ABSTRACT
Injuries are a public health problem in developing countries whether gunshot injuries or road traffic accident, resulting in major financial and productively losses and are associated with profound morbidity and mortality injuries vulnerable populations such as refugees and displaced people, make an even greater impact on loss of life.
Many previous studies were focused specific sites but our study was aimed to review the literature to estimate the magnitude and prevalence of gunshot wound and road traffic accident in Medina hospital, Mogadishu –Somalia.
Cross-sectional study from January to December 2007 was collected from records in according to mode of injury, body parts involved, sex distribution and fatalities. The main results were: road traffic accident account for 8.8 deaths per 339 patients and gun shot injuries were responsible for 13.1 deaths per 1371 patients proportion of persons below 25years were more in injuries and fatalities due to gunshot wound and road traffic accident. Among road traffic accident 53.3% died of head injures, and gunshot wound 36.1 died of abdominal injures.
Introduction:
Trauma: is any injury, whether physically or emotionally inflicted.
"Trauma" has both a medical and a psychiatric definition. Medically, "trauma" refers to a Serious or critical bodily injury, wound, or shock. This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. In psychiatry, "trauma" has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects.
Injuries are a public health problem in developing countries resulting in major financial and productivity losses. There are several causes of injuries among them the most common are gun shoot wound (GSW) and road traffic accident.
Analysis of mechanism and type of injury permits more focused planning of medical cover and trauma prevention. Gunshot injuries are major problems worldwide from the medical and economic perspectives and are associated with profound morbidity and significant mortality.
Gunshot injuries (GSI) cause profound morbidity and significant mortality.
These injuries occur in both military and civilian settings. The causes of gunshot injuries in Somalia like many other African and developing world include communal clashes, military violence, armed robbery, hunting, political violence and rarely sporting and suicidal attempt.
Gunshot injuries (GSI) were first reported in West Africa following the Nigerian civil war of 1967-1970. It is the second commonest cause of death per 1000 in Transkei region of South Africa. Recently the incidence has been on the increase worldwide. A case of loss of facial identification of a survivor after firearm injury to the head has been reported. Gunshot injuries could be devastating especially when it involves vital organs and could result to instant death. The cost of treating patients that survive these injuries could be enormous especially when the injuries are to the head, chest, abdomen and the spine.
Mechanism of injury by GSW:
“Bullets are composed of a casing enclosing an explosive powder charge, which, on striking, forces the end projectile element out at speeds of up to 1500 meters/second, dependant on the ammunition and type of gun. They inflict injury in a number of ways. Firstly, the projectile crushes structures along its track, similar to other forms of penetrating injury. Temporary cavitations causes shearing and compression, sometimes tearing structures (as with solid abdominal viscera) or stretching inelastic tissue (the brain is particularly susceptible), analogous to blunt trauma. As tissues recoil and hot gases dissipate, soft tissue collapses inwards with the permanent cavity being the resultant defect. Secondly, kinetic energy transfer occurs during retardation of the bullet and this may cause damage outside the tract.
Factors influencing the efficiency of kinetic energy transfer include:
1. The kinetic energy of a body (e), proportional to mass and velocity (mv²) Projectile's deformation and fragmentation.
2. Entrance profile and path traveled through the body.
3. Biological characteristics of the transit tissues .
Projectiles tend to be classified as low velocity (<300 m/second) or high velocity (>300 m/second). Those with higher velocity may be expected, on this basis, to dissipate more energy into surrounding tissue as they slow and cause more tissue damage but this is only a very approximate guide. This 'kinetic energy dump' theory is controversial, since high velocity injuries are frequently less extensive than would be predicted and fragmentation appears to be the most effective mechanism for wounding rather than yawing or other mechanisms for slowing high velocity rounds quickly ".
“Everyday around the world, almost 16 000 people die from all types of injuries. Injuries represent 12% of the global burden of disease, the third most important cause of overall mortality and the main cause of death among 1– 40-year-olds.
The category of injuries worldwide is dominated by those incurred in road
crashes. According to WHO data, deaths from road traffic injuries account for around 25% of all deaths from injury ”.
Road traffic injuries are a major but neglected global public health problem, requiring concerted efforts for effective and sustainable prevention. Of all the systems that people have to deal with on a daily basis, road transport is the most complex and the most dangerous.
“Worldwide, the number of people killed in road traffic crashes each year is estimated at almost 1.2 million, while the number injured could be as high as 50 million – the combined population of five of the world’s large cities. The tragedy behind these figures regularly attracts less media attention than other, less frequent but more unusual types of tragedy.
What is worse, without increased efforts and new initiatives, the total number of road traffic deaths worldwide and injuries is forecast to rise by some 65% between 2000 and 2020, and in low-income and middle-income countries deaths are expected to increase by as much as 80%. The majority of such deaths are currently among “vulnerable road users” – pedestrians, pedal cyclists and motorcyclists. In high-income countries, deaths among car occupants continue to be predominant, but the risks per capita that vulnerable road users face are high.
This is the first major report on road injury prevention jointly issued by the World Health Organization (WHO) and the World Bank, and underscores the concern that the two bodies share about the detrimental impact of an unsafe road transport system on public health and global development. It is the contention of the report, first, that the level of road deaths and injuries is
unacceptable, and second, that it is to a large extent avoidable.
There is thus an urgent need to recognize the worsening situation in road deaths and injuries and to take appropriate action. Road traffic injury prevention and mitigation should be given the same attention and scale of resources that is currently paid to other prominent health issues if increasing human loss and injury on the roads, with their devastating human impact and
large economic cost to society, are to be averted. Road Accidents are extremely common and the injuries suffered by those involved can vary greatly from minor whiplash to fatal injuries. Below you will find more information about the most common types of road accidents:
- Motorcycle Accident Claim
- Road Accident Compensation
- Road Accidents involving Cyclists
- Road Traffic Accident involving Emergency Vehicles
- Road Traffic Accident involving Hit & Run Drivers
- Road Traffic Accident involving Pedestrians
- Road Traffic Accident involving Uninsured or Stolen Vehicles
- Whiplash Injury Claim ”.
The aim of this study is to compare the medical impact of GSW with RTA on human in Medina hospital in the center of Mogadishu.
Literature review
1- In December 2006 gun-shot injuries in Nigeria Hospital
This was combined retrospective and prospective study of gunshot injuries in a Nigeria hospital it was concluded that gunshot injuries occur more below age of forty years , and the limps were more injured ,total number of patients was 38 and male: female ratio was 18:1, and (78.9%) of them were below the age of 40 years.
2 – 13 August 2004: injuries among Afghanistan refugee.
The study was electronic data base of MEDLINE POPLINE.
The literature review identified patients with reported war injuries who presented to hospital.
Injuries to extremities (45%) were more frequency than injuries to the hand or Neck (36%), thorax and abdominal (14%).
A majority of the injuries were caused by explosives which included landmines (32.5%), shell fregments (33%), and fire arms (27%).
The mean incidence of mortality in these studies was 11%.
Despite such an extensive search, limited information was found pertinent to injuries in afghan refugee residing in refugee camps.
3-1 march 2002: non-fatal injuries sustained in RTA in CHON BURI
THIALAND .
Information from two major sources was reviewed: the records of eight non-referral hospitals and in the 1999 injury surveillance REPORT of CHON BURI hospital.
Information was retrieved from the record of 324 patients with traffic injury
and was recorded by four trained research assistants.
The majority of the injured patients were from CHON BURI (n: 313: 96.6%).
One third of the patients were aged below 20 and 29 years.
More than twice as many men (230, 71%) than women (94, 29%) were injured.
their study investigated the characteristic of non- fetal RTA patients who received treatment at one referral –and eight non-referral public hospitals in a province with high morbidity and mortality rates.
their study results were similar to the results of other studies conducted in referral hospitals in urban and rural Thailand.
4-1 January –December 2004: epidemiological study of RTA
cases; a study from south India :
This study was conducted at Jawahar institute of post graduate medical and research hospital, pondicherry, south India from 1st January 31st December 1994.
This study group consists of all the RTA victims reporting to JIPMER casualty in the above one year period.
A total of 544 RTA, involves 752 victims including 26 fatalities from 24 RTA reported jipmer hospital during this period, due to certain limitations, it was decided not to include fatal accidents.
There were 603 (83%) male, and 123(17%) female victims, the average of the victims was 31.5 years, and the highest number of victims (31.3%) were between 20-29 years of age followed by 30-39 years, and the 40-49 age group.
There were 65 children (8.9%), between 12 years of age with an average age of 7.1 years.
There is clearly a need for road safety education it should be director towards road users who are frequently involved and injury in RTA (e.g. student)