Hospital-based injury data from level III institution in Cameroon: Retrospective analysis of the present registration system
Introduction
Injury is becoming one of the leading causes of death and disability in low-income countries, disproportionately affecting sub-Saharan Africa.1, 2 Management of injury in African settings is especially challenging due to limited resources and complex cultural contexts. Published epidemiological data on injuries are lacking in most African countries; to date, no such information is available from Cameroon. Without reliable data, strategies for the prevention and treatment of injuries remain extremely limited.
Ideally, community-based surveys (CBS) should be conducted to provide a comprehensive, population-based estimation of injury incidence and mortality.3 As the expense and time required to conduct CBSs can be prohibitive in a resource-limited setting, information from police reports, post-mortem records, and comprehensive analysis of hospital or pre-hospital records are often relied upon to give an improved understanding of incidence, mortality, and epidemiologic patterns of injury. In Cameroon, police inquiries are not systematically carried out; post-mortem analysis is considered a cultural taboo and is usually rejected by relatives of victims of injuries; and there is no pre-hospital transport and management system in our region. Given this scarcity of data sources, the best currently available resource is hospital-based information.
In settings where hospital records are used as a primary source of injury data, trauma registries can play a fundamental role in providing data on epidemiology of injury, as well as provide a tool for injury quality improvement.4, 5 Trauma registries have been shown to improve injury surveillance and serve as the fundamental tool of trauma care quality improvement, both in individual institutions and system-wide policy.6, 7, 8 In fact, trauma registries are a recommendation of the Essential Trauma Care project of the WHO, which is designed for implementation in low income countries.9
Despite the growing international consensus of the importance of trauma registries, formal trauma registries are a rarity in sub-Saharan Africa.5 Instead, retrospective review of administrative hospital records is often used to provide information about epidemiology of injury. Even in high-income settings, it has been shown that administrative data lack accuracy when compared to trauma registries from the same institution.10 In low- and middle-income countries, where other sources of injury data are rare, the inaccuracy of administrative data becomes even more relevant.
To date, there is very limited data on the incidence and pattern of injury in Cameroon. This study sought to analyse the available administrative data available from the emergency ward logs in a 200-bed regional hospital in Cameroon with respect to completeness and suitability to serve as an injury surveillance tool. The data available are also used to explore an overview of the epidemiological profile of injury in this institution.
Section snippets
Methods
This retrospective review was performed between July 1, 2007 and June 30, 2008 using hospital records from Limbe Regional Hospital in the city of Limbe, located in the Southwest Region of Cameroon. Limbe is a rapidly growing city, with an estimated 12-fold increase in population during the last 40 years, now approaching 100,000 people. Limbe Hospital is a 200-bed hospital in a semi-urban setting with an Emergency Department that is functional 24 h per day. No formal pre-hospital care system
Results
A total of 1713 injury cases were recorded over the one-year study period, representing 28% of the total number of emergency consultations in Limbe Hospital. After review of records for presence of age, sex, and injury mechanism variables, 368 patients (21%) were excluded from further analysis. Additionally, 34 (2%) patients were excluded because they attended another health institution prior to coming to Limbe regional hospital. Another 227 cases were patients below 15 years of age. Data from
Discussion
The contribution of injuries to mortality and disability is on the rise in sub-Saharan Africa due to the rapid growth of motorized transport and industrialization without any related increase in safety measures and education. Given the growing importance of injuries as a public health problem in sub-Saharan Africa and the limitation of resources available to institute formal surveillance programmes, the completeness of available hospital data needs to be examined as a potential source of
Conclusion
Despite limitations of the current hospital registration system, there is a strong indication that injuries are an important problem that is grossly underestimated in Cameroon. Institution of a formal trauma registry, as has been done in similar settings, is likely to improve the quality and completeness of injury surveillance data, both in terms of epidemiologic information and clinical parameters. Even if it does not improve the overall capture-rate of injury cases nor eliminate sources of
Source of funding
None.
Conflict of interest
No conflict of interest to disclose.
References (29)
- et al.
Mortality by cause for eight regions of the world: Global Burden of Disease Study
Lancet
(1997) - et al.
The potential for using a trauma registry for injury surveillance and prevention
Am J Prev Med
(1989) - et al.
The Strengthening of the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies
Lancet
(2007) Nordberg E Injuries as a public health problem in sub-Saharan Africa: epidemiology and prospects for control
East Afr Med J
(2000)- et al.
Guidelines for conducting community surveys on injuries and violence Geneva
World Health Org
(2004) - et al.
Injury surveillance guidelines
(2004) - et al.
History and development of trauma registry: lessons from developed to developing countries
World J Emerg Surg
(2006) - et al.
The first Italian trauma registry of national relevance: methodology and initial results
Eur J Emerg Med
(2006) - et al.
Development of a hospital-based trauma registry in Haiti: an approach for improving injury surveillance in developing and resource-poor settings
J Trauma
(2007) - et al.
Guidelines for essential trauma care
(2004)