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Prevalence and risk factor for injury in sub-Saharan Africa: a multicountry study
  1. Megan B Diamond1,
  2. Shona Dalal1,
  3. Clement Adebamowo2,3,
  4. David Guwatudde4,
  5. Carien Laurence5,
  6. Ikeoluwapo O Ajayi6,
  7. Francis Bajunirwe7,
  8. Marina A Njelekela8,
  9. Faraja Chiwanga9,
  10. Hans-Olov Adami1,10,
  11. Joan Nankya-Mutyoba4,
  12. Robert Kalyesubula11,
  13. Todd G Reid1,
  14. David Hemenway1,12,
  15. Michelle D Holmes1,13
  1. 1 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2 Institute of Human Virology, Abuja, Nigeria
  3. 3 Greenebaum Cancer Center and Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
  4. 4 Department of Epidemiology & Biostatistics, Makerere School of Public Health, Kampala, Uganda
  5. 5 Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, South Africa
  6. 6 Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
  7. 7 Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
  8. 8 Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
  9. 9 Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
  10. 10 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  11. 11 Department of Medicine, Makerere School of Medicine, Kampala, Uganda
  12. 12 Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
  13. 13 Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Megan B Diamond, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; mbd976{at}


Introduction Injury-related morbidity is a neglected health concern in many low-income and middle-income countries. Most injury data in Africa have been collected from hospital-based studies, and few studies have occurred across multiple countries. Using data from a novel cohort, we examined the prevalence and incidence of serious injuries and associated risk factors across five sites in sub-Saharan Africa (SSA).

Methods A common baseline and follow-up survey was administered to participants. The study population included 1316 persons at baseline and 904 persons at follow-up. Frequencies were calculated, and logistic regression models were used to assess risk factors for injury.

Results A total of 233 (17.7%) persons reported a serious injury at baseline and 60 (6.6%) reported a serious injury 6 months later at follow-up. Sixty-nine per cent of participants responded to the follow-up questionnaire. At baseline and follow-up, the most common cause of serious injury at urban sites was transport related, followed by poison/overdose. In rural Uganda, sharp instruments injuries were most common, followed by transport-related injuries. Living at an urban site was associated with an increased odds for serious injury compared with those at the rural site (OR: 1.83, 95% CI 1.15 to 2.90). Participants who consumed above a moderate amount of alcohol were at a higher risk of serious injury compared with those who did not consume alcohol (OR: 1.86, 95% CI 1.02 to 3.41). High level of education was an important risk factor for injury.

Conclusion At baseline and follow-up, common causes of serious injury were transport related, sharp instrument and poison/overdose. Alcohol consumption, urban location and education are important risk factors for injury. It is feasible to collect longitudinal injury data using a standardised questionnaire across multiples sites in SSA. Longitudinal data collection should be leveraged to obtain robust data on risk factors for injury in SSA.

  • Injury
  • accidents
  • sub-Saharan Africa
  • cross-sectional studies
  • epidemiology

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  • Contributor SD, CA, DG, CL, IOA, FB, MAN, FC, H-OA, JN-M, RK, TGR and MDH conceptualised the study. MBD conducted the data analysis and had primary responsibility for final content. All authors participated in editing and reading the manuscript and approved the final manuscript.

  • Funding This study is funded by Karolinska Institutet (grant no: Dnr: 2368/10–221).

  • Competing interests None declared.

  • Ethics approval Harvard T.H. Chan School of Public Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.