title: The role of Ugandan District Hospital orthopedic units in the care of vulnerable road users: a cross-sectional study.
abstract: BACKGROUND
  Musculoskeletal injuries are a common cause of morbidity after road traffic injury (RTI) in motorizing countries. District hospitals provide front-line orthopedic care in Uganda and other sub-Saharan African nations. Improving care at the district hospital level is an important component of the World Health Organization's strategy for surgical and trauma systems strengthening, but the data necessary to inform RTI safety and care initiatives has previously been insufficient at the district hospital level. The objective of this study was to provide data on the patient population and patterns of musculoskeletal injury caused by RTI at Ugandan district hospitals.
  
  
  METHODS
  In this cross-sectional study, all patients with musculoskeletal injuries identified on x-ray presenting to three Ugandan district hospitals from October 2013 to January 2014 were interviewed and examined to obtain data on patient demographics and injury context by road user category. This manuscript is a sub-group analysis of RTI victims from a broader dataset of all musculoskeletal injuries.
  
  
  RESULTS
  Vulnerable road users comprised 92 % of musculoskeletal RTI patients, with 49 % (95 % CI 41-57 %) pedestrians, 41 % (95 % CI 33-49 %) motorcyclists, and 2 % (95 % CI 0-4 %) cyclists. Commonly injured subgroups included student pedestrians (33 % (95 % CI 22-44 %) of pedestrians) and motorcyclists with less than a post-secondary education (74 % (95 % CI 63-85 %) of motorcyclists). The morning hours were the most common time of injury for all RTI patients (37 %%; 95 % CI 30-44 %) and motorcyclists (46 %; 95 % CI 34-58 %), while pedestrians were most commonly injured in the evening (32 %; 95 % CI 21-43 %).
  
  
  CONCLUSIONS
  By demonstrating commonly injured demographic groups and high frequency times of day for injury, this surveillance study of musculoskeletal RTI suggests targeted avenues for future road safety research in the districts of Uganda. Compared with previous studies from the capital of Uganda, these results suggest that Ugandan district hospitals care for a disproportionate share of vulnerable road users, a discrepancy which may pertain to other sub-Saharan African nations, as well. Strengthening district hospital orthopedic care should be considered a priority of strategies aimed at improving outcomes for these vulnerable groups.
authors.affiliation: Department of Surgery, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda.
authors.forename: Dan K
authors.initials: DK
authors.lastname: Kisitu
authors.affiliation: Center for Global Surgical Studies, San Francisco General Hospital, University of California, Box 0807, San Francisco, CA, 94143-0807, USA.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Eyler
authors.affiliation: Department of Orthopaedics, Makerere University College of Health Sciences, P.O. Box 8062, Kampala, Uganda.
authors.forename: Isaac
authors.initials: I
authors.lastname: Kajja
authors.affiliation: Department of Orthopaedics, Makerere University College of Health Sciences, P.O. Box 8062, Kampala, Uganda.
authors.forename: Gonzaga
authors.initials: G
authors.lastname: Waiswa
authors.affiliation: Mulago National Referral and Teaching Hospital, P.O. Box 7051, Kampala, Uganda.
authors.forename: Titus
authors.initials: T
authors.lastname: Beyeza
authors.affiliation: Safe Transportation Research and Education Center (SafeTREC), School of Public Health, University of California, 2614 Dwight Way, Berkeley, CA, 94720, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Ragland
authors.affiliation: Center for Global Surgical Studies, San Francisco General Hospital, University of California, Box 0807, San Francisco, CA, 94143-0807, USA.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Feldhaus
authors.affiliation: Center for Global Surgical Studies, San Francisco General Hospital, University of California, Box 0807, San Francisco, CA, 94143-0807, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Juillard
authors.affiliation: Center for Global Surgical Studies, San Francisco General Hospital, University of California, Box 0807, San Francisco, CA, 94143-0807, USA. rochelle.dicker@ucsf.edu.
authors.forename: Rochelle A
authors.initials: RA
authors.lastname: Dicker
keywords: Epidemiology; Injury; Less motorized countries; Road users