title: A pilot orthopedic trauma registry in Ugandan district hospitals.
abstract: Musculoskeletal injuries are a major public health problem in low-income countries like Uganda. Patterns of musculoskeletal injuries presenting to district hospitals are unknown. Our pilot orthopedic trauma registry establishes a framework for broader district hospital injury surveillance.
  
  
  
  We interviewed and examined patients presenting to Mityana, Entebbe, and Nakaseke hospitals with musculoskeletal injuries from October 2013 to January 2014. We compared patient and Demographic and Health Survey population demographics and determined predictors of delayed presentation for care.
  
  
  
  Men, adults, and individuals with postsecondary education were more common among patients than in the Demographic and Health Survey population. Common causes included road traffic injuries (48.5%) and falls (25.1%). Closed, simple fractures comprised 70% of injuries. Compared to the self-employed, subsistence farmers (odds ratio [OR] = 2.99, 95% confidence interval [CI] = 1.15-7.91), motorcycle taxi drivers (OR = 10.50, 95% CI = 1.92-64.57), and preschool children (OR = 4.24, 95% CI = 1.05-17.39) were significantly more likely to be delayed to care after adjustment for covariates. Subsistence farmers were more likely than other occupations to seek care from traditional bonesetters (23% versus 7%, P = 0.001). All patients who visited bonesetters were delayed to hospital care.
  
  
  
  Policies for trauma systems strengthening must address the needs of underserved groups and involve all stakeholders, including bonesetters. Research should address reasons for delayed care among subsistence farmers, motorcycle taxi drivers, and preschool children. Injury surveillance at district hospitals facilitates evidence-based resource allocation and should continue in the form of an Ugandan national trauma registry.
authors.affiliation: Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Dan K
authors.initials: DK
authors.lastname: Kisitu
authors.affiliation: Center for Global Surgical Studies, Department of Surgery, San Francisco General Hospital, University of California-San Francisco, San Francisco, California.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Eyler
authors.affiliation: Department of Orthopaedics, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: I
authors.initials: I
authors.lastname: Kajja
authors.affiliation: Department of Orthopaedics, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: G
authors.initials: G
authors.lastname: Waiswa
authors.affiliation: Department of Orthopedic Surgery, Mulago National Referral and Teaching Hospital, Kampala, Uganda.
authors.forename: T
authors.initials: T
authors.lastname: Beyeza
authors.affiliation: Center for Global Surgical Studies, Department of Surgery, San Francisco General Hospital, University of California-San Francisco, San Francisco, California.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Feldhaus
authors.affiliation: Center for Global Surgical Studies, Department of Surgery, San Francisco General Hospital, University of California-San Francisco, San Francisco, California.
authors.forename: Catherine
authors.initials: C
authors.lastname: Juillard
authors.affiliation: Center for Global Surgical Studies, Department of Surgery, San Francisco General Hospital, University of California-San Francisco, San Francisco, California. Electronic address: rochelle.dicker@ucsf.edu.
authors.forename: Rochelle A
authors.initials: RA
authors.lastname: Dicker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006306:Health Surveys; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D062486:Public Health Surveillance; D012042:Registries; D014454:Uganda / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D055815:Young Adult
keywords: Low- and middle-income countries; Musculoskeletal injury; Trauma registries; Uganda