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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 3  |  Page : 109-113

Demographic profile and pattern of fatal firearm injuries in an urban city in south-South Nigeria


1 Department of Morbid Anatomy and Histopathology, Delta State University, Abraka, Nigeria
2 Department of Pathology, Igbinedion University, Benin City, Edo State, Nigeria
3 Department of Pathology, Central Hospital, Warri, Delta State, Nigeria

Date of Submission19-Aug-2018
Date of Acceptance18-Dec-2018
Date of Web Publication26-Sep-2019

Correspondence Address:
Dr. Obiora Jude Uchendu
Department of Morbid Anatomy and Histopathology, Delta State University, Abraka, Delta State
Nigeria
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DOI: 10.4103/smj.smj_46_18

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  Abstract 


Background: Recurrent war, agitation, and terrorism in West African sub region have encouraged access to both local and imported firearm with a consequent increase in circulating firearm in Nigeria. Objective: This study aims to describe the demographic profile and pattern of firearm injuries in Warri, Delta state, Nigeria. Materials and Methods: This is a descriptive retrospective study of autopsied firearm deaths in Warri, Delta state from January 1, 2003, to December 31, 2016. The relevant information for this study was extracted from coroner forms and autopsy notes. Results: A total of 421 cases of firearm-related deaths comprising 399 males and 22 females were investigated. The ages of the victims ranged from 0.4 to 69 years, with a mean of 33. 99 (±11.36) years and a peak age group in the third decade. Homicide was the circumstance of death in 416 (98.8) cases, while accident accounted for the remaining 5 (1.2%) cases. Rifled guns and shotguns were the weapons used in 262 (62.2%) and 159 (37.7%) cases, respectively. Businessmen, civil and public servant, artisans, unemployed youths, students, and marine workers were the victims in 101 (24%), 79 (18.8), 71 (16.6), 39 (16.6%), and 36 (6.2%) of the cases, respectively. The victims hailed from multiple tribes with the Urhobos, Igbos, Ijaws, and Itsekiris accounting for 152 (36.1), 52 (12.4%), 38 (9.0%), and 28 (6.7%) of the cases, respectively. Conclusion: Firearm injury is a major cause of unnatural death in this region, affecting young males across all socioeconomic class of resident tribes. Amicable resolution of the lingering crisis in the Niger Delta region, reducing unemployment rate, educating, and re-orienting the youths, strict regulation of firearm possession, enforcement of law and order, and upgrading of the state of the health facility in Delta state will go a long way in ameliorating this ugly trend.

Keywords: Firearm, homicide, medicolegal


How to cite this article:
Uchendu OJ, Nwachokor NF, Ijomone EA. Demographic profile and pattern of fatal firearm injuries in an urban city in south-South Nigeria. Sahel Med J 2019;22:109-13

How to cite this URL:
Uchendu OJ, Nwachokor NF, Ijomone EA. Demographic profile and pattern of fatal firearm injuries in an urban city in south-South Nigeria. Sahel Med J [serial online] 2019 [cited 2019 Nov 20];22:109-13. Available from: http://www.smjonline.org/text.asp?2019/22/3/109/267897




  Introduction Top


‘Firearms can be defined as barreled weapons of any type from which a missile can be discharged with some momentum or velocity and which in appropriate circumstance, can cause injury or death.’[1]

Although firearm death has been on the increase globally, its incidence shows wide variation.[2] Among western countries, the United States of America (USA) has the highest rate of gun injuries, which is the second leading cause of injuries in that region.[3] On the contrary, European countries such as Finland [4] and Denmark [5] have relatively much lower incidence of firearm fatalities. In developing countries, the situation is further aggravated by interpersonal violence, armed robbery, communal crashes, religious violence, militancy, cultism, political vendettas, hunting escapade, police, and security agent escapades and accidental discharge.[6] Recurrent war, agitation, and terrorism in West African subregion have encouraged access to both local and imported firearm with a consequent increase in circulating firearm.[7],[8] In Nigeria, earlier work done on this subject matter was restricted to hospital- or autopsy-based studies with the incidence showing high variability, although this may in some cases be attributed to differences in inclusion criteria.

No earlier work has been done on this subject matter in Delta State. Information from this study will guide the government in policy formation and implementation and provide a reference material for future studies in this region.


  Materials and Methods Top


This study is a retrospective study of firearm-related autopsies performed by the authors in Warri and its environs, in government and private mortuaries, from January 1, 2003, to December 31, 2016. Information for the study was extracted from the coroner request forms, corresponding autopsy reports, and where necessary, from interaction with investigating police officers and relatives of the deceased. Data extracted included demography (age, sex, tribe and place of dwelling), occupation, circumstances surrounding injury and type of firearm used.

Inclusion criteria

Coroner cases of unnatural deaths seen within the study period.

Exclusion criteria

Cases with incomplete data on sex, age, manner of death, and type of gun used were excluded from the study.

Data handling

Data were extracted from the coroner request form and report. Continuous variables and categorical variables are presented as means and standard deviation and percentages, respectively. Data analysis was by descriptive statistics including frequency tables and graphs.

Limitation of the study

It is not all the cases of fatal gunshots that are referred to the coroner, and some autopsies are performed by medical officers working in rural centers. These cases were not captured in our investigation.

Ethical clearance

Ethical clearance protocol number reference number is CHW/ECC VOL 1/124 dated 11th May 2017 was granted by the Central Hospital Warri Ethical Clearance Committee.


  Results Top


During the 14-year period, a total of 1122 medicolegal autopsies were performed by the authors, with 422 (37.6%) of the cases being from fatal gunshot injuries. This amounted to about 30 deaths per year. The yearly distribution is shown in [Figure 1].
Figure 1: Yearly distribution of autopsied firearm deaths

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The sex distribution of cases of fatal firearm injuries is shown in [Table 1]. Males and females accounted for 399 (94.8%) and 22 (5.2%) of the cases, respectively, giving a male to female ratio (MFR) of 20:1.
Table 1: Age and sex distribution of death from firearm injuries

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The age distribution of the victims is also highlighted in [Table 1], the frequency of cases increased sharply from 2 (0.5%) cases in the first decade to a peak of 167 (39.7%) cases in the third decade and then declined progressively to 25 (5.9%) cases in the sixth decade. The mean age of cases was 33.99 (±11.36) years.

The types of firearms used are shown in [Figure 2]. Rifled injures and shotgun injuries accounted for 262 (62.2%) and 159 (37.7%) cases. Two of the victims with shotgun injuries also had additional stab injuries.
Figure 2: Type of injuries on the victims

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The types of occupation engaged in by the victims are shown in [Table 2]. Businessmen, civil servants, artisans, unemployed youths, students, and marine workers accounted for 101 (24%), 79 (18.8), 71 (16.6), 39 (16.6%), and 36 (6.2%) cases, respectively.
Table 2: Occupation distribution of the victims

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Social circumstances that led to the injuries are shown in [Table 3], with homicidal and accidental causes accounting for 98.8 and 1.2% of the cases, respectively.
Table 3: Manner of death of victims of firearm injuries

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Parts of body targeted are shown in [Table 4]. The chest, head and neck, abdomen, hip and leg accounted for 201 (47.7%), 96 (22.8%), 81 (19.2%), and 30 (1.2%) cases, respectively.
Table 4: The body part affected by the firearm

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Details of the distribution of the victims according to their tribes are shown in [Table 5] with Urhobo, Igbo, Ijaw, Itsekiri accounting for 152 (36.1), 52 (12.4%), 38 (9.0%), and 28 (6.7%) of the cases respectively.
Table 5: The tribe of the victims

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  Discussion Top


Our report shows that 37.6% of medicolegal deaths subjected postmortem examination resulted from firearm injuries with an average rate of a case per day. This is the highest recorded among similar studies from Benin City (27.2%),[9] Ibadan (1.6%),[10] and Ghana (2.3%).[11] Lower rates have also been reported in some non-African countries including India,[12] Thailand,[13] and Italy [14] with rates 1.5%, 2.1%, and 27.7%, respectively. Our observation is, however, lower than the rate in Pakistan (45.1%).[15] Heterogeneity in socioeconomic class created by oil wealth, insecurity, and long years of neglect in this region as well as ethnic conflict may be a key factor fuelling such level of violent injuries.[16]

This study showed an overwhelming male predominance with MFR of 20:1. An MFR of 10.7:1, 10.1, 5.5:1 and 6.1:1 has been reported in Benin City,[9] Ibadan,[10] and the USA,[17] respectively. The predominance of males may be attributed to the involvement of males in outdoor activities, competitive life, aggressive tendencies, socializing behavior, adventurous activities, and involvement in drugs and alcohol.

The peak incidence of firearms death among civilians, as observed in this study, was in the 3rd and fourth decades of life both of which accounted for 39.7% and 29.4%, respectively (a combined value of approximately 70%). The observed peak parallels reports from Benin City,[9] Ibadan,[10] India,[12] and the USA.[17] This is the productive age group in any society, and a fall in population of this age bracket amounts to huge economic loss.

The present study also shows that rifle gun and shotguns were used in 62.3% and 37.7% of the cases which is similar to the 66.6% and 33.4% reported in Ibadan, Nigeria.[10] This, in addition to other findings in this study, underscores the proliferation of all kinds of unregistered firearms in this region. The porous borders, compromising custom and security staff, the illicit arms deals, political vendetta, private security arrangements, terrorism, militancy, and all interplay to to account for the upsurge.[16],[18]

Businessmen and public and civil servants accounted for 24% and 18.8% of the victims, respectively. We believe that these groups constitute the upper socioeconomic class of the society and are therefore targets of armed robber and kidnappers. The artisans and the unemployed are the other frequently affected groups. These are the groups involved community crashes, armed robbery, cultism, political agitations, and militancy as their impoverished state predisposes them to such risks.

About a half of the victims died of chest injuries, while 22.8% died from head injuries. These regions are occupied by vital blood vessels and organs (such as the heart, the lungs, and brain), and failure of such organs from gun injuries often results in death. Furthermore, since the intention of the assailant was to kill, he may preferentially target these regions to achieve his evil intention. On the other hand, injuries to other parts of the body are more likely to be of less severity and therefore of better outcome if managed in hospitals when compared with the former. Even where the patients with head and chest gunshot injuries are successfully admitted to the hospital alive, the present health system is not formidable enough to handle such cases.

It was observed in this study that most firearm-related deaths were homicidal in circumstance. This is in line with most reports from other parts of Nigeria,[9],[10] Thailand,[13] and Pakistan.[19] On the contrary, reports from the USA showed that the majority of fatal firearm wounds were as a result of suicide.[17] The absence of suicide-related fatal firearm death in our series may be attributed to the strong religious and traditional belief system of the people in this region that influences their perception of suicide as a taboo.[20] It may also be attributed to the unavailability of firearms to the population who are at risk of committing suicide such as the mentally ill, low socioeconomic class and the disabled.[21]

We observed that the most vulnerable tribes are the Urhobos, the Igbos and the Ijaws. We think that while almost any person can be affected, unequal vulnerability may likely be interplay between differential tribal population distribution and individual vulnerability to firearm death.


  Conclusion Top


Firearm injury is a major cause of unnatural death in this region, affecting young males across all socioeconomic class of resident tribes. Amicable resolution of the lingering crisis in the Niger Delta region, reducing unemployment rate, educating and re-orienting the youths, strict regulation of firearm possession, enforcement of law and order, and upgrading of the state of the health facility in Delta state will go a long way in ameliorating this ugly trend.

Financial support and sponsorship

Self.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rao NG. Firearms and explosive injuries. In: Rao: Textbook of Forensic Medicine & Toxicology. 2nd ed. New Delhi: Jaypee; 2010. p. 272.  Back to cited text no. 1
    
2.
Rawson B. Aiming for prevention: Medical and public health approaches to small arms, gun violence, and injury. Croat Med J 2002;43:379-85.  Back to cited text no. 2
    
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Christoffel KK. Firearm injuries: Epidemic then, endemic now. Am J Public Health 2007;97:626-9.  Back to cited text no. 3
    
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Mattila VM, Mäkitie I, Pihlajamäki H. Trends in hospitalization for firearm-related injury in Finland from 1990 to 2003. J Trauma 2006;61:1222-7.  Back to cited text no. 4
    
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Thomsen JL, Albrektsen SB. An investigation of the pattern of firearms fatalities before and after the introduction of new legislation in Denmark. Med Sci Law 1991;31:162-6.  Back to cited text no. 5
    
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Omoke NI. Firearm injuries received in emergency room of a Nigerian teaching hospital: Aanalysis of pattern, morbidity, and mortality. Niger J Clin Pract 2017;20:587-94.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Solagberu BA. Epidemiology and outcome of gunshot injuries in a civilian population in West Africa. Eur J Trauma Emerg S 2003;29:92-6.  Back to cited text no. 7
    
8.
Musa S. Border Security, Arms Proliferation and Terorrism in Nigeria. Sahara Reporters; 20 April, 2013.  Back to cited text no. 8
    
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Akhiwu WO, Igbe AP. Fatal gunshot injuries in Benin city, Nigeria. Med Sci Law 2013;53:199-202.  Back to cited text no. 9
    
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Eze UO, Akang EE, Odesanmi WO. Pattern of gunshot deaths in a Nigerian tertiary health institution. Internet J Med Update 2016;11:25-8.  Back to cited text no. 10
    
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Ossei PP, Agyeman-Duah E. Trend of medicolegal manner of deaths in ghana: A forensic autopsy-based study. Ann Int Med Den Res 2017;3:56-61.  Back to cited text no. 11
    
12.
Kohli A, Aggarwal NK. Firearm fatalities in Delhi, India. Leg Med (Tokyo) 2006;8:264-8.  Back to cited text no. 12
    
13.
Myint S, Rerkamnuaychoke B, Peonim V, Riengrojpitak S, Worasuwannarak W. Fatal firearm injuries in autopsy cases at central Bangkok, Thailand: A 10-year retrospective study. J Forensic Leg Med 2014;28:5-10.  Back to cited text no. 13
    
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Nizamo H, Meyrowitsch DW, Zacarias E, Konradsen F. Mortality due to injuries in Maputo city, Mozambique. Int J Inj Contr Saf Promot 2006;13:1-6.  Back to cited text no. 14
    
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Mirza CF, Khan AW, Malik L, Malik M, Parveen K. An autopsy based study of pattern of firearm injuries in Karachi, Pakistan. Emerg Med 2013;3:165.  Back to cited text no. 15
    
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Usang EE, Ugwumba NF, Abang EO. Effect of proliferation of small arms and light weapons on the development of the Niger delta region of Nigeria. Dev Ctry Stud 2014;4:60-71.  Back to cited text no. 16
    
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Fowler KA, Dahlberg LL, Haileyesus T, Annest JL. Firearm injuries in the United States. Prev Med 2015;79:5-14.  Back to cited text no. 17
    
18.
Otodo I, Emelah GE, Ubodiom E, Michael C. An etiological study of the proliferation of small arms and light weapons in the Niger Delta Region of Nigeria. Int J Res 2018;5:1780-7.  Back to cited text no. 18
    
19.
Nasrullah M, Razzak JA. Firearm injuries presenting to a tertiary care hospital of Karachi, Pakistan. J Inj Violence Res 2009;1:27-31.  Back to cited text no. 19
    
20.
Lester D, Akande A. Attitudes about suicide among the Yoruba of Nigeria. J Soc Psychol 1994;134:851-3.  Back to cited text no. 20
    
21.
Adewuya AO, Ola BA, Coker OA, Atilola O, Zachariah MP, Olugbile O, et al. Prevalence and associated factors for suicidal ideation in the Lagos state Mental Health Survey, Nigeria. BJPsych Open 2016;2:385-9.  Back to cited text no. 21
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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