The health burden and cost of Motorcyle crash injuries presenting to tier iii hospitals in Kisumu city, Kenya

Abstract

Globally, there are more than 1.35 and 50 million road traffic fatalities and injuries repectively that occur each year, of which 28% are motorcyclists deaths. About 3000 die due to road traffic fatalities, with estimated loss of US$4 billion annually in Kenya. The growth of motorcycles usage for public transport in Kenya has resulted in corresponding surge in fatalities in the last 15 years. Motorcycle related fatalities increased from 6% in 2005 to 36.6%, in 2021. There is no national data on non-fatal motorcycle injuries. In Kisumu City, motorcycle fatalities increased by 51.2% between the year 2010 and 2016. To date, there is no study specifically focusing on health burden and cost of motorcycle crash injury cases in Kisumu City. Understanding the burden of motorcycle crash injuries can serve as a reference point for resource allocation and priority setting and ensure that motor vehicle crashes are ranked equitably in terms of safety investment. This study assessed the health burden and cost of motorcycle crash injury cases presenting to Tier III hospitals in Kisumu City for a period of six months (May, 6th 2019-November 6th 2019). These hospitals are: Jaramogi Oginga Teaching and Referral hospital, Kisumu county hospital, and Agha-khan University hospital. Specific objectives were to: determine the pattern of motorcycle injuries presenting to the hospitals; to determine the burden imposed on the health care services by motorcycle injuries; to quantify the cost incurred by the motorcycle injury patients, and; and to determine factors influencing the cost of motorcycle injuries. This was prospective study using both quantitative and qualitative strategies involving total population sampling technique which enrolled all 1073 motorcycle injury patients that presented to the hospitals. Inferential statistics including; Analysis of Variance was used to test for mean length of stay, and and associated factors. Multivariate logistic regression was used to assess factors influencing cost of injuries. Data were presented in tables, graphs, and charts. A total of 1073 motorcycle injured patients representing 50.3% of all the road traffic crash injuries, out of which 73.6% were males (M: F ratio= 2.8:1). The average age was 29.6 years (±standard deviation [SD] 12.19; range=2–84). Majority of crashes occurred during the day (79.1%), and week days (82%). Helmet non-use was 69.3% among motorcycle users. Head injuries and injuries to the limbs were overriding (63.8%). There were a remarkable proportion of deaths in both (70.5%) motorcycle rider and pillion passenger than other types of road users. Motorcycle crash injury cases represented 2.0%, 12.0%, and 13.6% of total emergency visits, total injuries, and total admissions to the hospitals, respectively. On average motorcycle injury cases were warded for 19.8 days± SD 8.23 and was the highest compared to other injuries. Surgery was required by 89.3% of those admitted. The total cost was Ksh. 158,236,383(US $ 1276099.9) with indirect cost representing 69.3%. The medical costs contributed 40% of direct costs. The mean value of preventing motorcycle injuries (VOSI) and fatalities (VOSL) was Kshs. 32,825,719,250 (US$ 26,472,354.23). Human factors like being Males (OR = 6.27, CI = 3.15-14.47; Married couples (OR = 4.571, CI = 1.60-13.06), alcohol use (OR = 4.67, CI = 1.55-8.51), helmet non use (OR = 6.964, CI = 3.32-14.86) being motorcycle rider (OR = 6.04, CI = 0.60-60.48.), influenced significantly the total cost and willingness to pay. In addition hospital factors like the principal diagnosis, head injuries (OR=7.470 CI=0.21.15.18); radiological investigation carried out (OR= 109.08 CI=4.001-2223.93) were more likely to pay higher costs than those who do not, hospital length of stay(OR= 109.017 CI=4.001-2223.93), craniotomy (OR=10.25; CI=-2.17—19.28) admission to intensive critical care unit (OR=2564.68 CI=503.61-13060.82); impacted significantly on the medical cost and willingness to pay for the reduction of road traffic fatalities. These findings confirmed substantial morbidity, mortality and cost of motorcycle injuries, comprehensively described the spectrum of the impact of crashes on motorcycle injured cases, health system, provide information to the body of literature on motorcycle transport and potentially will assist in policy decisions on road safety focusing on motorcycle use.