Household economic impact of road traffic injury versus routine emergencies in a low-income country
Authors: Mowafi Hani , Rice Brian , Nambaziira Rashida , Nirere Gloria , Wongoda Robert , James Matthew ,   GECC Writing Group, Bisanzo Mark , Post Lori 
Published: October 2020

Introduction

Road traffic injuries (RTIs) are increasing and have disproportionate impact on residents of low- and middle-income countries (LMICs) where 90% of deaths occur. RTIs are a leading cause of death for those aged 15 – 29 years with costs estimated to be up to 3% of GDP. Despite this fact, little primary research has been done on the household economic impact of these events.

Methods

From July to October 2016, 860 consecutive emergency department patients were enrolled and followed up at 6-8 weeks to assess the household financial impacts of these emergency presentations. At follow-up, patients were queried regarding health status, lost wages or schooling, household costs incurred due to their injury or illness, and assets sold.

Results

860 patients were enrolled and 675 patients (78%) completed follow-up surveys. Of those, 661 had a confirmed reason for visit - 304 (45%) road traffic injuries, 357 (53%) other emergency presentations (non-RTI) - encompassing medical presentations and other types of injury. Data was missing for 14 patients (2%). More than 90% of RTI patients were working or in school prior to their injury. In the economically productive ages (15-44 years) RTI predominated (70%) vs non-RTI (39%). RTI patients were more likely to report residual major disability (28% RTI vs 21% non-RTI, p<0.03). All emergency patients reported difficulty paying for basic needs (food, housing and medical expenses). More than ⅓ of emergency patients reported having to sell assets in order to meet basic needs after their illness or injury. Despite similar hospital costs and fewer lost days of work for both patients and caregivers, the mean financial impact on households of RTI patients was 37% more than for non-RTI patients. These costs equaled between 6-16 weeks of income for patients based on their occupation type and median reported pre-hospitalization income.

Discussion

Ugandans emergency care patients suffered significant personal and household economic hardship. In addition to the need for policy and infrastructural changes to improve road safety, these findings highlight the need for basic emergency care systems to secure economic gains in vulnerable households and prevent medical impoverishment of marginal communities.

Highlights

Road traffic injuries (RTIs) and routine emergencies result in residual disability among the majority of patients in Uganda 6-8 weeks after their initial presentation with less than 20% reporting full recovery.

The household financial impact from road traffic injuries is significant - ranging from the equivalent of 6 to 16 weeks of income - and is broadly felt across types of workers.

Despite similar hospital costs and fewer lost days of work for both patients and caregivers, the mean financial impact on households of RTI patients was 37% more than for non-RTI patients, which included medical presentations and non-RTI injuries.

All emergency patients reported difficulty paying for basic needs including food, housing and medical expenses 6-8 weeks post emergency unit encounter. More than ⅓ of emergency patients reported having to sell assets in order to meet basic needs after their illness or injury.

Economic impacts extended beyond injured patients to family members, 79% of whom missed work or school to provide care to the patient.