The epidemiology of road traffic crashes in rural Zambia: A retrospective hospital-based study at Monze Mission Hospital

Abstract

Background: Road trauma represents a significant yet neglected public health challenge in Zambia leading to loss of lives, severe disabilities and hampering development. It disproportionately affects low and middle income countries (LMIC) with 90% of all road deaths occurring there. Zambia, like many other LMIC lacks robust evidence to guide road safety initiatives and program planning due to limited research, poor quality data and competing health priorities.

Objectives: We aimed to investigate the epidemiology of road trauma cases seen at a general hospital in Monze district from 2013 to 2017. We further assessed the road trauma data quality as captured by the hospital registry.

Methods: We reviewed records for all road trauma cases seen at Monze Mission Hospital from 2013 to 2017. Descriptive statistics were used to summarised using means and proportion. We further assess the variables captured for each case that presented at the hospital including socio-demographic and trauma-related details. Depending on the quality of data obtained, statistical methods were applied to explain the epidemiology including Chi-square, t-tests and proportional tests were used to assess the differences in means and proportions, respectively.

Results: The road trauma data at MMH are very poor evidenced by a lot of missing variables for road trauma cases that would aid understanding of the epidemiology of road trauma cases seen at the facility. However, of the 449 road trauma cases reviewed, 62.4% of these were males. The highest road trauma burden was recorded among those aged 15-44. Time trend analysis shows a decreasing pattern in road deaths in Monze district. The case-fatality rates were very high with more than 90% the of deaths occurring before arrival at the hospital. However, many case files lacked data on occupation, education level, type of road user, type of vehicles involved and time of collision.

Conclusion: The available data at MMH suggested that young and active people aged 15-44 years were the most affected of road trauma in Monze district, with males experiencing a higher burden than females. The data also showed a decreasing trend in the road trauma burden in Monze district. However, these results should be interpreted with great caution as the data are highly unreliable due to suspected very high levels of underreporting.

Keywords: Road trauma, epidemiology, underreporting, Zambia