Enhancing post-road traffic orthopaedic injury rehabilitation to reduce disability in Rwanda: Policy brief

Introduction

In Rwanda, the surge of road traffic injuries (RTIs) poses a formidable public health challenge, significantly shaping the morbidity landscape of the nation (Ingabire et al., 2024). These injuries often culminate in orthopedic damage which constitutes nearly half of all such events, with approximately 49% of these accidents leading to orthopedic complications. The sequelae of these injuries not only encompass immediate physical harm but also extend into prolonged or permanent disabilities, affecting a substantial 36% of the afflicted individuals (Allen Ingabire et al., 2024a). Reference for Such outcomes severely impair quality of life, diminish economic productivity, and inhibit social integration, thus imposing a multifaceted burden on individuals and on the broader socioeconomic framework of Rwanda (Ingabire et al., 2024; Allen Ingabire et al., 2024b).

This escalating issue commands an urgent need for a detailed exploration and refinement of national policies concerning road safety, medical response, and rehabilitation practices. Therefore, our policy brief endeavors to elucidate the prevalence and implications of disabilities resulting from RTIs in Rwanda. Drawing upon recent empirical data, we advocate for robust, evidence-backed strategies aimed at mitigating the incidence of RTIs and enhancing the rehabilitation services post-injury. Through a comprehensive study, this brief not only seeks to spotlight the gravity and specifics of the issue but also to catalyze transformative changes in how these injuries are managed and prevented.

Figure 1. Average score of domains and WHODAS 2.0.

Among the 368 patients, the overall disability score of all domains was mild (22.9), the most affected domain was life activities with 26.46 and participation in life with 23.8 (Allen Ingabire et al., 2024).

Figure 2. Disability level according to the WHODAS 2.0 Domains.

Most participants post-traffic accident was not disabled in interpersonal skills (83%), communication (81%), self-care (66%), and mobility (53%), with severe disability in societal participation and life activities (28%) (Allen Ingabire et al., 2024).

Figure 3. Probability of disability vs Age group, Socioeconomic status, KTS and Rehabilitation.

The study reveals that the probability of having no disability is higher in younger individuals (36.9%), with milder cases (49%), moderator cases (9.8%), and severer cases (4.3%). The probability of disability increases with age (50-70 years), socioeconomic status (I), and with KTS. Rehabilitation improves moderate and severe disabilities (Allen Ingabire et al., 2024).

Methods

Study design and setting: A cross-sectional analysis was adopted for this study, conducted across five major referral hospitals in Rwanda. This design was selected to capture a snapshot of the health outcomes and rehabilitation status of individuals who sustained Road Traffic-Related Orthopaedic Injuries (RTOI) in the year 2019.

Participants: The study involved 368 adults who were victims of RTOI. These participants were identified from hospital records and included based on specific criteria: individuals aged 18 and over who had sustained injuries in traffic accidents in 2019 and had undergone or were undergoing treatment at one of the selected hospitals. Data was gathered two years post-injury, between June 2, 2022, and August 31, 2022. Participants filled out a series of detailed assessment forms to evaluate the functional outcomes of their injuries. This included the World Health Organization Disability Assessment Schedule (WHODAS 2.0) (Üstün et al., 2010). Questionnaire to assess overall impairment levels, along with the Upper Extremity Functional Scale (UEFS) (Pransky et al., 1997) and Lower-Extremity Functional Scale (LEFS) to specifically measure limb functionality (Tumusiime et al., 2014). The data collected were analyzed using a combination of descriptive and inferential statistical techniques. The Chi-square test was utilized for categorical data to identify patterns and associations, while multinomial regression models helped explore the predictors of different disability outcomes. All analyses were performed using R Studio (https://r4ds.hadley.nz/), which provided robust tools for managing complex data sets and conducting extensive statistical evaluations.

Conclusion/Discussion

The analysis undertaken in this study illuminates a growing crisis of orthopedic injuries stemming from road traffic accidents in Rwanda, where almost half of such incidents result in significant impairments. With an orthopedic injury rate at 49% and a consequential disability prevalence of 35.6%, the ramifications on public health and on socioeconomic structures are profound and far-reaching. The data not only reveal the extensive nature and severity of these disabilities but also highlight a distressing insufficiency of rehabilitation services; a critical 37.1% of the injured lack proper access to necessary rehabilitation, exacerbating the severity and prolongation of disabilities.

Our findings establish a direct correlation between inadequate post-injury care and increased severity and persistence of disabilities, particularly affecting those in higher age brackets and individuals initially subjected to severe injuries. The study emphasizes the drastic disparity in outcomes for those receiving adequate rehabilitation versus those who do not, with those missing out on rehabilitation services experiencing considerably worse outcomes.

Ethical and consent

We obtained the ethical approval to conduct the study from the University of Rwanda College of Medicine and Health Sciences Institutional Review Board (18/CMHS IRB/2022) obtained on the 09 March 2022. The Rwanda National Research Committee operating in the Ministry of Health approved this study (NHRC/2022/PROT/014) obtained on 14 March 2022 and the collaboration with the Rwanda Biomedical Centre (5535/RBC/2022) injury department. We obtained the local ethical approvals from the five hospitals’ ethics committees: CHUK (EC/CHUK/051/2022) of the 30 March 2022, CHUB (REC/UTHB/089/2022) of the 21 March 2022, RH (313/RRH/DG/2022) of the 12 April 2022, KFH (EC/KFH/015/2022) of the 31 March 2022, RMH (RMH IRB/027/2022) of the 25 March 2022. All participants signed the consent form before enrolment into the study, and all data was kept confidential for only the study’s purposes.