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158 Paediatric Trauma: Epidemiology, Prevention, and Control
Table 25.1: Childhood road traffic injuries with emphasis on pedestrian knockdowns in sub-Saharan Africa.

Number of road traffic Number of pedestrian
Source* Country Age bracket (years)
injuries injuries**
Kibel SM, et al., 1990 South Africa 0–12 1311 927 (70.7)

Abantanga FA, et al., 1998 Ghana 0–14 271 219 (80.8)

Lerer LB, et al., 1997 South Africa 0–14 150 123 (82.0)

Roux P, et al., 1992 South Africa 100 91 (91.0)

Archibong EO, et al.,1996 Nigeria 0–14 17 12 (68.6)

Adejuyigbe O, et al., 1992 Nigeria 0–15 16 9 (56.3)

Adesunkanmi ARK, et al., 1998 Nigeria 0–15 324 292 (90.0)

Solagberu BA, 2000 0–15 169 109 (64.5)

*See Suggested Reading at the end of the chapter.
**Numbers in parentheses show pedestrian injuries as a percentage of road traffic injuries.

4 years of age, most fall-related injuries occur at home; in those aged 5
to 15 years, approximately half of the falls occur at home and about a
quarter at school on playgrounds during sports and recreational activi-
ties. Studies have shown that infants are at risk of falling from furniture
or stairs, toddlers are at risk of falling from windows and beds, and
older children are at risk of falling from playground equipment, espe-
cially climbing equipment and trees. Fall injuries range from very minor
(bump or bruise) to severe, depending on the height of the fall, and may
result in fractures, cuts, head injury, or even death.
The following ways children fall and injure themselves is by no
means exhaustive. Falls can occur on level ground while playing or
running, or from a height. Falls may occur either at home or in school.
Locations for unintentional falls include playgrounds (from equipment
such as climbing apparatus, trampolines, seesaws, tree houses, swings
and so on); football fields; or from trees (especially fruit trees). Other
fall scenarios are from multistorey buildings, down the stairs, from cots
or beds, in the bathroom (due to water and slippery surfaces), or from
objects or collapsing walls falling on children. Falls from the back or
Figure 25.1: Injury sustained by an 8-year-old boy who climbed a carpenter’s arms of caregivers/attendants also can cause injury.
work table to pluck mangoes from a mango tree. He fell off the table, and
in the process fractured his radius and ulna. He was treated by a traditional Fall injuries can be blunt or penetrating, with the possibility of
bonesetter who applied herbal concoctions. This is the end result of his fall. permanent disability, loss of an organ or part of it (Figure 25.1), or
Treatment in hospital was by above-elbow amputation of the right upper limb. even death.
He survived the ordeal, but he will be permanently disabled.
Burns
Paediatric burn injuries in sub-Saharan African are rampant and often
Falls lead to permanent disfigurement or death. The majority of fire deaths
Unintentional falls are usually the most common cause of nonfatal injury occur in homes, and most victims die from smoke and toxic gases rather
leading to a hospital visit in children younger than 15 years of age in than from the actual burns. Factors cited that may lead to an increase
developing countries. Accident and emergency (A&E) departments and in burn injury include: poverty, illiteracy, cooking with open fires, and
outpatient surveillance systems show that falls are one of the most com- smoking. It is difficult to infer the rate of paediatric burns in commu-
mon mechanisms of injuries that require medical care and the most com- nities in Africa because there are not many community-based studies
mon nonfatal injury that at times needs hospitalisation. As many as 60% available. Most of what we know about burns is largely from hospital-
of all visits to the emergency department due to unintentional injuries based studies. Available literature about paediatric burns treated per
in children younger than 1 year of age are due to falls. The combination annum in Africa reveals the following:
of inquisitiveness, immature motor skills, and lack of judgment renders • Luanda, Angola – 1,407
infants and toddlers particularly susceptible to falling. Most studies
identify young age (0 to 6 years), male sex, and low socioeconomic • Ashanti Region, Ghana – 1,300
status as consistent risk factors for fall injuries. In children younger than
• Abidjan, Cote d’Ivoire – 195