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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 3  |  Page : 179-183

Pattern of fatal unintentional injuries in an urban setting in a developing nation


1 Department of Morbid Anatomy and Histopathology, Delta State University, Abraka; Department of Histopathology, Delta State University Teaching Hospital, Oghara, Delta State, Nigeria
2 Department of Pathology, Igbinedion University, Okada, Edo State, Nigeria
3 Department of Morbid Anatomy and Histopathology, Delta State University, Abraka; Central Hospital, Sapele, Delta State, Nigeria

Date of Submission13-May-2019
Date of Acceptance26-Sep-2019
Date of Web Publication7-Oct-2020

Correspondence Address:
Dr. Obiora Jude Uchendu
Department of Morbid Anatomy/Histopathology, Delta State University, Abraka, Department of Histopathology, Delta State University, Oghara, Delta State
Nigeria
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DOI: 10.4103/smj.smj_23_19

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  Abstract 


Background: Epidemiologic survey in most countries show a shift from infectious disease to noncommunicable diseases and injuries as major causes of death. Fatal nonintentional injuries constitute a significant but preventable cause of death in sub-Sahara Africa. Objective: The objective of this study is to describe the age, sex, and causes of fatal unintentional deaths from autopsies performed in Warri, Delta State. Materials and Methods: This is a descriptive retrospective study, based on coroner's autopsies performed in Warri, Delta State, from 2003 to 2016. Information on age, sex, and causes of fatal nonintentional injuries was extracted from autopsy reports and analyzed using SPSS version 21. Results: A total of 236 fatal unintentional death victims, composed 190 (80.5%) male and 46 (19.5%) female, with a mean age of 33.08 years and peak incidence in the fourth decade were studied. Major causes of accidental deaths in this investigation include road traffic accident (RTA) (48.7%), drowning (15.5%), burns (12.3%), electrocution (10.2%), falls (4.7%), and poisoning (3.4%). Fatal RTA victims consist of 87 (75.7%) male and 28 (24.3%) female, with motorcycle-related death accounted for 52 (45%) deaths, whereas pedestrian and vehicle users each accounted for 32 (27.8%) cases. Conclusion: Unintentional deaths are relatively common but highly preventable through education and enforcement of safety practices; and safety-targeted engineering and infrastructural designs.

Keywords: Autopsy, fatal, injury


How to cite this article:
Uchendu OJ, Nwachokor NF, Ijomone EA. Pattern of fatal unintentional injuries in an urban setting in a developing nation. Sahel Med J 2020;23:179-83

How to cite this URL:
Uchendu OJ, Nwachokor NF, Ijomone EA. Pattern of fatal unintentional injuries in an urban setting in a developing nation. Sahel Med J [serial online] 2020 [cited 2020 Oct 25];23:179-83. Available from: https://www.smjonline.org/text.asp?2020/23/3/179/297451




  Introduction Top


Recent reports from most countries in the past few decades show an epidemiologic transition from communicable diseases to noncommunicable diseases and injuries.[1] Whereas the global burden of injuries has relatively declined, unintentional injuries, particularly road traffic accident (RTA) and fall have been disproportionally on the rise in sub-Saharan Africa.[2]

Unintentional injuries are defined as injuries that occur in the absence of predetermined intent. These are usually attributed to RTA, burns, drowning, electrocution, burns, falls, poisoning, suffocation, firearm injuries, occupational, and recreational activities.[3]

Its consequences are extensive, including physical, emotional, psychological, and financial consequences to individual, family, and society, temporary or long-term disability, extra burden on health-care facilities, loss of productivity, and finally, premature death.[4] Such death accounts for 10% of mortality in low- and middle-income countries (LMIC).[5]

There is paucity of publication on deaths resulting from unintentional injuries in Delta State. The aim of the study is therefore to review cases of fatal unintentional injuries encountered in medicolegal autopsies in Delta State by the authors. The outcome may influence government policy, and guide development of prevention strategies.


  Materials and Methods Top


This study is retrospective and descriptive in design. It was carried out in a tertiary hospital in an urban centre in southern Nigeria. All consecutive medicolegal autopsy reports of fatal unintentional injuries including RTA, burns, drowning, electrocution, burns, falls, poisoning, suffocation, firearm injuries, occupational, and recreational activities seen between January 1, 2003, to December 31, 2016 were included.

Variables such as the age, gender, cause, and mechanism of death were extracted from the autopsy records.

Data was analyzed using SPSS version 21 (IBM Corp, Chicago, USA). The results were subsequently presented using simple frequency tables.

The Ethical clearance committee of the Central Hospital Warri gave the required approval before the study was commenced (Reference number: CHW/ECC VOL1/124 dated 11th May 2017.


  Results Top


A total of 236 fatal unintentional death victims, representing 24.2% of the 975 medicolegal autopsies performed in this series were studied. This gives a mean incidence of about seven deaths per annum with a peak incidence occurring in 2005. Details are shown in [Table 1].
Table 1: Yearly distribution of accidental mortality

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The victims consist of 190 male and 46 females. The mean age of the victims is 33.08 years with a peak incidence in the fourth decade. Details of both sex and age distribution are shown in [Table 2].
Table 2: Age and sex distribution of accidental mortality

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The causes of death in relation to the sex of the victims are shown in [Table 3]. All causes of death show a male predominance, with causes of female deaths limited to RTA, burns, drowning, carbon monoxide (CO) poisoning, and fall from height. Major causes of accidental deaths in this investigation include RTA (48.7%), drowning (15.5%), burns (12.3%), electrocution (10.2%), falls (4.7%), and poisoning (2.7%).
Table 3: Sexwise distribution of causes of death

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The agewise distribution of the various causes of death is shown in [Table 4]. The highest incidence for RTA, electrocution, drowning, and burns were all in the fourth decade.
Table 4: Cause of death and age (years)

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The epidemiological pattern of RTA is shown in [Table 5] and [Table 6]. Motorcycle-related death accounted for 52 (45%) deaths while pedestrian and vehicle users each accounted for 32 (27.8%) cases. The sex distribution of fatal RTA victims consists of 87 (75.7%) male and 28 (24.3%) female.
Table 5: Age and mechanism of road traffic accident

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Table 6: Sex and distribution of road traffic accident death

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  Discussion Top


A preliminary study in this region showed that unintentional (accidental) death is the second leading cause of unnatural deaths after homicide[6]. This is in contrast with observations in Ile-Ife,[7] Ibadan,[8] and Benin City,[9] where accident is the leading cause, accounted for 71%, 35.5%, and 28.6% of medico-legal autopsies. The relatively lower rate in our study may be attributed to the noninclusion of some accidental cases for autopsy by coroner. Besides being relatively high, fatal unintentional injuries represent only a tip of the iceberg, as majority of victims escape death with long-term disabilities, psychological trauma, and financial loss.[4] The disproportionate higher rate of fatal unintentional injuries in LMIC is generally attributed to poor planning, lack of infrastructure, and weak intervention strategies in those countries amidst rapid population growth and accelerated development.[4]

A male-to-female ratio of 4.1:1 was observed in all categories of accidental death, reflecting a male predominance in the labor force. This gender gap is a general observation by other investigators[7],[8],[9] and is attributed to man's perceived role as breadwinner, his higher involvement in outdoor activities, and his more adventurous, risk-taking, and competitive lifestyle.[9],[10] This observation underscores the need for application of safety practice in our various activities.

We also observed most accidental death in the second, third, and fourth decades, accounting for 71.2% of the cases. This observation is comparable to other findings in other parts of the country.[7],[8],[9] There is no doubt that this statistics impacts negatively on productivity and economic capacity of the country, and above all, a depletion of the workforce.

Overwhelmingly, RTA is the leading cause of accidental deaths (48.7%), most of which are males with age within the third and fourth decades. Similarly, Nwafor et al. in Benin[9] and Amakiri et al.[8] in Ibadan observed that RTA is the leading cause of accidental deaths amounting to 88.4% and 78% of cases, respectively. This is also the general observations in other low-income countries.[4] In this study, motorcycle-related death is the leading cause of RTA. This contrasts with report from Benin City[9] and Jos[11] (Nigeria), where motor vehicle-related death is the leading cause. Our report is also at variance with that from Odesanmi in IleIfe,[7] where pedestrians are the leading casualty in RTA.

The emergence of motorcycles and tricycles as major means of transport, the increasing number of motor vehicles and pedestrians on the road culminate in increased traffic heterogeneity with resultant increase in RTA. Poor traffic planning and design, poor road maintenance, overspeeding, road unworthy vehicles, fatigue among drivers, use of handheld mobile telephones by drivers and pedestrians, poor attitude toward safety, ineffective road safety regulation, alcohol, and substance abuse, and above all the weak health emergency unit are among the factors responsible for the high RTA.[9],[12]

Motorcycle helmet legislation, drink-drive legislature, effective road safety regulation, stiffer penalty for offenders, safer traffic planning and design, better roads, and more safety consciousness among road users will go a long way in ameliorating this trend.

Drowning fatality is relatively common, accounting for 15.3% of unintentional deaths. Our observation is higher than the rate recorded in Ile-Ife,[7] Ibadan,[8] Benin City,[9] and Jos, probably because of the vast hydrographic network of the region, boat-centric activities, fishing, leisure, and even antisocial vices such as armed robbery and oil bunkering. Soil excavation sites, borrow pits, and water wells are vulnerable spots associated with drowning risk in this study. Educating citizens on preventive methods, use of lifeguards, surveillance, personal protective/safety equipment, fencing risky areas, and use of signposts are ways of reducing drowning risk.

Falls among young victims was noted to occur mainly in their home and work place, while those occurring among older victims occur only around their homes. This further emphasizes the importance of personal safety equipment at workplace. In elderly, low bone density and comorbidity may contribute partly to associated mortality.

Electrocution affects male exclusively in this study with most of the victims in the first to fifth decades. This accounted for 10.3% of unintentional deaths in our study and is higher than observation in other local studies.[7],[8],[9] This may be attributed to the accelerated infrastructural development in this region. Ignorance, poor maintenance of equipment and wire lining, and poor application of safety rules at workplace seem to be important factors.

Burns-related death is relatively common arising from gas explosion and domestic accidents. Domestic accidents appear relatively common among females because of their domestic roles. Inflammable substances such as premium motor spirit fuel, gas, and kerosene and use of naked frames (candles) and hot liquids were identified in most of these domestic burns. Warri is home to many multinational petrochemical exploration companies and therefore a reservoir station for their products. Pipeline corrosion and vandalization leads to gas and oil leakage into the environment and ultimately human intoxication, fire and explosion accident.

The poor outcome of management of patients with burns injury may be related to the poorly equipped intensive care unit and lack of specialized personnel in this field of medical care in these regions. Poisoning accounted for eight cases, four of which are as a result of CO poisoning or while others were due to exposure to chemicals at home. Seventy-five cases of CO poisoning were reported in a 10-year study in Port Harcourt Nigeria,[13] confirming that the incidence is relatively common. These cases were the result of using gasoline generators in poorly ventilated homes. Public safety campaign of the source and dangers of CO are important in reversing this trend. Parental supervision, safekeeping of household chemicals, and education will do a lot in reducing the incidence of accidental poisoning. This study being retrospective is limited by loss of record or incomplete data.


  Conclusion Top


Unintentional deaths are relatively common but paradoxically highly preventable. Leading causes are RTA, drowning, electrocution, burns, fall from height and poisoning, and with frequency skewed toward young males. Education and enforcement of safety practices, as well as engineering and infrastructural designs that improve safety are paramount to reducing their incidence.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vecino-Ortiz AI, Jafri A, Hyder AA. Effective interventions for unintentional injuries: A systematic review and mortality impact assessment among the poorest billion. Lancet Glob Health 2018;6:e523-34.  Back to cited text no. 1
    
2.
Haagsma JA, Graetz N, Bolliger I, Naghavi M, Higashi H, Mullany EC, et al. The global burden of injury: Incidence, mortality, disability-adjusted life years and time trends from the global burden of disease study 2013. Inj Prev 2016;22:3-18.  Back to cited text no. 2
    
3.
de Ramirez SS, Hyder AA, Herbert HK, Stevens K. Unintentional injuries: Magnitude, prevention, and control. Ann Rev Public Health 2012;33:175-91.  Back to cited text no. 3
    
4.
Chandran A, Hyder AA, Peek-Asa C. The global burden of unintentional injuries and an Agenda for progress. Epidemiol Rev 2010;32:110-20.  Back to cited text no. 4
    
5.
Mock C, Nugent R, Kobusingye O, Smith KR. Disease control priorities. In: Injury Prevention and Environmental Health. 3rd ed., Vol. 7. Washington, DC: World Bank Group; 2017. p. 25.  Back to cited text no. 5
    
6.
Nwachokor FN, Ijomone EA, Uchendu OJ. A forensic study of unnatural death in Warri, Delta State, Nigeria. Int J of Forensic Med Invest 2016; 3:8-19.  Back to cited text no. 6
    
7.
Odesanmi WO. Forensic pathology in Nigeria: The Ife experience. Med Sci Law 1982;22:269-74.  Back to cited text no. 7
    
8.
Amakiri CN, Akang EE, Aghadiuno PU, Odesanmi WO. A prospective study of coroner's autopsies in university college hospital, Ibadan, Nigeria. Med Sci Law 1997;37:69-75.  Back to cited text no. 8
    
9.
Nwafor CC, Akhiwu WO, Igbe AP. Accidental deaths in a university teaching hospital 1990-2009. Afr J Med Health Sci 2013;12:35-7.  Back to cited text no. 9
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10.
Sorenson SB. Gender disparities in injury mortality: Consistent, persistent, and larger than you'd think. Am J Public Health 2011;101 Suppl 1:S353-8.  Back to cited text no. 10
    
11.
Mandong BM, Madaki JK, Mohammed AZ, Kidmas AT. Echejoh GO. Epidemiology of accident deaths in Jos, Nigeria 1996-2000. Ann Afr Med 2006;5:149-52.  Back to cited text no. 11
    
12.
Afolabi OJ, Kolawole GT. Road traffic crashes in Nigeria: Causes and consequences. Transp Logist 2017;17:40-9.  Back to cited text no. 12
    
13.
Seleye-Fubara D, Etebu EN, Athanasius B. Pathology of deaths from carbon monoxide poisoning in Port Harcourt: An autopsy study of 75 cases. Niger J Med 2011;20:337-40.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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