Patterns of Injuries After Road Traffic Crashes Involving Bodabodas

Author Information

Kigera J.W.M. MBChB, Naddumba E.K. MBChB (MUK), MMed(MUK), FCS (ECSA)

Corresponding author:

Dr. Kigera J.W.M., Makerere University, Kampala Uganda. E-mail: jameskigera@yahoo.co.uk

Abstract

Background: Trauma is a leading cause of morbidity and mortality in Africa. Bodabodas are a main form of transport in Kampala and are becoming a major cause of road traffic crashes. We examined the pattern of injuries attributed to bodabodas. Patients and Methods: We retrospectively reviewed the charts of all trauma patients who presented between June and August 2008 to the emergency ward of the Mulago hospital in Kampala and identified the patient characteristics and the nature of injuries sustained.
Results: Road Traffic Crashes (RTC’s) were the leading cause of trauma and bodabodas were involved in 41% of all trauma patients. Majority of the patients were young males below the age of 40. The commonest injuries were fractures, cranial trauma and soft tissue injuries. The lower limbs bore the brunt of the injuries. Conclusions: Injuries seen as a result of bodabodas constitute a majority of trauma cases and are hence a pressing problem in need of urgent solutions. The relevant authorities should ensure preparedness of the health system to cater for the care of these patients.

Introduction

Globally, trauma resulting from road traffic crashes is a major cause of death and disability with majority occurring in developing countries (1). This is partly due to increased motorization but also due to failure by authorities to enforce necessary regulations. Bodaboda is a term that refers to both bicycles and small motorcycles with low engine capacity. It is a corruption of the word ‘border border’ derived from the fact that the vehicles were first used to ferry passengers across the Kenya-Uganda border. Bodabodas are a major form of transport in the city of Kampala and in other towns in East Africa. Kampala is a rapidly growing urban centre with majority of the city and its suburbs not well serviced by the shared taxis that constitute the other major form of transport. This forces the bulk of the population to rely on bodabodas which are also faster and meander better through traffic compared to the taxis. Since the introduction of bodabodas in Kampala in 2001, the proportion of accidents attributable to them has been increasing annually and currently a leading cause of accident scene fatalities in Kampala (2).

Road traffic crashes generally affect young people and this is most evident in bodaboda crashes because the bodabodas business is predominated by youths as a means to a livelihood (3,4). In earlier studies in Uganda, bodaboda injuries accounted for 14.5% of patients sustaining long bone fractures and 25.6% of all tibial fractures (5,6). Mulago has borne the brunt of managing patients with injuries caused by bodabodas since it is the most equipped public hospital in Kampala.

This study aimed at describing the magnitude and variety of trauma seen as a result of crashes involving bodabodas. We hypothesised that we would note an increase in the number of casualties compared to the figures published earlier in the decade and that majority of these injuries would affect the limbs especially the lower limbs. A retrospective review accorded us the opportunity to quickly, and effectively evaluate the current patterns of injuries attributable to bodabodas. Documenting the injuries will highlight the patterns of trauma that will confront the surgeon today. It will also highlight the changes in patterns of trauma in the last decade. This data will be essential to policy makers in re-evaluating the different resource allocation requirements for preventive curative and rehabilitation services.

Whereas the Galukande (7) study attempted to highlight some of the patterns of bodaboda injuries, this current study investigated the magnitude of the problem and highlights the changes in these patterns in the last decade.

Patients and Methods

This retrospective study included all patients admitted for trauma at Mulago hospital’s emergency surgical ward in the three month period ending 30th August 2008. Patients with pathological fractures and burns were excluded. Cases that were seen as referrals after initial management at peripheral centres were also included. Charts initially retrieved for perusal that were found to be ineligible were excluded. Mulago is the National Teaching and Referral Hospital serving as the apex of medical care in Uganda and the teaching hospital for Makerere University. Mulago hospital also receives acute trauma cases that occur in the greater Kampala region and beyond. Patients seen at the Accident and Emergency for trauma are evaluated and those found to have major trauma are admitted to the Emergency ward. Here they are attended to by the residents and consultants in the various surgical fields. The patients were identified from the patient log in the emergency ward and their files retrieved from the records department and perused by the first author (JK). The demographic data was retrieved from the admission face sheet of the charts and the cause of trauma and diagnosis was retrieved from the case notes as recorded by the admitting doctor and the review notes of the resident on call. A road traffic crash was deemed to have involved a bodaboda if the patient was hit by a bodaboda, was a passenger or a rider of a bodaboda (Fig. 1).

It was difficult to divide the groups of patients into riders, passengers or pedestrians as this information was not clearly recorded in majority of the files perused. The lower limb was considered as the pelvic girdle and the rest of the lower limb and the upper limb included the pectoral girdle. Injuries to the face and head including concussions were classified as head injuries. Injuries involving the thorax including rib fractures and injuries to the thoracic viscera were classified as chest injuries. Injuries to the abdominal wall and abdominal and pelvic viscera were classified as abdominal injuries. The data was collected using a research tool designed for that purpose and later keyed in to a computer using MS Excel and for proportions.

Results

Nine hundred and twenty of 1500 (61.4%) files identified from the admission log for possible perusal were retrieved. Road traffic crashes (RTCs) contributed 51% (n=470) of all trauma patients seen. Of the patients admitted after RTCs, 73 % were due to bodaboda accidents (n=344). Males were involved in 81% of the cases with a male to female ratio of 4.4:1. The peak age was 21-30 years and the average age was 29.1 years. About two thirds of the patients were between 20 and 40 and 85% of patients were below 40 years of age (Figure 1).

Only about 10.4% of patients sustained multiple injuries (n=36). About half of the cases seen were limb fractures (n=163) and 78.53% were closed injuries (n=128). Cranial trauma and soft tissue injuries comprised majority of the remainder (Fig.2).

 

About three quarters of all limb fractures were in the lower limbs (n=122) with most being the long weight bearing bones. Both limbs were fractured in 10.5% of cases.The leg was involved more than the thigh (Figure 3).

 

Discussion

Bodabodas were responsible for about three quarters of all injuries caused by road traffic crashes (RTCs). This is a very high figure when compared to other countries in the region. A study in Rwanda estimated that motorcycles were responsible for about 30% of all RTC’s (8). This exposes the dependence on bodabodas as a form of transport in Kampala and indeed in the rest of Uganda though the Rwanda study included both inpatient and outpatient data.

Our study results depict an evolution of an important public health problem. In 2001 Naddumba found that bodabodas contributed only 25% of all accidents compared to the current 75% (4). This indicates that the number of bodabodas has increased substantially replacing other forms of transport. It may also indicate a lack of proportionate increase in the regulation of the subsector and education of the riders. Most of the patients admitted due to injuries related to bodabodas were young men under the age of 30. This was the finding of Naddumba in 2001 and Galukande in his 2009 survey