Epidemiology and outcomes of injuries in Kenya: A multisite surveillance study Isaac M. Botchey, Jr, MD, MPH, a Yuen W. Hung, MHS, a Abdulgafoor M. Bachani, PhD, MHS, a Fatima Paruk, MD, MPH, a Amber Mehmood, MBBS, a Hassan Saidi, MD, MMed, FACS, b and Adnan A. Hyder, MD, MPH, PhD, a Baltimore, MD, and Nairobi, Kenya Background. Injury is a leading cause of disability and death worldwide, accounting for over 5 million deaths each year. The injury burden is higher in low- and middle-income countries where more than 90% of injury-related deaths occur. Despite this burden, the use of prospective trauma registries to describe injury epidemiology and outcomes is limited in low- and middle-income countries. Kenya lacks robust data to describe injury epidemiology and care. The objective of this study was to investigate the epidemiology and outcomes of injuries at 4 referral hospitals in Kenya using hospital-based trauma registries. Methods. From January 2014 to May 2015, all injured patients presenting to the casualty departments of Kenyatta National, Thika Level 5, Machakos Level 5, and Meru Level 5 Hospitals were enrolled prospectively. Data collected included demographic characteristics, type of prehospital care received, prehospital time, injury pattern, and outcomes. Results. A total of 14,237 patients were enrolled in our study. Patients were predominantly male (76.1%) and young (mean age 28 years). The most common mechanisms of injury were road traffic injuries (36.8%), falls (26.4%), and being struck/hit by a person or object (20.1%). Burn was the most common mechanism of injury in the age category under 5 years. Body regions commonly injured were lower extremity (35.1%), upper extremity (33.4%), and head (26.0%). The overall mortality rate was 2.4%. Significant predictors of mortality from multivariate analysis were Glasgow Coma Scale #12, estimated injury severity score $9, burns, and gunshot injuries. Conclusion. Hospital-based trauma registries can be important sources of data to study the epidemiology of injuries in low- and middle-income countries. Data from such trauma registries can highlight key needs and be used to design public health interventions and quality-of-care improvement programs. (Surgery 2017;j:j-j.) From the Johns Hopkins International Injury Research Unit, a Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and the Department of Human Anatomy, b University of Nairobi, Nairobi, Kenya INJURIES kill more than 5 million people annually worldwide with more than 90% of the deaths occurring in low- and middle-income countries (LMICs). 1 In 2015, mortality resulting from road traffic injuries (RTI) exceeded the mortalities from malaria, tuberculosis, and HIV/AIDS worldwide. 2 Additionally, injury fatality rates in LMICs are 6 times higher than in high-income countries. 1 In the sub-Saharan African (SSA) re- gion, injury fatality ranks among the highest in the world. 3 The myriad of factors contributing to the high injury mortality rates in LMICs include rapid urbanization, poor road networks, underen- forcement of road safety laws, and the poor quality of trauma care systems. 4-11 Despite the high burden of injuries in LMICs, data on patterns of injury and care of the injured in SSA are limited, with the exception of South Africa. 12-18 Attempts to describe the epidemiology and outcomes of injuries in SSA using hospital and administrative data have been helpful, but such data are limited. 17,19-21 The establishment of prospective, hospital-based trauma registries is an essential alternative for meeting this challenge. 22 Supported by the Global Road Safety Programme funded by Bloomberg Philanthropies. Accepted for publication January 26, 2017. Reprint requests: Adnan A. Hyder, MD, MPH, PhD, Interna- tional Injury Research Unit/Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205. E-mail: ahyder1@ jhu.edu. 0039-6060/$ - see front matter Ó 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2017.01.030 SURGERY 1 ARTICLE IN PRESS