Table 1
Demographic characteristics of children (N = 449).
| Characteristic | n | % |
|---|---|---|
| Age (n = 447) | ||
| <5 years | 142 | 31.8 |
| 5–10 years | 171 | 38.2 |
| 11–15 years | 134 | 30.0 |
| Gender | ||
| Boys | 297 | 66.1 |
| Girls | 152 | 33.9 |
| District Hospital | ||
| Kirehe | 292 | 65.0 |
| Rwinkwavu | 96 | 21.4 |
| Butaro | 61 | 13.6 |
| Type of insurance | ||
| CBHI* (Mutuelle) | 348 | 77.5 |
| Private insurance | 78 | 17.4 |
| No insurance | 23 | 5.1 |
[i] * CBHI: Community Based Health Insurance.
Table 2
Cause and presentation of injuries for children in rural Rwandan district hospitals (N = 449).
| n | % | |
|---|---|---|
| Description of injuries | ||
| Injury type | ||
| Fall | 261 | 58.1 |
| Burn | 101 | 22.5 |
| Road traffic accident | 67 | 14.9 |
| Animal-related injury | 20 | 4.5 |
| Cause of burn (n = 100) | ||
| Hot liquids | 89 | 89.0 |
| Fire burns | 8 | 8.0 |
| Electrical | 2 | 2.0 |
| Insecticides | 1 | 1.0 |
| Vehicle involved in road traffic accident (n = 67) | ||
| Motorcycle | 56 | 83.6 |
| Car | 11 | 16.4 |
| Child involved in accident (n = 52) | ||
| Pedestrian | 38 | 73.1 |
| Passenger | 14 | 26.9 |
| Cause of animal-related injury (n = 20) | ||
| Dog bite | 11 | 55.0 |
| Snake bite | 7 | 35.0 |
| Hit/bitten by domestic animal (not dog) | 1 | 5.0 |
| Hit/bitten by wild animal (not dog) | 1 | 5.0 |
| Presentation of injuries | ||
| Patient’s status on arrival (n = 432) | ||
| Stable† | 383 | 88.7 |
| Confused | 45 | 10.4 |
| Coma | 4 | 0.9 |
| Patient’s primary diagnosis of injury | ||
| Closed fracture/dislocation | 172 | 38.3 |
| Open fracture | 117 | 26.1 |
| Burn | 92 | 20.5 |
| Soft tissue injury | 30 | 6.7 |
| Head/spine injury | 25 | 5.6 |
| Infection | 3 | 0.7 |
| Abdominal and thoracic injury | 2 | 0.4 |
| Other | 8 | 1.8 |
[i] † Stable refers to the patient status in which his/her consciousness is lucid. Not in coma nor confused.
Table 3
Clinical care provided to injured children at the district hospital (N = 449).
| Type of care provided | n | % |
|---|---|---|
| Vital signs and exams | ||
| Heart rate recorded | 400 | 89.1 |
| Blood pressure recorded | 107 | 23.8 |
| Breath rate recorded | 354 | 78.8 |
| Glasgow Coma Scale score recorded | 214 | 47.7 |
| Imagery exam done | 142 | 31.6 |
| Blood tests performed | 49 | 10.9 |
| Non-surgical care | ||
| Intra Venous fluid administered | 70 | 15.6 |
| Blood transfusion conducted | 9 | 2.0 |
| Antibiotics administered | 210 | 46.8 |
| Pain medication administered | 388 | 86.4 |
| Wound dressed | 250 | 55.7 |
| Anti-venom for patients with snake bite (n = 7) | 7 | 100 |
| Anti-rabies for patients with animal bite (n = 13) | 9 | 69.2 |
| Surgical care | ||
| Patients who received surgery | 166 | 37.0 |
| Type of surgical service (n = 166) | ||
| Closed reduction and immobilization | 120 | 72.3 |
| Wound debridement and suture | 41 | 24.7 |
| Exploratory laparotomy | 10 | 6.0 |
| Other surgery | 6 | 3.6 |
| Surgical provider’s cadre (n = 141) | ||
| General Practitioner | 114 | 80.9 |
| Specialist | 6 | 4.3 |
| More than one cadre | 21 | 14.9 |
| Type of anesthesia used (n = 166) | ||
| No anesthesia | 145 | 87.4 |
| Loco-regional anesthesia | 15 | 9.0 |
| General anesthesia | 6 | 3.6 |
| ASA class* for patients who received anesthesia (n = 21) | 21 | 100 |
| Surgical complications | 3 | 1.8 |
| Type of surgical complication (n = 3) | ||
| Surgical site infection | 1 | 33.3 |
| Poor bone alignment | 1 | 33.3 |
| Other surgical complication | 1 | 33.3 |
[i] * American Society of Anesthesiologists Classification.
Table 4
Outcomes among injured children (N = 449).
| Outcome | n | % |
|---|---|---|
| Patient outcomes | ||
| Successfully managed at outpatient clinic and discharged | 115 | 25.6 |
| Admitted to district hospital | 311 | 69.3 |
| Admitted to district hospital while waiting for appointment at referral hospital | 10 | 2.2 |
| Referred directly to tertiary care | 12 | 2.7 |
| Absconded from care | 1 | 0.2 |
| Length of stay at district hospital, in days; median (IQR) (n = 297) | 5 (3–10) | |
| Reason for referral to tertiary hospital (n = 7)* | ||
| Lack of specialists | 5 | 71.4 |
| Lack of drugs | 4 | 57.1 |
| Family preference | 1 | 14.3 |
| Better management | 1 | 14.3 |
[i] * Percentages exceed 100% because one patient could have been referred due to more than one reason.