Long-term injury related disability in Ghana

Purpose: We sought to: (1) estimate the prevalence of longterm injury-related disability in Ghana; (2) understand the mechanisms of injury causing such disability, with implications for prevention; and (3) understand the anatomic nature of such disability, with implications for treatment. Methods: A household survey was carried out, seeking information on any injury occurring greater than one year ago, from which the injured person had not yet fully recovered. Results: Of 21 105 persons surveyed, 169 reported a long-term injury-related disability, for a prevalence of 0.83% (95% CI 0.67, 1.01%). There was no difference in the prevalence for males vs. females nor for urban vs. rural. Prevalence did increase with increased age. The injury producing events occurred a mean of 6.8 years previously. In the urban area, there was a predominance of transport-related injuries (43%). In the rural area, agricultural injuries predominated (22%), with lesser numbers of transport-related injuries (20%). The anatomic nature of the disabilities included: lower extremity (41%), upper extremity (37%), vision (12%), and miscellaneous (10%). Conclusions: In addition to mortality, long-term disability from injury is a significant problem in this African nation. Based on the mechanisms of injury priorities for injury prevention should be motor vehicle safety in both areas and agricultural safety in the rural area. In terms of injury treatment, the preponderance of injuries was to the extremities. This indicates the potential need to improve orthopaedic care and rehabilitative services. Introduction Injury has become an increasingly significant cause of mortality in developing countries, especially among older children and working aged adults. The Global Burden of Disease Study estimates that injury related causes account for three of the top six killers of children aged 5 – 14 years and for four of the top six killers of young, working aged adults, aged 15 – 44 years. To understand the total burden of any disease, we must also consider disability as well as death. In an effort to add this consideration to its estimation of disease burden, the above noted Global Burden of Disease study looked at the relative contributions of various diseases to Disability Adjusted Life Years (DALYs) lost. The DALY combines the concepts of years of life lost due to death with years of productive life lost due to varying levels of disability. The Study estimated that 12% of the DALYs lost world wide were due to injury. 3 However, the actual data that contributed to these estimates were fairly sparse, especially as regards disability and especially as regards the poorest countries. Furthermore, detailed information on the characteristics of all causes of disability, and especially of injury related disability, is very limited for most developing countries. In the current study, we sought to gain a better idea of the prevalence of long-term injury related disability in a particular African country, Ghana. Given the limited reliability of existing data sources such as hospital records and police accident reports, we undertook a community based survey. We sought to obtain a better understanding of the extent of the problem, as reflected by prevalence rates. We also sought to gain a better understanding of the mechanisms of injury contributing * Author for correspondence; Charles Mock MD PhD, Harborview Injury Prevention and Research Center, Box 359960, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA; e-mail: cmock@u.washington. edu DISABILITY AND REHABILITATION, 2003; VOL. 25, NO. 13, 732–741 Disability and Rehabilitation ISSN 0963–8288 print/ISSN 1464–5165 online # 2003 Taylor & Francis Ltd http://www.tandf. co.uk/journals DOI: 10.1080/0963828031000090524 the most to disability, as an indication of priorities for injury prevention efforts. Finally, we sought to gain a better understanding of the anatomic nature of the disabilities, as an indication of the priorities for improvements in both acute injury treatment and rehabilitation. Several different theoretical constructs have been used for understanding functional loss from injury and other disease processes. The World Health Organization (WHO) has developed the scheme of impairment, disability and handicap. 5 Impairment indicates the dysfunction at the level of an organ or organ system, such as loss of range of motion in an extremity. Disability implies dysfunction at the level of the individual, such as loss of ability to perform the activities of daily living. Handicap indicates how impairment and disability affect an individual’s role in society. – 6 In this study, we primarily utilized and measured the concept of disability, as determined by self-report from the respondents.