Household economic impact of road traffic injury versus routine emergencies in a low-income country

Hani Mowafi; Brian Rice; Rashida Nambaziira; Gloria Nirere; Robert Wongoda; Matthew James; Gecc Writing Group; Mark Bisanzo; Lori Post

doi:10.1016/j.injury.2021.06.007

Household economic impact of road traffic injury versus routine emergencies in a low-income country

Injury. 2021 Sep;52(9):2657-2664. doi: 10.1016/j.injury.2021.06.007. Epub 2021 Jun 20.

Authors

Hani Mowafi¹, Brian Rice², Rashida Nambaziira³, Gloria Nirere³, Robert Wongoda⁴, Matthew James⁵, Gecc Writing Group³, Mark Bisanzo⁶, Lori Post⁷

Affiliations

¹ Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, USA. Electronic address: hani.mowafi@yale.edu.
² Stanford University, 900 Welch Rd, Suite 350, Palo Alto, CA, 94304, USA; Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA.
³ Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA.
⁴ Makerere University, PO Box 7062, Kampala, Uganda.
⁵ Yale University, 464 Congress Ave, Suite 260, New Haven, CT, 06519, USA.
⁶ Global Emergency Care Collaborative, PO Box 4404, Shrewsbury, MA 01545, USA; University of Vermont, 111 Colchester Avenue, Burlington, VT 05401, USA.
⁷ Northwestern University, 211 E. Ontario St, Suite 200, Chicago, IL, 60611, USA.

PMID: 34210454
DOI: 10.1016/j.injury.2021.06.007

Abstract

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, 660 had a confirmed reason for visit - 303 (45%) road traffic injuries, 357 (53%) other emergency presentations (non-RTI) - encompassing medical presentations and other types of injury, and reason for visit was missing for 15 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 disability (78.2% RTI vs 68.1% non-RTI, p=0.004). 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 equalled between 6-16 weeks of income for patients based on their occupation type and median reported pre-hospitalization income.

Discussion: Ugandan 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.

Keywords: Economic impact; Emergency; Injury; Low- and middle-income countries; Road traffic.

MeSH terms

Accidents, Traffic / prevention & control
Adolescent
Adult
Emergencies
Emergency Medical Services*
Emergency Service, Hospital
Family Characteristics
Humans
Wounds and Injuries* / epidemiology
Wounds and Injuries* / therapy
Young Adult