Trauma-Related Mortality among Adults in Rural Western Kenya: Characterising Deaths Using Data from a Health and Demographic Surveillance System

Frank O. Odhiambo; Caryl M. Beynon; Sheila Ogwang; Mary J. Hamel; Olivia Howland; Anna Van Eijk; Robyn Norton; Nyaguara Amek; Laurence Slutsker; Kayla F. Laserson; Kevin M. De Cock; Penelope Phillips-Howard

doi:10.1371/journal.pone.0079840

Trauma-Related Mortality among Adults in Rural Western Kenya: Characterising Deaths Using Data from a Health and Demographic Surveillance System

Frank O. Odhiambo, Caryl M. Beynon, Sheila Ogwang, Mary J. Hamel, Olivia Howland, Anna Van Eijk, Robyn Norton, Nyaguara Amek, Laurence Slutsker, Kayla F. Laserson, Kevin M. De Cock, Penelope Phillips-Howard

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

Abstract

Background

Information on trauma-related deaths in low and middle income countries is limited but needed to target public health interventions. Data from a health and demographic surveillance system (HDSS) were examined to characterise such deaths in rural western Kenya.

Methods And Findings

Verbal autopsy data were analysed. Of 11,147 adult deaths between 2003 and 2008, 447 (4%) were attributed to trauma; 71% of these were in males. Trauma contributed 17% of all deaths in males 15 to 24 years; on a population basis mortality rates were greatest in persons over 65 years. Intentional causes accounted for a higher proportion of male than female deaths (RR 2.04, 1.37-3.04) and a higher proportion of deaths of those aged 15 to 65 than older people. Main causes in males were assaults (n=79, 25%) and road traffic injuries (n=47, 15%); and falls for females (n=17, 13%). A significantly greater proportion of deaths from poisoning (RR 5.0, 2.7-9.4) and assault (RR 1.8, 1.2-2.6) occurred among regular consumers of alcohol than among non-regular drinkers. In multivariate analysis, males had a 4-fold higher risk of death from trauma than females (Adjusted Relative Risk; ARR 4.0; 95% CI 1.7-9.4); risk of a trauma death rose with age, with the elderly at 7-fold higher risk (ARR 7.3, 1.1-49.2). Absence of care was the strongest predictor of trauma death (ARR 12.2, 9.4-15.8). Trauma-related deaths were higher among regular alcohol drinkers (ARR 1.5, 1.1-1.9) compared with non-regular drinkers.

Conclusions

While trauma accounts for a small proportion of deaths in this rural area with a high prevalence of HIV, TB and malaria, preventive interventions such as improved road safety, home safety strategies for the elderly, and curbing harmful use of alcohol, are available and could help diminish this burden. Improvements in systems to record underlying causes of death from trauma are required.

Original language	English
Article number	e79840
Pages (from-to)	e79840
Journal	PLoS ONE
Volume	8
Issue number	11
DOIs	https://doi.org/10.1371/journal.pone.0079840
Publication status	Published - 1 Nov 2013

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Odhiambo, F. O., Beynon, C. M., Ogwang, S., Hamel, M. J., Howland, O., Van Eijk, A., Norton, R., Amek, N., Slutsker, L., Laserson, K. F., De Cock, K. M., & Phillips-Howard, P. (2013). Trauma-Related Mortality among Adults in Rural Western Kenya: Characterising Deaths Using Data from a Health and Demographic Surveillance System. PLoS ONE, 8(11), e79840. Article e79840. https://doi.org/10.1371/journal.pone.0079840

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title = "Trauma-Related Mortality among Adults in Rural Western Kenya: Characterising Deaths Using Data from a Health and Demographic Surveillance System",

abstract = "BackgroundInformation on trauma-related deaths in low and middle income countries is limited but needed to target public health interventions. Data from a health and demographic surveillance system (HDSS) were examined to characterise such deaths in rural western Kenya.Methods And FindingsVerbal autopsy data were analysed. Of 11,147 adult deaths between 2003 and 2008, 447 (4\%) were attributed to trauma; 71\% of these were in males. Trauma contributed 17\% of all deaths in males 15 to 24 years; on a population basis mortality rates were greatest in persons over 65 years. Intentional causes accounted for a higher proportion of male than female deaths (RR 2.04, 1.37-3.04) and a higher proportion of deaths of those aged 15 to 65 than older people. Main causes in males were assaults (n=79, 25\%) and road traffic injuries (n=47, 15\%); and falls for females (n=17, 13\%). A significantly greater proportion of deaths from poisoning (RR 5.0, 2.7-9.4) and assault (RR 1.8, 1.2-2.6) occurred among regular consumers of alcohol than among non-regular drinkers. In multivariate analysis, males had a 4-fold higher risk of death from trauma than females (Adjusted Relative Risk; ARR 4.0; 95\% CI 1.7-9.4); risk of a trauma death rose with age, with the elderly at 7-fold higher risk (ARR 7.3, 1.1-49.2). Absence of care was the strongest predictor of trauma death (ARR 12.2, 9.4-15.8). Trauma-related deaths were higher among regular alcohol drinkers (ARR 1.5, 1.1-1.9) compared with non-regular drinkers.ConclusionsWhile trauma accounts for a small proportion of deaths in this rural area with a high prevalence of HIV, TB and malaria, preventive interventions such as improved road safety, home safety strategies for the elderly, and curbing harmful use of alcohol, are available and could help diminish this burden. Improvements in systems to record underlying causes of death from trauma are required.",

author = "Odhiambo, \{Frank O.\} and Beynon, \{Caryl M.\} and Sheila Ogwang and Hamel, \{Mary J.\} and Olivia Howland and \{Van Eijk\}, Anna and Robyn Norton and Nyaguara Amek and Laurence Slutsker and Laserson, \{Kayla F.\} and \{De Cock\}, \{Kevin M.\} and Penelope Phillips-Howard",

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Odhiambo, FO, Beynon, CM, Ogwang, S, Hamel, MJ, Howland, O, Van Eijk, A, Norton, R, Amek, N, Slutsker, L, Laserson, KF, De Cock, KM & Phillips-Howard, P 2013, 'Trauma-Related Mortality among Adults in Rural Western Kenya: Characterising Deaths Using Data from a Health and Demographic Surveillance System', PLoS ONE, vol. 8, no. 11, e79840, pp. e79840. https://doi.org/10.1371/journal.pone.0079840

TY - JOUR

T1 - Trauma-Related Mortality among Adults in Rural Western Kenya: Characterising Deaths Using Data from a Health and Demographic Surveillance System

AU - Odhiambo, Frank O.

AU - Beynon, Caryl M.

AU - Ogwang, Sheila

AU - Hamel, Mary J.

AU - Howland, Olivia

AU - Van Eijk, Anna

AU - Norton, Robyn

AU - Amek, Nyaguara

AU - Slutsker, Laurence

AU - Laserson, Kayla F.

AU - De Cock, Kevin M.

AU - Phillips-Howard, Penelope

PY - 2013/11/1

Y1 - 2013/11/1

N2 - BackgroundInformation on trauma-related deaths in low and middle income countries is limited but needed to target public health interventions. Data from a health and demographic surveillance system (HDSS) were examined to characterise such deaths in rural western Kenya.Methods And FindingsVerbal autopsy data were analysed. Of 11,147 adult deaths between 2003 and 2008, 447 (4%) were attributed to trauma; 71% of these were in males. Trauma contributed 17% of all deaths in males 15 to 24 years; on a population basis mortality rates were greatest in persons over 65 years. Intentional causes accounted for a higher proportion of male than female deaths (RR 2.04, 1.37-3.04) and a higher proportion of deaths of those aged 15 to 65 than older people. Main causes in males were assaults (n=79, 25%) and road traffic injuries (n=47, 15%); and falls for females (n=17, 13%). A significantly greater proportion of deaths from poisoning (RR 5.0, 2.7-9.4) and assault (RR 1.8, 1.2-2.6) occurred among regular consumers of alcohol than among non-regular drinkers. In multivariate analysis, males had a 4-fold higher risk of death from trauma than females (Adjusted Relative Risk; ARR 4.0; 95% CI 1.7-9.4); risk of a trauma death rose with age, with the elderly at 7-fold higher risk (ARR 7.3, 1.1-49.2). Absence of care was the strongest predictor of trauma death (ARR 12.2, 9.4-15.8). Trauma-related deaths were higher among regular alcohol drinkers (ARR 1.5, 1.1-1.9) compared with non-regular drinkers.ConclusionsWhile trauma accounts for a small proportion of deaths in this rural area with a high prevalence of HIV, TB and malaria, preventive interventions such as improved road safety, home safety strategies for the elderly, and curbing harmful use of alcohol, are available and could help diminish this burden. Improvements in systems to record underlying causes of death from trauma are required.

AB - BackgroundInformation on trauma-related deaths in low and middle income countries is limited but needed to target public health interventions. Data from a health and demographic surveillance system (HDSS) were examined to characterise such deaths in rural western Kenya.Methods And FindingsVerbal autopsy data were analysed. Of 11,147 adult deaths between 2003 and 2008, 447 (4%) were attributed to trauma; 71% of these were in males. Trauma contributed 17% of all deaths in males 15 to 24 years; on a population basis mortality rates were greatest in persons over 65 years. Intentional causes accounted for a higher proportion of male than female deaths (RR 2.04, 1.37-3.04) and a higher proportion of deaths of those aged 15 to 65 than older people. Main causes in males were assaults (n=79, 25%) and road traffic injuries (n=47, 15%); and falls for females (n=17, 13%). A significantly greater proportion of deaths from poisoning (RR 5.0, 2.7-9.4) and assault (RR 1.8, 1.2-2.6) occurred among regular consumers of alcohol than among non-regular drinkers. In multivariate analysis, males had a 4-fold higher risk of death from trauma than females (Adjusted Relative Risk; ARR 4.0; 95% CI 1.7-9.4); risk of a trauma death rose with age, with the elderly at 7-fold higher risk (ARR 7.3, 1.1-49.2). Absence of care was the strongest predictor of trauma death (ARR 12.2, 9.4-15.8). Trauma-related deaths were higher among regular alcohol drinkers (ARR 1.5, 1.1-1.9) compared with non-regular drinkers.ConclusionsWhile trauma accounts for a small proportion of deaths in this rural area with a high prevalence of HIV, TB and malaria, preventive interventions such as improved road safety, home safety strategies for the elderly, and curbing harmful use of alcohol, are available and could help diminish this burden. Improvements in systems to record underlying causes of death from trauma are required.

U2 - 10.1371/journal.pone.0079840

DO - 10.1371/journal.pone.0079840

M3 - Article

VL - 8

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JO - PLoS ONE

JF - PLoS ONE

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M1 - e79840

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Trauma-Related Mortality among Adults in Rural Western Kenya: Characterising Deaths Using Data from a Health and Demographic Surveillance System

Abstract

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