Trauma practice in Nigeria

Abstract

Background: Trauma has assumed a pre-eminent epidemic proportion in the hierarchy of diseases afflicting the growing population of many developing countries including Nigeria competing with infections, cardiovascular diseases and cancers for attention and funding. The spectrum, quantum and future prospects of trauma and its practices have continued to expand but the response towards improving the current Nigerian situation is lagging behind. Objectives: To examine the current situation of trauma practice and the contribution of practitioners in the areas of research, training and community service in Nigeria and make suggestions for progress. Methodology: Electronic and manual bibliographic search was done using such words as trauma, injury, coupled with morbidity, mortality, death or fatality from publications across Nigeria. Personal contacts with colleagues for relevant papers were also done. Papers were reviewed for content, through the abstracts and all published works that provided information relevant to the objectives were read fully. Personal experience in the field was contributory. Results: Eight hundred and three abstracts were selected from the over 10,100 generated by the searches. Thirty four articles were contributed by colleagues and eleven were clearly used. Trauma from road traffic injuries and violence (gunshot, assault) constituted 40-90% of emergency room incidence with high rates in hospitals near highways. Autopsy reports confirmed road traffic injuries as commanding up to 80% of unnatural deaths in many teaching hospitals in Nigeria. There is no organized Emergency Medical Services but ambulance services are common in some cities. Many patients are largely transported by relations or bystanders when involved in trauma. Preventable Trauma Death rate is reportedly high, as much as 73.7% in one report. Conclusion: the spectre of trauma as an epidemic is receiving attention from practitioners and government but it is a far cry from what is needed. The spectrum is elongated in variety with the menace of motorcycle transport injuries overtaking other vehicle injuries in the some major cities and commanding an increasing prevalence in sub-urban areas. All health Institutions in Nigeria especially the Orthopaedic Hospitals and Federal Medical Centres need to improve on trauma research and publications just as the Nigeria Orthopaedic Association should intensify its championing of research efforts. A committee to evaluate and classify institutions on their level of trauma practice in order to guide referrals and sanction erring practitioners and establishments by complementing the Medical and Dental Council of Nigeria is desirable.