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Prehospital epidemiology and management of injured children in Kigali, Rwanda
  1. Myles Dworkin1,
  2. Vizir Nsengimana2,
  3. Ashley Rosenberg3,
  4. John Scott4,
  5. Robert Riviello5,
  6. Elizabeth Krebs1,
  7. Christian Umuhoza2,
  8. Edmond Ntaganda6,
  9. Jean Marie Uwitonze7,
  10. Ignace Kabagema7,
  11. Theophile Dushime7,
  12. Sudha Jayaraman3
  1. 1 Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  2. 2 Department of Emergency Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
  3. 3 Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
  4. 4 Department of Surgery, University of Washington, Seattle, Washington, USA
  5. 5 Division of Trauma, Burns, Surgical Critical Care and Emergency General Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  6. 6 Department of Surgery, University Teaching Hospital of Kigali, Kigali, Rwanda
  7. 7 Service d’Aide Medicale Urgente, Republic of Rwanda Ministry of Health, Kigali, Rwanda
  1. Correspondence to Myles Dworkin, Thomas Jefferson University, Philadelphia, Pennsylvania 19010, USA; msd009{at}jefferson.edu

Abstract

Introduction Paediatric injuries are a major cause of mortality and disability worldwide, yet little information exists regarding its epidemiology or prehospital management in low-income and middle-income countries. We aimed to describe the paediatric injuries seen and managed by the prehospital ambulance service, Service d’Aide Medicale d’Urgence (SAMU), in Kigali, Rwanda over more than 3 years.

Methods A retrospective, descriptive analysis was conducted of all injured children managed by SAMU in the prehospital setting between December 2012 and April 2016.

Results SAMU responded to a total of 636 injured children, 10% of all patients seen. The incidence of paediatric injury in Kigali, Rwanda was 140 injuries per 100 000 children. 65% were male and the average age 13.5 (±5.3). Most patients were between 15 and 19 years old (56%). The most common causes of injuries were road traffic incidents (RTIs) (447, 72%), falls (70, 11%) and assaults (50, 8%). Most RTIs involved pedestrians (251, 56%), while 15% (65) involved a bicycle. Anatomical injuries included trauma to the head (330, 52%), lower limb (280, 44%) and upper limb (179, 28%). Common interventions included provision of pain medications (445, 70%), intravenous fluids (217, 34%) and stabilisation with cervical collar (190, 30%).

Conclusion In Kigali, RTIs were the most frequent cause of injuries to children requiring prehospital response with most RTIs involving pedestrians. Rwanda has recently instituted several programmes to reduce the impact of paediatric injuries especially with regard to RTIs. These include changes in traffic laws and increased road safety initiatives.

  • Pediatric
  • Injury
  • LMIC
  • Prehospital
  • Africa
  • Emergency Medicine
  • Global Surgery
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Footnotes

  • MD and VN are joint first authors.

  • Twitter @crissumuh

  • Contributors The study was designed by JS, RR, EK, CU, EN, JMU, IK, TD and SJ. Data collection was completed by VN and CU. Data analysis and interpretation were conducted by MD, VN, AR and SJ. Manuscript writing was done by MD, VN, AR and SJ. Critical edits were provided by EK, CU, EN and SJ. Revisions were made by MD, AR and SJ. SJ is responsible for the overall content as guarantor. All authors reviewed and agreed on the final manuscript.

  • Funding Sources of funding: This work was supported by the National Institutes of Health R21:1R21TW010439-02, NIH P20: 1P20CA210284-01A, as well as, the Rotary Foundation Global Grant #GG1749568.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Scientific and ethical approvals were obtained from the University Teaching Hospital of Kigali (CHUK) Ethics Committee. The REDCap registry has been IRB approved at Harvard, VCU and the Rwandan Ministry of Health since 2012.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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