Causes of injuries resulting in a visit to the emergency department of a Provincial General Hospital, Nyanza, western Kenya

Background

There is increasing importance of trauma not only as a major cause of surgical admissions, but also a significant cause of morbidity, mortality and disability.

Objective

To document injury-related visits and hospitalization in a provincial hospital, western Kenya.

Methods

On-site review of records of all patients who visited emergency department (ED) from January 2002 through December 2003, and admissions of year 2003.

Results

A total of 15365 patients visited the ED, of which 41% (6319/15395) were injury cases. The leading causes of injury were assault (42%), road traffic crashes (RTC) (28%), unspecified soft tissue injury (STI) (11%). Cut-wounds, dog-bites, falls, burns and poisoning were infrequently reported (each <10%). The age group 15–44 years formed the largest proportion (75%). A total of 3253 patients were admitted in 2003, of which 1010 (31%) were due to injuries. RTC were leading cause of hospitalization (49%) followed by assault (16%). Men were more likely to be hospitalized due to assault (OR=2.22; CI = 1.45 – 3.41) and not burns or poisoning (p<0.01). There were 64 (6.3%) injury-related deaths, mainly resulting from RTC (41.9%), burns (19.4%) and assault (16.1%).

Conclusions

This study provides considerable information on major causes of injuries, useful for epidemiological surveillance and injury prevention campaigns.     

Pattern of Pedestrian Injuries in the City of Nairobi: Implications for Urban Safety Planning

Pedestrians are overrepresented in road traffic injuries and deaths in Nairobi, the capital city of Kenya, yet little research has been done to provide better understanding of the characteristics of pedestrian injuries. This paper presents the data obtained from road traffic injury admissions to Kenyatta National Hospital (KNH) over a 3-month period starting from 1 June to 31 August 2011. A total of 176 persons involved road traffic injuries in Nairobi were admitted to KNH during this period. Pedestrians comprised the highest (59.1 %) proportion of road traffic injury admissions, followed by motor vehicle passengers (24.4 %) and motor cyclists (9.7 %). Bicyclists and drivers accounted for 5.1 and 1.7 %, respectively. Cars (39.4 %) were the leading category of motorized four-wheeler vehicles that were involved in collisions with pedestrians, followed by matatus (35.5 %). Seventy percent of pedestrians were hit while crossing the road, 10.8 % while standing by the road, and 8.1 % while walking along the road. The highest proportion of pedestrian crashes occurred on Saturdays (25.5 %) and Sundays (16.7 %). Most of the pedestrian injuries (67.7 %) affected the limbs. The paper argues that safety of pedestrians should be a priority in road safety efforts in the city of Nairobi. Urban road safety planners should adopt existing cost-effective interventions to improve the safety of pedestrians such as area-wide traffic calming to limit the speeds of motor vehicles to 30 km/h, providing sidewalks for pedestrians, traffic calming in residential neighborhoods, people-and-not-car-oriented urban road designs, traffic education, and enforcement of traffic regulations.     

Effects of acid-volatile sulfide on metal bioavailability and toxicity to midge (Chironomus tentans) larvae in black shale sediments

Metal bioavailability and toxicity to aquatic organisms are greatly affected by variables such as pH, hardness, organic matter, and sediment acid-volatile sulfide (AVS). Sediment AVS, which reduces metal bioavailability and toxicity by binding and immobilizing metals as insoluble sulfides, has been studied intensely in recent years. Few studies, however, have determined the spatial variability of AVS and its interaction with simultaneously extracted metals (SEM) in sediments containing elevated concentrations of metals resulting from natural geochemical processes, such as weathering of black shales. We collected four sediment samples from each of four headwater bedrock streams in northcentral Arkansa (USA; three black shale-draining streams and one limestone-draining stream). We conducted 10-d acute whole-sediment toxicity tests using the midge Chironomus tentans and performed analyses for AVS, total metals, SEMs, and organic carbon. Most of the sediments from shale-draining streams had similar total metal and SEM concentrations but considerable differences in organic carbon and AVS. Zinc was the leading contributor to the SEM molar sum, averaging between 68 and 74%, whereas lead and cadmium contributed less than 3%. The AVS concentration was very low in all but two samples from one of the shale streams, and the sum of the SEM concentrations was in molar excess of AVS for all shale stream sediments. No significant differences in mean AVS concentrations between sediments collected from shale-draining or limestone-draining sites were noted (p > 0.05). Midge survival and growth in black shale-derived sediments were significantly less (p < 0.001) than that of limestone-derived sediments. On the whole, either SEM alone or SEM-AVS explained the total variation in midge survival and growth about equally well. However, survival and growth were significantly greater (p < 0.05) in the two sediment samples that contained measurable AVS compared with the two sediments from the same stream that contained negligible AVS.