title: Economic loss due to traumatic injury in Uganda: The patient's perspective.
abstract: BACKGROUND
  Traumatic injury is a growing public health concern globally, and is a major cause of death and disability worldwide. The purpose of this study was to quantify the socioeconomic impact of lower extremity fractures in Uganda.
  
  
  METHODS
  All adult patients presenting acutely to Uganda's national referral hospital with a single long bone lower extremity fracture in October 2013 were recruited. Consenting patients were surveyed at admission and again at six-months and 12-months post-injury. The primary outcome was the cumulative 12-month post-injury loss in income. Secondary outcome measures included the change in health-related quality of life (HRQoL) and the injury's effect on school attendance for the patients' dependents.
  
  
  RESULTS
  Seventy-four patients were recruited during the study period. Sixty-four (86%) of the patients were available for 12-months of follow-up. Compared to pre-injury earnings, patients lost 88.4% ($1822 USD) of their annual income in the 12-months following their injury. To offset this loss in income, patients borrowed an average of 28% of their pre-injury annual income. Using the EuroQol-5D instrument, the mean HRQoL decreased from 0.91 prior to the injury to 0.39 (p<0.0001) at 12-months post-injury. Ninety-three percent of school-aged dependents missed at least one month of school during their guardian's recovery and only 61% had returned to school by 12-months post-injury.
  
  
  CONCLUSIONS
  This study demonstrates that lower extremity fractures in Uganda had a profound impact on the socioeconomic status of the individuals in our sample population, as well as the socioeconomic health of the family unit.
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, Canada. Electronic address: nohara@umoa.umm.edu.
authors.forename: Nathan N
authors.initials: NN
authors.lastname: O'Hara
authors.affiliation: Department of Orthopaedics, Makerere University, Kampala, Uganda.
authors.forename: Rodney
authors.initials: R
authors.lastname: Mugarura
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Potter
authors.affiliation: Centre for Clinical Epidemiology & Evaluation, University of British Columbia, Vancouver, Canada.
authors.forename: Trina
authors.initials: T
authors.lastname: Stephens
authors.affiliation: Vancouver School of Economics, University of British Columbia, Vancouver, Canada; Canadian Institute for Advanced Research, Toronto, Canada.
authors.forename: M Marit
authors.initials: MM
authors.lastname: Rehavi
authors.affiliation: Vancouver School of Economics, University of British Columbia, Vancouver, Canada; Canadian Institute for Advanced Research, Toronto, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Francois
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
authors.forename: Piotr A
authors.initials: PA
authors.lastname: Blachut
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: O'Brien
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Bababunmi K
authors.initials: BK
authors.lastname: Fashola
authors.affiliation: Vancouver School of Economics, University of British Columbia, Vancouver, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Mezei
authors.affiliation: Department of Orthopaedics, Makerere University, Kampala, Uganda.
authors.forename: Tito
authors.initials: T
authors.lastname: Beyeza
authors.affiliation: Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, USA.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000191:economics* / Q000453:epidemiology* / Q000523:psychology; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors; D014454:Uganda / Q000453:epidemiology
keywords: Africa; Dependent; Economics; Income; Lower extremity fractures; Road traffic injury; Trauma; Uganda