Modelling memory decay after injuries using household survey data from Khartoum State, Sudan.

BACKGROUND: Injuries represent an important cause of morbidity and mortality worldwide. In retrospective epidemiological studies, estimated rates of reported injuries often decline considerably when information is included from periods more than a few months before the data collection. Such low rates are usually regarded as a consequence of memory decay. It is largely unknown whether the extent of memory decay depends on external factors otherwise affecting injury rates. METHODS: A statistical model was introduced to separate the influence of external factors on true injury rates from effects on memory decay. The relationship between apparent rates and time elapsed between injury occurrence and data collection was described by a parametric regression model. Relationships between memory decay and external factors were modelled by effect modification of the relationship with time. The procedure was applied to data collected in a retrospective household survey, carried out in Khartoum State in 2010, which elicited information about injuries that had occurred during the last year. The survey included 5661 individuals in 973 households, reporting a total of 481 non-fatal injuries. RESULTS: In the data from Khartoum State, differences in memory recall were observed between socioeconomic groups, with considerably faster memory decay in the lower socioeconomic tertile. In this tertile the estimated probability that an injury which occurred 6 months ago was reported was only 18%, compared to probabilities of about 35% in the remainder of the population. In the lower socioeconomic tertile, in contrast to other groups, a simple exponential model was not sufficient for describing memory decay. Memory decay did not depend on sex, age, urban/rural status or education. Road traffic injuries were subject to less memory decay than injuries due to falls, mechanical causes and burns. Memory decay seriously affected crude overall injury rates and also to some degree estimated relative rates. CONCLUSION: In the statistical analysis of retrospective injury data it is important to take into account the effects of memory decay.

Socioeconomic and disability consequences of injuries in the Sudan: a community-based survey in Khartoum State.

BACKGROUND: Fatal and non-fatal injuries are of increasing public health concern globally, particularly in low and middle-income countries. Injuries sustained by individuals also impact society, creating a loss of productivity with serious economic consequences. In Sudan, there is no documentation of the burden of injuries on individuals and society. METHODS: A community-based survey was performed in Khartoum State, using a stratified two-stage cluster sampling technique. Households were selected in each cluster by systematic random sampling. Face-to-face interviews during October and November 2010 were conducted. Fatal injuries occurring during 5 years preceding the survey and non-fatal injuries occurring during 12 months preceding interviews were included. RESULTS: The total number of individuals included was 5661, residing in 973 households. There were 28 deaths due to injuries out of a total of 129 reported deaths over 5 years. A total of 441 cases of non-fatal injuries occurred during the 12 months preceding the survey. The number of disability days differed significantly between mechanisms of injury. Road traffic crashes and falls caused the longest duration of disability. Men had a higher probability than women of losing a job due to an injury. CONCLUSIONS: This study demonstrates the importance of prioritising prevention of road traffic crashes and falls. The loss of productivity in lower socioeconomic strata highlights the need for social security policies. Further research is needed for estimating the economic cost of injuries in Sudan.

Use of healthcare services by injured people in Khartoum State, Sudan.

BACKGROUND: Trauma care is an important factor in preventing death and reducing disability. Injured persons in low- and middle-income countries are expected to use the formal healthcare system in increasing numbers. The objective of this paper is to examine use of healthcare services after injury in Khartoum State, Sudan. METHODS: A community-based survey using a stratified two-stage cluster sampling technique in Khartoum State was performed. Information on healthcare utilisation was taken from injured people. A logistic regression analysis was used to explore factors affecting the probability of using formal healthcare services. RESULTS: During the 12 months preceding the survey a total of 441 cases of non-fatal injuries occurred, with 260 patients accessing formal healthcare. About a quarter of the injured persons were admitted to hospital. Injured people with primary education were less likely to use formal healthcare compared to those with no education. Formal health services were most used by males and in cases of road traffic injuries. The lowest socio-economic strata were least likely to use formal healthcare. CONCLUSIONS: Public health measures and social security should be strengthened by identifying other real barriers that prevent low socio-economic groups from making use of formal healthcare facilities. Integration and collaboration with traditional orthopaedic practitioners are important aspects that need further attention.

Injuries in Khartoum state, the Sudan: a household survey of incidence and risk factors.

Low- and middle-income countries have a higher burden of fatal and non-fatal injuries. The lack of evidence-based information hampers efforts for injury prevention. The aim of this study was to calculate non-fatal injury incidence rates and to investigate causes and risk factors for non-fatal injuries in Khartoum state. Information was gathered in a community-based survey using a stratified two-stage cluster sampling technique. Methods of data collection were face-to-face interviews during October and November 2010. The total number of individuals included was 5661, residing in 973 households. The overall injury incidence rate was 82.0/1000 person-years-at-risk. The three leading causes were falls, mechanical forces and road traffic crashes. Low socio-economic status was a risk factor for injuries in urban areas. Males had a significantly higher risk of being injured in both urban and rural areas. Our findings can contribute to the planning of prevention programmes.