This study set out to determine the pattern of injuries presenting to the accident centre of a major hospital in sub-Saharan Africa. In the two-year study, the majority of the burden of injuries was borne by road traffic accidents and falls, accounting for 39.1 and 19.7% respectively (Fig. 1). Although injuries are generally thought to be preventable, they account for a significant proportion of global mortality, a prevalence which requires international conscientious efforts to control. Road traffic injuries have taken a greater share of this burden in several regions over the past several decades due to the production of higher velocity vehicles, with likely increase in the prevalence as more people, especially in LMIC are gradually inclining to own vehicles, a phenomenon associated with economic growth [6]. The proportion of injuries attributable to RTAs in our study (39.1%) is consistent with findings of 43.9% in Tanzania [7] and 49% in Kampala, Uganda [8]. While this finding is consistent with many reports, even beyond Africa [9, 10], our study puts the associated morbidity, mortality, and cost of RTA in Ghana into perspective. We found that most of the patients injured through RTAs were passengers, and deaths resulting from RTA was mostly accounted for by pedestrians. Afukaar et al., in their review of road traffic injuries in Ghana using police data, likewise observed that most casualties of RTA were passengers followed by pedestrians, while the inverse was observed for RTA fatalities [11]. This finding, also corroborated by Hesse and Ofosu, (2014), therefore, suggests that pedestrians and bystanders are the categories of individuals at most risk of mortality in road traffic accidents. While seat-belts, helmets, and enforced blood alcohol limits lead the way in public health policies to reduce traffic injuries, roadside safety and proper use of the roads by pedestrians, sellers and non-traveling users of roads should also be given critical consideration.
Motorcycles have gradually become a popular means of travel in many places in sub-Saharan Africa, but quite unfortunately, not without grave consequences. The mortality and morbidity associated with the vehicle in LMICs have been well documented [12, 13], but is yet to see a full commitment by governments and policymakers. Even in high-income countries, it has been reported that the risk of death for every kilometer traveled on a motorcycle accident is 20 times higher than from a car crash [14]. The government of Lagos State, Southwest Nigeria, in 2012 passed a law banning the use of motorcycles on many major roads. The law prohibited motorcycle riders below 18 years and prescribed the use of standardized protective gear for all riders and passengers in the region. A survey done two years after the passage of this law saw a three-fold decrease in the proportion of death from motorcycle crashes in the region [15]. This current study found that 25.5% of road injuries involved motorcycles while explaining for 10% of all injuries that presented to the study site. The high prevalence in this current study, corroborated by other reports implicates motorcycle injuries to be a rising public health problem in Ghana, that requires urgent measures, education, and law enforcement to reduce associated morbidity.
Our finding of high prevalence of injuries from falls also calls for targeted policies, to focus especially on the extremes of age, reining in interventions such as making playgrounds safer, the use of safety gates, grab bars, improving general geriatric care and screening programs for elderly Ghanaians.
The pattern of leading causes of injuries in this study was similar to reports in Zambia Tanzania [7], Nigeria and Sierra-Leone, where the most common etiology was road traffic accidents, being responsible for 55% of injuries, followed by falls (17%) and then assaults (14%) [16].
There was a two-peak pattern of patient attendance to the Casualty and accident centre. These were around January/December, and April. These could probably have been accounted for by the national festive seasons that characterize these periods, namely the Christmas/New Year festivities, and Easter festivities respectively. Also, patient presentation generally peaked on Saturdays, which again, is consistent with the many socio-cultural weekly events such as weddings, funerals and outdooring ceremonies which characterize most weekends in many parts of the country. People would typically commute further distances to attend such events, thereby increasing the risk of road traffic accidents. This finding also favourably compares with that of other studies [17].
Our study, being retrospective was limited in the number and depth of variables considered. Inefficiencies in record keeping systems were also a limitation to data retrieval, evident by the quantity of unspecified information for some of the variables. This study did not record prehospital deaths, thus potentially skewing the mode of injuries that contributed most to mortality. Caution must also be exercised in extrapolating the results of this study to the general population as the single source of data may be a threat to external validity. This study, however, using a major hospital in the country as a case study, provides useful information on the pattern of injury occurrences and presentations which could inform health policy, as well as the generate hypotheses for future studies.