urban units. Using cluster analysis, this study sought to determine if the observed pattern in the distribution of pedestrian injuries and deaths among parishes in Kampala city is significant. Pedestrian crash data from 2015 to 2019 were collected from the Uganda Traffic Police database. Serious and fatal pedestrian injury rates were mapped by parish using ArcMap and cluster analyses conducted. Results from spatial autocorrelation (Moran’s Index of 0.18 and 0.17 for fatal and serious injury rates respectively) showed that the distributions were clustered within parishes crossed by highways and located in the inner city respectively. Z-scores of 3.32 (p < 0.01) for serious injury rates and 3.71 (p < 0.01) for fatal injury rates indicated that the clustering was not random. This study’s main contribution was providing a detailed spatial distribution of pedestrian fatal and serious injury rates for Kampala; a city in a low developing country in Africa at the micro-scale of a parish. This foundational exploratory paper formed the first step of a broader study examining built environment factors explaining this pattern.

Keywords: Kampala-Uganda; Road traffic crashes; pedestrian deaths; pedestrian injuries; spatial analysis.


Factor analysis of community-ranked built environment factors contributing to pedestrian injury risk in Kampala city, Uganda

Esther Bayiga-Zziwa1, Rogers Nsubuga2, Milton Mutto1

Correspondence to Esther Bayiga-Zziwa, Department of Disease Control and Environmental Health, School of Public health, Makerere University College of Health Sciences, Kampala, Uganda; estherbayiga@gmail.comebayiga@musph.ac.ug; Dr Milton Mutto, Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; milton.mutto@gmail.com

Abstract

Background Examining community perspective on an issue is not only a key consideration in research on road safety but also on other topics. There is substantial theoretical and empirical knowledge on built environment factors that contribute to pedestrian injury but how the community views these factors is least studied and constitutes the focus of this study. Our study investigated how respondents ranked the relative importance of selected built environment factors that contribute to pedestrian injury risk in Kampala city, Uganda and examined the underlying pattern behind the rankings.

Methods Eight hundred and fifty-one pedestrians selected from 14 different road sections in Kampala city were asked to rank each of the 27 built environment variables on a 4-point Likert scale. Point score analysis was used to calculate scores for the different built environment variables and rank them in order of perceived contribution while factor analysis was used to determine the pattern underlying the responses.

Results Factor analysis isolated two factors that explained 92% of the variation in respondents’ rankings: ‘road adjacent trip generators and attractors’ and ‘structure of traffic flows’. This finding implies that pedestrians in Kampala city perceived trip generators and attractors adjacent to the road and the structure of traffic flows as major explanations of the influence of the built environment on pedestrian injury risk.

Conclusion While these rankings and factors identified may not necessarily equate to actual risk, they are important in providing an understanding of pedestrian injury risk from the perspective of the community.

http://dx.doi.org/10.1136/ip-2022-044811

 


AUTHORS:

Frederick Oporia, Fred Nuwaha, Simon P S Kibira, Olive Kobusingye, Fredrick Edward Makumbi, Mary Nakafeero, Ronald Ssenyonga, John Bosco Isunju, Jagnoor Jagnoor

Correspondence to Frederick Oporia, Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Kampala, Uganda; foporia@musph.ac.ug

Abstract

Background Drowning death rates in lakeside fishing communities in Uganda are the highest recorded globally. Over 95% of people who drowned from a boating activity in Uganda were not wearing a lifejacket. This study describes the prevalence of lifejacket wear and associated factors among boaters involved in occupational boating activities on Lake Albert, Uganda.

Methods We conducted a cross-sectional survey, grounded on etic epistemology and a positivist ontological paradigm. We interviewed 1343 boaters across 18 landing sites on Lake Albert, Uganda. Lifejacket wear was assessed through observation as boaters disembarked from their boats and self-reported wear for those who ‘always wore a life jacket while on the lake’. We used a mixed-effects multilevel Poisson regression, with landing site-specific random intercepts to elicit associations with lifejacket wear. We report adjusted prevalence ratios (PRs) at 95% confidence intervals.

Results The majority of respondents were male, 99.6% (1338/1343), and the largest proportion, 38.4% (516/1343) was aged 20–29 years. Observed lifejacket wear was 0.7% (10/1343). However, self-reported wear was 31.9% (428/1343). Tertiary-level education (adjusted PR 1.57, 95% CI 1.29- 1.91), boat occupancy of at least four people (adjusted PR 2.12, 95% CI 1.28 – 3.52), big boat size (adjusted PR 1.55, 95% CI 1.13 – 2.12) and attending a lifejacket-use training session (adjusted PR 1.25, 95% CI 1.01 – 1.56) were associated with higher prevalence of self-reported lifejacket wear. Self-reported wear was lower among the 30–39 year-olds compared to those who were aged less than 20 years (adjusted PR 0.66, 95% CI 0.45 – 0.99).

Conclusion Lifejacket wear was low. Training on lifejacket use may improve wear among boaters involved in occupational boating activities on Lake Albert.

 

 


 

State of pedestrian road safety in Uganda: a qualitative study of existing interventions

AUTHORS:

Jimmy Osuret, Stellah Namatovu, Claire Biribawa, Bonny Enock Balugaba, Esther Bayiga Zziwa, Kennedy Muni, Albert Ningwa, Frederick Oporia, Milton Mutto, Patrick Kyamanywa, David Guwatudde, Olive Kobusingye

Abstract

Background: Pedestrians in Uganda account for 40% of road traffic fatalities and 25% of serious injuries annually. We explored the current pedestrian road traffic injury interventions in Uganda to understand why pedestrian injuries and deaths continue despite the presence of interventions.

Methods: We conducted a qualitative study that involved a desk review of road safety policy, regulatory documents, and reports. We supplemented the document review with 14 key informant interviews and 4 focus group discussions with par- ticipants involved in road safety. Qualitative thematic content analysis was done using ATLAS. ti 7 software.

Results: Five thematic topics emerged. Specifically, Uganda had a Non-Motorized Transport Policy whose implementation revealed several gaps. The needs of pedestrians and contextual evidence were ignored in road systems. The key program- matic challenges in pedestrian road safety management included inadequate funding, lack of political support, and lack of stakeholder collaboration. There was no evidence of plans for monitoring and evaluation of the various pedestrian road safety interventions.

Conclusion: The research revealed low prioritization of pedestrian needs in the design, implementation, and evaluation of pedestrian road safety interventions. Addressing Uganda’s pedestrian needs requires concerted efforts to coordinate all road safety activities, political commitment, and budgetary support at all levels.

https://www.ajol.info/index.php/ahs/article/view/215244

 


Kennedy Maring Muni, Albert Ningwa, Jimmy Osuret, Esther Bayiga Zziwa, Stellah Namatovu, Claire Biribawa, Mary Nakafeero, Milton Mutto, David Guwatudde, Patrick Kyamanywa, Olive Kobusingye

Abstract

Background In many low-income countries, estimates of road injury burden are derived from police reports, and may not represent the complete picture of the burden in these countries. As a result, WHO and the Global Burden of Diseases, Injuries and Risk Factors Project often use complex models to generate country-specific estimates. Although such estimates inform prevention targets, they may be limited by the incompleteness of the data and the assumptions used in the models. In this cross-sectional study, we provide an alternative approach to estimating road traffic injury burden for Uganda for the year 2016 using data from multiple data sources (the police, health facilities and mortuaries).

Methods A digitised data collection tool was used to extract crash and injury information from files in 32 police stations, 31 health facilities and 4 mortuaries in Uganda. We estimated crash and injury burden using weights generated as inverse of the product of the probabilities of selection of police regions and stations.

Results We estimated that 25 729 crashes occurred on Ugandan roads in 2016, involving 59 077 individuals with 7558 fatalities. This is more than twice the number of fatalities reported by the police for 2016 (3502) but lower than the estimate from the 2018 Global Status Report (12 036). Pedestrians accounted for the greatest proportion of the fatalities 2455 (32.5%), followed by motorcyclists 1357 (18%).

https://injuryprevention.bmj.com/content/27/3/208

 


 

Determinants of lifejacket use among boaters on Lake Albert, Uganda: a qualitative study

AUTHORS:Frederick Oporia, Simon P S Kibira, Jagnoor Jagnoor, Fred Nuwaha, Fredrick Edward Makumbi, Tonny Muwonge, Lesley Rose Ninsiima, Kjell Torén, John Bosco Isunju, Olive Kobusingye

Abstract

Background Drowning is a major cause of unintentional injury death worldwide. The toll is greatest in low and middle-income countries. Over 95% of people who drowned while boating in Uganda were not wearing a lifejacket. We explored the determinants of lifejacket use among boaters on Lake Albert, Uganda.

Methods We conducted a qualitative enquiry with a hermeneutic phenomenological undertone leaning on relativism ontology and emic subjectivism epistemology. Focus group discussions (FGDs) and in-depth interviews (IDIs) were held with boaters in 10 landing sites. We explored experiences and perspectives on lifejacket use. We used thematic analysis technique to analyse data and report results according to the Consolidated Criteria for Reporting Qualitative Research.

Results We recruited 88 boaters in 10 FGDs and 11 to take part in the IDIs. We identified three themes: motivators and opportunities for lifejacket use, barriers and threats to lifejacket use, and strategies to improve lifejacket use. Many boaters attributed their lifejacket use to prior experience or witness of a drowning. Perceived high costs of lifejackets, limited knowledge, reluctance to use lifejackets because of distrust in their effectiveness, and the belief that it is women who should wear lifejackets were among the barriers and threats. Participants mentioned the need for mandatory enforcement together with community sensitisations as strategies to improve lifejacket use.

Conclusion Determinants of lifejacket use among boaters include experience or witness of drowning, limited knowledge about lifejackets and distrust in the effectiveness of the available lifejackets. Mandatory lifejacket wearing alongside educational interventions might improve lifejacket use.

https://injuryprevention.bmj.com/content/early/2022/01/23/injuryprev-2021-044483.full

 


 

Geospatial Distribution of Pedestrian Injuries and Associated Factors in the Greater Kampala Metropolitan Area, Uganda

Frederick Oporia1,&, Nazarius Mbona Tumwesigye2, John Bosco Isunju1, Rebecca Nuwematsiko1, Abdulgafoor Mahmood Bachani3, Angela Nakanwagi Kisakye4,5, Mary Nakafeero2, Qingfeng Li3, Fiston Muneza2, George Kiwanuka4, Nino Paichadze6, Olive Kobusingye

Abstract

Background: Road traffic injuries (RTIs) are the leading cause of death among 15-29- year olds, of which 22% are pedestrians. In Uganda, pedestrians constitute 43% of RTIs. Over 52% of these injuries occur in Greater Kampala Metropolitan Area (GKMA). However, information on geospatial distribution of RTIs involving pedestrians and associated factors is scanty. We established the geospatial distribution of pedestrian injuries and associated factors in GKMA, Uganda. Methods: We conducted a mixed methods cross sectional study in three districts of GKMA. We used a structured questionnaire to interview 332 injured pedestrians at ten purposively selected health facilities from May to July 2017. We used a modified Australian Walkability Audit Tool to assess road characteristics and videography to capture road user behaviour at reported injury sites. Injury location (outcome) was categorized into three locations according to primary land use: residential areas, commercial/business areas and bar & entertainment areas. The injury hotspots were then mapped out using Quantum Geographic Information System (QGIS). Multinomial logistic regression was used to identify factors associated with injury location and adjusted prevalence ratios (APR) reported at 95% confidence interval. Results: Males represented 66.5% (221/332) of the sample. Pedestrian injuries were most prevalent among 15-29-year olds (45.5%, 151/332). Most (47.2%, 157/332) injuries occurred in commercial and business areas. Namasuba-Zana (13%, 43/332) followed by Nakawa-Kireka on Jinja road (9.7%, 32/332) had the highest number of injuries. Presence of speed humps was protective (APR=0.13, 95%CI 0.01-0.93). However, zebra crossings (APR=6.41, 95% CI: 1.14-36.08) and clear traffic (APR=6.39, 95%CI: 2.75-14.82) were associated with high prevalence of pedestrian injuries. Conclusion: Presence of speed humps was safer for pedestrians but zebra crossings and clear traffic had more than 6-fold risk for injuries. Findings suggest that constructing speed humps on the roads in busy areas and sensitizing motorists to respect zebra crossings could reduce pedestrian injuries.

 

https://www.afenet-journal.net/content/article/3/2/pdf/2.pdf

 


AUTHORS:
Tessa Clemens Frederick Oporia Erin M Parker Merissa A Yellman Michael F Ballesteros Olive Kobusingye

Inj Prev 2021 Feb 26. Epub 2021 Feb 26.
Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
Background: Drowning death rates in the African region are estimated to be the highest in the world. Data collection and surveillance for drowning in African countries are limited. We aimed to establish the availability of drowning data in multiple existing administrative data sources in Uganda and to describe the characteristics of drowning based on available data.

Methods: We conducted a retrospective descriptive study in 60 districts in Uganda using existing administrative records on drowning cases from January 2016 to June 2018 in district police offices, marine police detachments, fire/rescue brigade detachments, and the largest mortuary in those districts. Data were systematically deduplicated to determine and quantify unique drowning cases.

Results: A total of 1435 fatal and non-fatal drowning cases were recorded; 1009 (70%) in lakeside districts and 426 (30%) in non-lakeside districts. Of 1292 fatal cases, 1041 (81%) were identified in only one source. After deduplication, 1283 (89% of recorded cases; 1160 fatal, 123 non-fatal) unique drowning cases remained. Data completeness varied by source and variable. When demographic characteristics were known, fatal victims were predominantly male (n=876, 85%), and the average age was 24 years. In lakeside districts, 81% of fatal cases with a known activity at the time of drowning involved boating.

Conclusion: Drowning cases are recorded in administrative sources in Uganda; however, opportunities to improve data coverage and completeness exist. An improved understanding of circumstances of drowning in both lakeside and non-lakeside districts in Uganda is required to plan drowning prevention strategies

 

The state of emergency medical services and acute health facility care in Uganda: findings from a National Cross-Sectional Survey.

AUTHORS: Albert Ningwa Kennedy Muni Frederick Oporia Joseph Kalanzi Esther Bayiga Zziwa Claire Biribawa Olive Kobusingye


BMC Health Serv Res 2020 Jul 9;20(1):634. Epub 2020 Jul 9.

Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
Background: There is limited information on the state of emergency medical services (EMS) in Uganda. The available evidence is from studies that focused on either assessing EMS capacity and gaps at the national level especially in Kampala or identifying risk factors for specific emergency medical conditions (e.g., injuries). In this study, we sought to provide a snapshot of the state of EMS in Uganda by assessing the pre-hospital and hospital emergency care capacity at both national and sub-national (district) levels.

Methods: We conducted a cross-sectional national survey administering structured questionnaires to EMS providers and policy makers from 38 randomly selected districts across seven of the 14 health regions of Uganda. This resulted in a study sample of 111 health facilities and 52 pre-hospital service providers. We collected data on six pillars of EMS whose frequencies and percentages were calculated and qualitatively compared for different levels of the health care system.

Results: At the time of this study, Uganda did not have any EMS policy or guidelines. In addition, there was no functional toll-free number for emergency response in the country. However, Ministry of Health reported that a taskforce had been set up to lead development of EMS policy, guidelines, and standards including establishment of a toll-free emergency number. At the sub-national level, ambulances lacked the products and supplies needed to provide pre-hospital care, and mainly functioned as emergency transport vehicles, with no capacity for medical care. Only 16 (30.8%) of the 52 pre-hospital providers assessed had standard ambulances with required equipment, medicines, and personnel. The rest of the service providers had improvised ambulances that were not equipped to provide pre-hospital care. Traffic police and bystanders were the first responders to the majority (> 90%) of the emergency cases.

Conclusion: Our findings reveal weaknesses at every level of what should be a critical component in the health care system – one that deals with the ability to treat life-threatening conditions in a time sensitive manner. The Ministry of Health needs to speed up efforts to provide policies and guidelines, and to increase investments for the creation of a functional EMS in Uganda.

 

Estimating the burden of road traffic crashes in Uganda using police and health sector data sources.

AUTHORS:
Kennedy Maring, Muni Albert Ningwa, Jimmy Osuret, Esther Bayiga Zziwa, Stellah Namatovu, Claire Biribawa, Mary Nakafeero, Milton Mutto, David Guwatudde, Patrick Kyamanywa, Olive Kobusingye


Inj Prev 2020 Mar 30. Epub 2020 Mar 30.
Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Kampala, Uganda.
Background: In many low-income countries, estimates of road injury burden are derived from police reports, and may not represent the complete picture of the burden in these countries. As a result, WHO and the Global Burden of Diseases, Injuries and Risk Factors Project often use complex models to generate country-specific estimates. Although such estimates inform prevention targets, they may be limited by the incompleteness of the data and the assumptions used in the models. In this cross-sectional study, we provide an alternative approach to estimating road traffic injury burden for Uganda for the year 2016 using data from multiple data sources (the police, health facilities and mortuaries).

Methods: A digitised data collection tool was used to extract crash and injury information from files in 32 police stations, 31 health facilities and 4 mortuaries in Uganda. We estimated crash and injury burden using weights generated as inverse of the product of the probabilities of selection of police regions and stations.

Results: We estimated that 25 729 crashes occurred on Ugandan roads in 2016, involving 59 077 individuals with 7558 fatalities. This is more than twice the number of fatalities reported by the police for 2016 (3502) but lower than the estimate from the 2018 Global Status Report (12 036). Pedestrians accounted for the greatest proportion of the fatalities 2455 (32.5%), followed by motorcyclists 1357 (18%).

Conclusions: Using both police and health sector data gives more robust estimates for the road traffic burden in Uganda than using either source alone.

 

Prevalence and factors associated with utilization of rehabilitation services among people with physical disabilities in Kampala, Uganda. A descriptive cross sectional study.

AUTHORS:
Swaibu Zziwa, Harriet Babikako, Doris Kwesiga, Olive Kobusingye, Jacob A Bentley, Frederick Oporia, Rebecca Nuwematsiko, Abdulgafoor Bachani, Lynn M Atuyambe, Nino Paichadze


BMC Public Health 2019 Dec 27;19(1):1742. Epub 2019 Dec 27.

Department of Global Health, Milken Institute School of Public Health, the George Washington University, Washington, DC, USA.
Background: Worldwide, fifteen percent (15%) of the world’s population or one (1) billion people live with some form of disability. In Uganda, 12.4% of the Uganda’s population lives with some form of disability and Kawempe division accounts for (22.6%) of all persons with disabilities living in Kampala district. Rehabilitation services are provided within Kawempe division at Mulago hospital physiotherapy department and Katalemwa rehabilitation center in Kampala district, Uganda at a free and a subsidized cost to help to improve the function, independence, and quality of life of persons with physical disabilities. However, many people with physical disabilities do not utilize the services and the reasons are not clear.

Methods: The study design was a descriptive cross-sectional study employing quantitative methods of data collection. A total of 318 participants were included in the study. Simple random sampling was used to select the study participants. Ethical issues were maintained at all levels during data collection and dissemination of results.

Results: The study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Kampala, Uganda. Factors that were significantly associated with utilization of rehabilitation services among people with physical disabilities at multivariable logistic regression analysis included; age (AOR: 0.30; 95% CI: 0.12-0.74), socioeconomic status (AOR: 2.13; 95% CI: 1.03-4.41), education level (AOR: 4.3; 95% CI: 1.34-13.91) and awareness of the participants about the rehabilitation services (AOR: 5.1; 95% CI: 2.74-9.54) at p value ≤0.05.

Conclusion: The study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Uganda. Factors that were significantly associated with utilization of rehabilitation services included; age, socioeconomic status, education level and awareness of the participants about the services. Therefore, the government and other relevant stake holders should increase sensitization and awareness of rehabilitation services, their benefits and facilities providing such services to people with physical disabilities, healthcare professionals and the general public.

 

Emergency care surveillance and emergency care registries in low-income and middle-income countries: conceptual challenges and future directions for research.
AUTHORS:
Hani Mowafi, Christine Ngaruiya, Gerard O’Reilly, Olive Kobusingye, Vikas Kapil, Andres Rubiano, Marcus Ong, Juan Carlos, Puyana Akm, Fazlur Rahman, Rashid Jooma, Blythe Beecroft, Junaid Razzak


BMJ Glob Health 2019 29;4(Suppl 6):e001442. Epub 2019 Jul 29.
Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. Using these articles, a working group was convened by the US National Institutes of Health Fogarty International Center to discuss challenges and potential solutions for established systems to better understand global emergency care in LMICs. The working group focused on potential uses for emergency care surveillance and registry data to improve the quality of services provided to patients. Challenges included a lack of dedicated resources for such research in LMIC settings as well as over-reliance on facility-based data collection without known correlation to the overall burden of emergency conditions in the broader community. The group outlined potential solutions including incorporating data from sources beyond traditional health records, use of standard clinical forms that embed data needed for research and policy making and structured population-based research to establish clear linkages between what is seen in emergency units and the wider community. The group then identified current gaps in LMIC emergency care surveillance and registry research to form a research agenda for the future.

 

Road safety compliance among motorcyclists in Kawempe Division, Kampala, Uganda: a cross-sectional study.
AUTHORS:
Margaret Ndagire, Suzanne Kiwanuka, Nino Paichadze, Olive Kobusingye


Int J Inj Contr Saf Promot 2019 Sep 11;26(3):315-321. Epub 2019 Jun 11.
a Makerere University School of Public Health , Kampala , Uganda.
Motorcyclists are vulnerable road users in Uganda and 21.7% (3912/18,016) experienced crashes in 2012. This study determined the prevalence of and factors associated with compliance to selected road safety measures (helmet use, retro-reflective jackets use, riding permit and carrying one passenger) among commercial motorcyclists in Kawempe, from April to June 2014 using interviewer administered questionnaires. Total compliance was 0.9% and 24.4% to at least 3/4 measures. Compliance by measure was; 7.6% retroreflective jackets, 28.8% riding permits, 69.4% helmet use and 86.1% carrying one passenger. The associated factors were; knowing that (training before one starts to ride prevents crashes, Adjusted-odds-ratio (AOR) = 2.38 (1.36-4.19), maintaining the motorcycle in good condition prevents crashes, AOR = 0.34 (0.15-0.77) and padding reduces impact of road traffic injury, AOR = 0.37 (0.15-0.89)). Prevalence to compliance is very low. Road safety messages should highlight the importance of all road safety measures to improve compliance.

 

Motorcycle taxi programme is associated with reduced risk of road traffic crash among motorcycle taxi drivers in Kampala, Uganda.
AUTHORS:
Kennedy Muni, Olive Kobusingye, Charlie Mock, James P Hughes, Philip M Hurvitz, Brandon Guthrie


Int J Inj Contr Saf Promot 2019 Sep 10;26(3):294-301. Epub 2019 Jun 10.
a Department of Epidemiology, University of Washington , Seattle , WA , USA.
is a transportation company that provides road safety training and helmets to its motorcycle taxi drivers in Kampala. We sought to determine whether risk of road traffic crash (RTC) was lower in compared to regular (non-SafeBoda) motorcycle taxi drivers during a 6-month follow-up period. We collected participant demographic and behavioural data at baseline using computer-assisted personal interview, and occurrence of RTC every 2 months using text messaging and telephone interview from a cohort of 342 drivers. There were 85 crashes (31 in and 54 in regular drivers) during follow-up. Over the 6-month follow-up period, drivers were 39% less likely to be involved in a RTC than regular drivers after adjusting for age, possession of a driver’s license, and education (RR: 0.61, 95% CI: 0.39-0.97,  = .04). These findings suggest that the programme results in safer driving and fewer RTCs among motorcycle taxi drivers in Kampala.

 

Assessment of pre-hospital emergency medical services in low-income settings using a health systems approach.
AUTHORS:
Amber Mehmood, Armaan Ahmed Rowther, Olive Kobusingye, Adnan A Hyder


Int J Emerg Med 2018 Nov 22;11(1):53. Epub 2018 Nov 22.
Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
Emergency medical services (EMS) is defined as the system that organizes all aspects of care provided to patients in the pre-hospital or out-of-hospital environment. Hence, EMS is a critical component of the health systems and is necessary to improve outcomes of injuries and other time-sensitive illnesses. Still there exists a substantial need for evidence to improve our understanding of the capacity of such systems as well as their strengths, weaknesses, and priority areas for improvement in low-resource environments. The aim was to develop a tool for assessment of the pre-hospital EMS system using the World Health Organization (WHO) health system framework. Relevant literature search and expert consultation helped identify variables describing system capacity, outputs, and goals of pre-hospital EMS. Those were organized according to the health systems framework, and a multipronged approach is proposed for data collection including use of qualitative and quantitative methods with triangulation of information from important stakeholders, direct observation, and policy document review. The resultant information is expected to provide a holistic picture of the pre-hospital emergency medical services and develop key recommendations for PEMS systems strengthening.

 

An analysis of trends and distribution of the burden of road traffic injuries in Uganda, 2011 to 2015: a retrospective study.
AUTHORS:
Frederick Oporia, Angela Nakanwagi Kisakye, Rebecca Nuwematsiko, Abdulgafoor Mahmood Bachani, John Bosco Isunju, Abdullah Ali Halage, Zziwa Swaibu, Lynn Muhimbuura Atuyambe, Olive Kobusingye


Pan Afr Med J 2018 2;31. Epub 2018 Sep 2.
Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
Introduction: Gobally, 1.3 million people die from road traffic injuries every year. Over 90% of these deaths occur in low-and-middle-income countries. In Uganda, between 2012 and 2014, about 53,147 road traffic injuries were reported by the police, out of which 8,906 people died. Temporal and regional distribution of these injuries is not known, hence hindering targeted interventions. We described the trends and distribution of health facility reported road traffic injuries in Uganda from 2011 to 2015.

Methods: We obtained monthly data on road traffic injuries, from 112 districts from the Ministry of Health Uganda. We analyzed the data retrospectively to generate descriptive statistics.

Results: A total of 645,805 road traffic injuries were reported from January 2011 through December 2015 and 2,807 deaths reported from 2011 through 2014. Injuries increased from 37,219 in 2011 to 222,267 in 2014 and sharply dropped in December 2015 to 57,149. Kampala region had the highest number of injuries and deaths (18.3% (117,950/645,805) and 22.6% (634/2807)) respectively whereas Karamoja had the lowest injuries and deaths (1.7% (10,823/645,805) and 0.8% (21/2807)) respectively. Children aged 0-4 years accounted for 21.9% (615/2807) deaths; mostly females 81% (498/615) were affected.

Conclusion: Road traffic injuries increased during 2011-2014. Injuries and deaths were highest in Kampala and lowest in Karamoja region. It was noted that health facilities mostly received serious injuries. It is likely that the burden is higher but under reported. Concerted efforts are needed to increase road safety campaigns in Kampala and surrounding regions and to link pre-hospital deaths so as to understand the burden of road traffic crashes and recommend appropriate interventions.

 

Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry.
AUTHORS:
Nukhba Zia, Amber Mehmood, Rukia H Namaganda, Hussein Ssenyonjo, Olive Kobusingye, Adnan A Hyder


Trauma Surg Acute Care Open 2019 22;4(1):e000259. Epub 2019 Feb 22.
The Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Background: Traumatic brain injury (TBI) is an important cause of morbidity and mortality in low/middle-income countries. The objective was to assess causes and outcomes of unintentional and intentional TBI among patients presenting to a tertiary care hospital in Uganda.

Methods: This study was conducted at Mulago National Referral Hospital, Kampala, Uganda, for 15 months in 2016-2017. Patients of all ages, males and females, presenting to the emergency department with suspected or documented TBI were enrolled. Patient demographics, TBI causes and outcomes were recorded. The outcome of interest was unintentional and intentional TBI.

Results: Intent was known for 3749 patients, of these 69.7% were unintentional TBI and 30.3% were intentional TBI. The average age of patients in both groups was similar (28±14 years) with over 70% of patients between 19 and 45 years age group. About 80% were males in both groups. The main causes of unintentional TBI were road traffic injuries (RTI) (88.9%) and falls (11.1%). Pedestrians (42.1%) and motorcycle drivers (28.1%) were the most common road users. Among patients with unintentional TBI, about 43.6% were admitted, 34.0% were sent home. There were 73 deaths: 63 were patients with RTI and 10 had a fall. Although assault (97.1%) was the main cause of intentional TBI, those patients with self-harm were likely to be in severe Glasgow Coma Scale range (39.4%) compared with victims of assault (14.2%). Among patients with intentional TBI, 42.6% were admitted and 37.1% were sent home. There were 30 deaths: 29 were assault victims and 1 of self-harm.

Discussion: Unintentional TBI caused by RTI and intentional TBI caused by assault are common among young males attending Mulago Hospital in Kampala.

Level Of Evidence: Prospective observational study, level III.

 

Patterns of traumatic brain injury and six-month neuropsychological outcomes in Uganda.
AUTHORS:
Paul Bangirana, Bruno Giordani, Olive Kobusingye, Letisia Murungyi, Charles Mock, Chandy C John. Richard Idro


BMC Neurol 2019 Feb 4;19(1):18. Epub 2019 Feb 4.
Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda.
Background: Traumatic brain injuries in Uganda are on the increase, however little is known about the neuropsychological outcomes in survivors. This study characterized patients with traumatic brain injury (TBI) and the associated six-month neuropsychological outcomes in a Ugandan tertiary hospital.

Methods: Patients admitted at Mulago Hospital with head injury from November 2015 to April 2016 were prospectively enrolled during admission and followed up at six months after discharge to assess cognition, posttraumatic stress symptoms (PTSS), depression symptoms and physical disability. The outcomes were compared to a non-head-injury group recruited from among the caretakers, siblings and neighbours of the patients with age and sex entered as covariates.

Results: One hundred and seventy-one patients and 145 non-head injury participants were enrolled. The age range for the whole sample was 1 to 69 years with the non-head injury group being older (mean age (SD) 33.34 (13.35) vs 29.34 (14.13) years of age, p = 0.01). Overall, motorcycle crashes (36/171, 38.6%) and being hit by an object (58/171, 33.9%) were the leading causes of TBI. Head injury from falls occurred more frequently in children < 18 years (13.8% vs 2.8%, p = 0.03). In adults 18 years and older, patients had higher rates of neurocognitive impairment (28.4% vs 6.6%, p < 0.0001), PTSS (43.9% vs 7.9%, p < 0.0001), depression symptoms (55.4% vs 10%, p < 0.0001) and physical disability (7.2% vs 0%, p = 0.002). Lower Glasgow Coma Score (GCS) on admission was associated with neurocognitive impairment (11.6 vs 13.1, p = 0.04) and physical disability (10 vs 12.9, p = 0.01) six months later.

Conclusion: This first such study in the East-African region shows that depth of coma on admission in TBI is associated with neurocognitive impairment and physical disability.

 

Determinants of emergency department disposition of patients with traumatic brain injury in Uganda: results from a registry.
AUTHORS:
Amber Mehmood, Nukhba Zia, Olive Kobusingye, Rukia H Namaganda, Hussein Ssenyonjo, Joel Kiryabwire, Adnan A Hyder


Trauma Surg Acute Care Open 2018 19;3(1):e000253. Epub 2018 Dec 19.
Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Background: Traumatic brain injuries (TBIs) are a common cause of emergency department (ED) visits and hospital admissions in Kampala, Uganda. The objective of this study was to assess determinants of ED discharge disposition based on patient demographic and injury characteristics. Four ED outcomes were considered: discharge home, hospital admission, death, and others.

Methods: This prospective study was conducted at Mulago National Referral Hospital, Kampala, Uganda, from May 2016 to July 2017. Patients of all age groups presenting with TBI were included. Patient demographics, external causes of injury, TBI characteristics, and disposition from EDs were noted. Injury severity was estimated using the Glasgow Coma Scale (GCS), Kampala Trauma Score (KTS), and the Revised Trauma Score (RTS). A multinomial logistic regression model was used to estimate conditional ORs of hospital admission, death, and other dispositions compared with the reference category “discharged home”.

Results: A total of 3944 patients were included in the study with a male versus female ratio of 5.5:1 and a mean age of 28.5 years (SD=14.2). Patients had closed head injuries in 62.9% of cases. The leading causes of TBIs were road traffic crashes (58.8%) and intentional injuries (28.7%). There was no significant difference between the four discharge categories with respect to age, sex, mode of arrival, cause of TBI, place of injury, type of head injury, transport time, and RTS (p>0.05). There were statistically significant differences between the four discharge categories for a number of serious injuries, GCS on arrival, change in GCS, and KTS. In a multinomial logistic regression model, change in GCS, area of residence, number of serious injuries, and KTS were significant predictors of ED disposition.

Discussion: This study provides evidence that ED disposition of patients with TBI is differentially affected by injury characteristics and is largely dependent on injury severity and change in GCS during ED stay.

 

Road traffic injuries in Uganda: pre-hospital care time intervals from crash scene to hospital and related factors by the Uganda Police.
AUTHORS:
Esther Bayiga Zziwa, Christine Muhumuza, Kennedy M Muni, Lynn Atuyambe, Abdulgafoor M Bachani, Olive C Kobusingye


Gutentor Advanced TextInt J Inj Contr Saf Promot 2019 Jun 12;26(2):170-175. Epub 2018 Dec 12.
a Department of Disease Control and Environmental Health , Makerere University College of Health Sciences, School of Public Health , Kampala , Uganda.
A cross-sectional survey was conducted to collect primary data prospectively on pre-hospital care time intervals of Road Traffic Crash (RTC) victims that had been rescued by the Uganda police and to determine what factors were related to those intervals. The survey was conducted between 1 May 2015 and 31 May 2015. The Police responses to 96 RTCs were recorded, but only 74 of them were considered serious enough to warrant hospital transfer, and those 74 are the subject of the analysis. Pre-hospital care time ranged between 10 and 220 min. Seventy-two per cent of the calls were completed within 1 h of call initiation. The scene to hospital transport interval was the longest with a mean of 19.07 min (SD 10.11). Activation time was the shortest interval with a mean of 4.58 min (SD 5.67). Key factors for delays included: understaffing, lack of skills and long distances. A toll-free Universal Access Number, a law mandating provision of free basic emergency medical services at every health facility and gazetting of lanes for emergency services and might decrease on pre-hospital care time and could reduce on the notification and transport time interval respectively.

 

Motorcycle taxi programme increases safe riding behaviours among its drivers in Kampala, Uganda.
AUTHORS:
Kennedy Muni, Olive Kobusingye, Charles Mock, James P Hughes, Philip M Hurvitz, Brandon Guthrie


Inj Prev 2020 02 24;26(1):5-10. Epub 2018 Nov 24.
Department of Epidemiology, University of Washington, Seattle, Washington, USA.
Background: is a motorcycle taxi company that provides road safety training and helmets to its drivers in Kampala, Uganda. We sought to determine whether drivers are more likely to engage in safe riding behaviours than regular drivers (motorcycle taxi drivers not part of ). METHODS : We measured riding behaviours in and regular drivers through: (1) computer-assisted personal interview (CAPI), where 400 drivers were asked about their riding behaviours (eg, helmet and mobile phone use) and (2) roadside observation, where riding behaviours were observed in 3000 boda-boda drivers and their passengers along major roads in Kampala.

Results: Across the two cross-sectional studies, a higher proportion of drivers than regular drivers engaged in safe riding behaviours. For instance, helmet use among compared with regular drivers was 21% points higher (95% CI 0.15 to 0.27; p<0.001) based on the CAPI and 45% points higher (95% CI 0.43 to 0.47; p<0.001) based on roadside observation. Furthermore, compared with regular drivers, drivers were more likely to report having a driver’s license (66.3% vs 33.5 %; p<0.001) and a reflective jacket (99.5% vs 50.5 %; p<0.001) and were less likely to report driving towards oncoming traffic (4% vs 45.7 %; p<0.001) in the past 30 days.

Conclusion: The programme is associated with increased safe riding behaviours among motorcycle taxi drivers in Kampala. Therefore, the promotion and expansion of such programmes may lead to a reduction in morbidity and mortality due to road injuries.

 

Burden of gluteal fibrosis and post-injection paralysis in the children of Kumi District in Uganda.
AUTHORS:
Kristin Alves, Norgrove Penny, John Ekure, Robert Olupot, Olive Kobusingye, Jeffrey N Katz, Coleen S Sabatini


BMC Musculoskelet Disord 2018 Sep 24;19(1):343. Epub 2018 Sep 24.
University of California San Francisco Department of Orthopaedic Surgery, UCSF Benioff Children’s Hospital Oakland, 747 52nd Street, OPC 1st Floor, Oakland, CA, 94609, USA.
Background: The purpose of this study was to estimate the prevalence of postinjection paralysis (PIP) and gluteal fibrosis (GF) among children treated in a rural Ugandan Hospital.

Methods: We conducted a retrospective cohort study by reviewing the musculoskeletal clinic and community outreach logs for children (age < 18 yrs) diagnosed with either PIP or GF from Kumi Hospital in Kumi, Uganda between 2013 and 2015. We estimated the prevalence as a ratio of the number of children seen with each disorder over the total population of children seen for any musculoskeletal complaint in musculoskeletal clinic and total population of children seen for any medical complaint in the outreach clinic.

Results: Of 1513 children seen in the musculoskeletal clinic, 331 (21.9% (95% CI 19.8-24.1%)) had PIP and another 258 (17.1% (95% CI 15.2-19.0%)) had GF as their diagnosis. Of 3339 children seen during outreach for any medical complaint, 283 (8.5% (95% CI 7.6-9.5%)) had PIP and another 1114 (33.4% (95% CI 31.8-35.0%)) had GF. Of patients with GF, 53.9% were male with a median age of 10 years (50% between 7 and 12 years old). Of patients with PIP, 56.7% were male with a median age of 5 years (50% between 2 and 8 years old).

Conclusion: PIP and GF comprise over 30% of clinical visits for musculoskeletal conditions and 40% of outreach visits for any medical complaint in this area of Uganda. The high estimated prevalence in these populations suggest a critical need for research, treatment, and prevention.

 

Postgraduate training for trauma prevention, injury surveillance and research, Uganda.
AUTHORS:
Abdulgafoor M Bachani, Nino Paichadze, Jacob A Bentley, Nazarius Mbona Tumwesigye, David Bishai, Lynn Atuyambe, Stephen Wegener, David Guwatudde, Olive C KobusingyeAdnan A Hyder


Bull World Health Organ 2018 Jun 12;96(6):423-427. Epub 2018 Apr 12.
Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E-8132, Baltimore, Maryland, 21205, United States of America (USA).
Problem: The burden of trauma and injuries in Uganda is substantial and growing. Two important gaps that need addressing are the shortage of trained people and a lack of national data on noncommunicable diseases and their risk factors in Uganda.

Approach: We developed and implemented a new track within an existing master of public health programme, aimed at developing graduate-level capacity and promoting research on key national priorities for trauma and injuries. We also offered training opportunities to a wider audience and set up a high-level national injury forum to foster national dialogue on addressing the burden of trauma, injuries and disability.

Local Setting: The Chronic Consequences of Trauma, Injuries and Disability in Uganda programme was implemented in 2012 at Makerere University School of Public Health in Kampala, Uganda, in conjunction with Johns Hopkins Bloomberg School of Public Health in Baltimore, United States of America.

Relevant Changes: Over the years 2012 to 2017 we supported four cohorts of master’s students, with a total of 14 students (9 females and 5 males; mean age 30 years). Over 1300 individuals participated in workshops and seminars of the short-term training component of the programme. The forum hosted three research symposia and two national injury forums.

Lessons Learnt: Institutional support and collaborative engagement is important for developing and implementing successful capacity development programmes. Integration of training components within existing academic structures is key to sustainability. Appropriate mentorship for highly motivated and talented students is valuable for guiding students through the programme.

 

Incidence and characteristics of unintentional injuries among children in a resource limited setting in Kampala, Uganda.
AUTHORS:
Charles Ssemugabo, Trasias Mukama, Abdullah Ali Halage, Nino Paichadze, Dustin G Gibson, Olive Kobusingye


Int J Inj Contr Saf Promot 2018 Dec 30;25(4):449-457. Epub 2018 May 30.
a Department of Disease Control and Environmental Health, School of Public Health , College of Health Sciences, Makerere University , Kampala , Uganda.
Given that little is known about the epidemiology of unintentional injuries in children in low-income countries, this study sought to determine the incidence and characteristics of unintentional injuries among children aged ≤18 years in a slum community in Uganda. From a household survey, the incidence and odds ratios for factors associated with unintentional injury characteristics were calculated. Of 1583 children, 706 had suffered 787 unintentional injuries yielding an annual incidence rate of 497 injuries per 1000 children. Commonest injuries were cuts, bites or open wounds (30.6%) and bruises or superficial injuries (28.6%) with majority (75.5%) occurring at home. Boys were more likely to be injured at school (AOR 4.34; 95% CI 1.22-15.54) and to be injured from falls (AOR 1.41; 95% CI 1.01-1.96). Older children (12-18 years) were more likely to suffer from fractures (AOR 2.37; 95% CI 1.26-4.43), concussions and organ system injuries (AOR 3.58; 95% CI 1.03-12.39) and cuts, bites or open wounds (AOR 2.05; 95% CI 1.21-3.48). Older children were less likely to suffer burns or scalds as compared to the young children (AOR: 0.23; 95% CI 0.11-0.50). Unintentional injury incidence rate was high among children with most occurring in the homes.

 

Traumatic brain injury in Uganda: exploring the use of a hospital based registry for measuring burden and outcomes.

AUTHORS:
Amber Mehmood, Nukhba Zia, Connie Hoe, Olive Kobusingye