title: Socioeconomic correlates of trauma: An analysis of emergency ward patients in Yaoundé, Cameroon.
abstract: BACKGROUND
  Injury is a significant and increasingly common cause of morbidity and mortality in sub-Saharan Africa; however, the social and economic factors underlying these trends are not well understood. We evaluated the relationship between socioeconomic status (SES) and trauma outcomes using a prospective registry of patients presenting to the largest trauma hospital in Yaoundé, Cameroon.
  
  
  METHODS
  Trauma patients (n=2855) presenting to the emergency ward at Central Hospital, Yaoundé between April 15 and October 15, 2009 were surveyed regarding demographic and socioeconomic background, nature and severity of injuries, treatment, and disposition. A wealth score was estimated for each patient, corresponding to an SES index constructed using principle components analysis of the urban Cameroonian Demographic and Health Survey. Logistic regression was used to evaluate the effects of SES on care-seeking behaviour, injury severity, and treatment outcome.
  
  
  METHODS
  SES wealth score, care-seeking prior to visiting hospital, injury severity, treatment outcome.
  
  
  RESULTS
  Patients aged 1-89 presented with road traffic injuries (59.83%), falls (7.76%), and penetrating trauma (6.16%), and had higher SES than the broader urban Cameroonian population. Within the Yaoundé sample, being in the lowest SES quintile was associated with an increased likelihood of having sought care elsewhere before presenting to the hospital (aOR=3.28, p<0.001), after controlling for background and injury characteristics. Patients in the lowest SES quintile were also more likely to present with moderate/severe injuries (aOR=4.93, p<0.001), and were more likely to be transferred to the operating room.
  
  
  CONCLUSIONS
  Patients presenting to this trauma centre were wealthier than the broader community, suggesting the possibility of barriers to accessing care. Poorer patients were more likely to have severe injuries and more likely to need surgery, but were less likely to seek care from a major trauma centre immediately. Substantial differences in SES between the sample visiting the hospital and the broader community suggest a need for community-based sampling approaches in future trauma research.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Seema
authors.initials: S
authors.lastname: Kacker
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.affiliation: Cameroon Ministry of Health, PO Box 4282, Yaoundé, Cameroon.
authors.forename: Georges Alain Etoundi
authors.initials: GA
authors.lastname: Mballa
authors.affiliation: World Health Organization, Africa Regional Office, Brazzaville, Congo.
authors.forename: M E
authors.initials: ME
authors.lastname: Monono
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: Cameroon Ministry of Health, PO Box 4282, Yaoundé, Cameroon.
authors.forename: Marquise Kouo
authors.initials: MK
authors.lastname: Ngamby
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
authors.affiliation: Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, CA, USA. Electronic address: Catherine.Juillard@ucsf.edu.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Juillard
mesh_terms: D000058:Accidental Falls / Q000191:economics / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000191:economics / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D012923:Social Class; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult
keywords: Cameroon; Epidemiology; Global health; Socioeconomic status; Trauma