|Year : 2016 | Volume
| Issue : 2 | Page : 48-53
Community-based study of road traffic accident among Almajirai in Zaria
Jerry Godfrey Makama1, Tukur Dahiru2, Alaji A Aliyu2
1 Department of Surgery, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria
2 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
|Date of Web Publication||9-Aug-2017|
Jerry Godfrey Makama
Department of Surgery, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna
Source of Support: None, Conflict of Interest: None
Background: Trauma is a leading cause of morbidity and mortality among people of age <45 years. Almajiri is a boy of age 5–15 years that has left his parents to a distanced place in search of Islamic knowledge. They are often left on their own to cater for themselves, roaming on roads and streets from one place to another searching for alms and food. Therefore, we aim to assess the characteristics of road traffic injury among the Almajirai in Zaria.
Materials and Methods: This was a cross-sectional, descriptive study, conducted in Zaria metropolis from June to December 2012. A multistage sampling technique was used to sample clusters of Almajirai. A structured interviewer-administered questionnaire was used to obtain the data. The information obtained from the respondents included the biodata, basic understanding of the use of roads, application of traffic rules and regulations, involvement in road traffic crash (RTC), the frequency and severity of RTC, where the Almajiri was managed and the outcome of each episode. The analysis was done using SPSS version 20 for the purpose of generating frequency tables, pie and bar charts including mean and Chi-square where applicable.
Results: A total of 417 Almajirai participated in the study. Of this number, three hundred and sixteen (75.8%) admitted being involved in at least one form of RTC while 101 (24.2%) were not. Most accidents (23.5%) occurred in their neighborhoods and during rush hours (25%). Only 1%–2% had basic knowledge of road signs and proper use of busy roads. The majority (41.5%) were involved as pedestrian with injury, commonly, affecting the lower extremity.
Conclusion: RTC was a significant cause of injury among the Almajirai in Zaria. The most common injury was trauma to the lower extremity. Special attention needs to be paid to this group of children in our society by all road users.
Keywords: Almajiri, community-based, road traffic accident
|How to cite this article:|
Makama JG, Dahiru T, Aliyu AA. Community-based study of road traffic accident among Almajirai in Zaria. Afr J Trauma 2016;5:48-53
| Introduction|| |
Trauma is a leading cause of morbidity and mortality among people of aged <45 years,, and a significant number of them are children and young males., Almajiri is a child who is usually, a boy of age between 5 and 15 years that has left his parents to a distanced place in search of Islamic knowledge. “Almajirai boys” are therefore, a group of children who have left their parents and are under the care of an Islamic scholar. This care among other things includes feeding, accommodation, social and spiritual care. This is a common practice that is found mainly in the northern part of Nigeria, particularly among Hausa communities. In most instances, in this environment, the Islamic scholar is a retired, elderly man and without any viable economic resources, who is known to have a wealth of experience in Islamic knowledge and teaching skills. Because, they are financially incapacitated, the Almajirai are often left on their own to cater for themselves, roaming from one place to another searching for alms and food. They move on the roads, including highways and major streets in various groups more often in the course of doing this. Thus, they constitute a special group of children at higher risk of road traffic crash (RTC) than their counterparts who are not Almajirai. We hypothesized that there is a significant burden of trauma among this groups of Almajirai in our environment that has been neglected for long. Therefore, we aim to determine the burden of road traffic injury among the Almajirai in Zaria.
| Materials and Methods|| |
Zaria is particularly suitable for this study because it has been a nucleus of Islamic education since the 19th century A.D. Today Zaria is widely known for the high concentration of Islamic schools of all types and levels. These Islamic schools are largely populated by the Almajirai who have left their parents in search of Islamic education.
The Zaria area comprises, majorly, two local government areas: Zaria and Sabon Gari local government areas. In this study, the Zaria area was divided into four clusters, namely, Zaria Ciki, (city), Zaria Waje (outside city) Sabon Gari, Samaru and villages around Zaria. This is done to provide adequate representation of the study population.
This was a cross-sectional, descriptive study that was done in Zaria metropolis from June to December 2012. The study population was the Almajirai in identifiable Almajiri schools. The sample size was 385 Almajirai, calculated using the formula . A multistage sampling technique was used to sample the community or clusters of Almajirai. Of the entire Zaria metropolis, four areas were identified and selected by purposive sampling technique. Proportional allocation of Almajirai schools with a minimum number of thirty students was done in each area. The actual selection of the respondents (the Almajirai) was done by cluster sampling technique. In essence, all the Almajirai present in the so selected school at the time of data collection were interviewed until the sample size of 420 was achieved. A structured interviewer-administered questionnaire was used to obtain the data. The information obtained from the respondents/participants included the biodata, basic understanding of the use of roads including application of traffic rules and regulations and if the respondent has ever been involved in a RTC during the Almajiri program, the frequency of RTCs, severity, where the Almajiri was managed and the outcome of each episode. Responses to the questionnaire were inputted into a spreadsheet and analyzed using SPSS version 20 (Chicago, SPSS Inc) for the purpose of generating frequency tables, pie and bar charts where applicable.
Permission was sought and obtained from the local government authority of both Zaria and Sabon Gari Local government areas, the district heads, the “Mallam” (the Islamic teacher or scholar) in-charge of the school and each Almajiri, after a detailed explanation of the purpose of the data collection, how the information obtained will only be used for the purpose of the research and will not be disclosed to a third party. They were also told in details, the risks associated with granting consent to participate in the research and the options to decline and/or even withdraw, without consequences, in the course of the study.
| Results|| |
A total of 420 questionnaires were administered, but 417 were filled and returned given a respond rate of 99.3%. Therefore, data of 417 Almajirai that participated in the study were analyzed. Of this number, 316 (75.8%) admitted being involved in at least a road traffic accident (RTA) or the other while 101 (24.2%) were not. Majority 399 (95.7%) of respondents were in the age group of 5–10 years with a median age of 7 years. The common places where the accident occurred were shown in [Figure 1] with the most common place being inside “Angwa” (neighborhoods) (23.5%).
|Figure 1: Magnitude of road traffic accident among Almajirai on the main roads of Zaria metropolis|
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Risk of accident
Almost all (96%) of respondents agreed that the most common risk factor to RTA was crossing or being along the road. Environmental factors adjudged to have increased the risk of RTA among this group of children were shown in [Figure 2] with (25%) of the accidents occurring during rush hours (early morning 7–9 a.m. hours and late evening 5–7 p.m. hours).
|Figure 2: Environmental circumstance surrounding the road traffic accident among Almajirai|
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Knowledge on road safety
The knowledge of respondents about safe areas to cross the road was identified as shown in [Table 1]. However, 78% believe that the safest place to cross the road was where there was a traffic officer. Even though majority 364 (87.3%) of the respondents knew it was proper to look right and left before crossing the road, only 7 (1.7%) reported that they will look right side, left and right side again before crossing [Table 2]. Similarly, only (2%) appropriately responded that a pedestrian is expected to walk against the traffic while on the main road. However, 98% felt that a pedestrian is expected to walk along the traffic. Extremely few 49 (11.8%) could identify or correctly tell the full meaning of some basic road signs such as zebra crossing, pass sign, no U-turn, T-junction, animal crossing sign, and children crossing sign.
|Table 2: Frequency distribution of the number of times to look at the road before crossing|
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The Almajirai had different collision patterns of the accident as shown in [Figure 3]. Majority of the Almajirai 174 (41.8%) were involved in the RTA as pedestrian closely followed by motorcycle 87 (20.9%). Of those that were involved as pedestrians, most 110 (26.3%) of them were involved while attempting to cross the road. A multiple regression analysis of these factors showed that trying to cross the road as a pedestrian was associated with high risk of accident (P ≤ 0.0001) (n = 316).
About 46.3% of the Almajirai were noted to have had 2–3 RTCs since enrollment into the Almajirai program [Figure 4]. Overall, the burden of road traffic injuries among these children was calculated to be 0.8 per week.
|Figure 4: Trend of road traffic accidents by each Almajiri over the previous 1 year|
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The parts of the body that were mostly injured were extremities 147 (35.3%), abdomen 74 (17.7%) and chest 50 (12.0%), head and neck 45 (10.8%). In the majority of respondents 200 (48%), the injury sustained was not severe [Figure 5].
|Figure 5: Severity of the traumatic injury sustained following the road traffic accident|
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After the accidents, the Almajirai sought help at different places such as hospital/clinic 44 (10.6%), self-medication 47 (11.3%), medication from a chemist 59 (14.1%) remaining without treatment 62 (14.9%) with majority 104 (24.9%) of the Almajirai children ending up seeking the traditional healer for treatment. A good number 259 (62.1%) recovered completely from the injury they sustained because a significant percentage 200 (48%), had only minor injuries [Table 3].
|Table 3: Outcome of injury sustained, following the road traffic accident|
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| Discussion|| |
This study, a community-based assessment of the burden of RTA among Almajirai in Zaria, Nigeria showed that RTA was a significant cause of traumatic injury among the Almajirai. This suggests that measures that aim at trauma prevention, reduction of concomitant morbidity and increasing overall survival of the Almajirai victims should be an important and a vital component of policy formulation as is also reported by earlier authors.,,,
It has been reported that RTCs accounted for the majority of pediatric/adolescent trauma deaths.,,, It is, therefore, not surprising that the magnitude of morbidity among this neglected group of children is highly significant in Zaria metropolis. The findings of this study also corroborated with other reports in the African subregion.,,,
The high incidence of RTCs as a common cause of pediatric and adolescent trauma in this region may not be unconnected with the deplorable conditions of the roads, poor roadworthiness of the vehicles and the high prevalence of reckless driving, particularly on the highways., Moreover, other researchers have reported that the low literacy level and insufficient knowledge of the use of safety measures play a significant contributory role in the high rate of RTCs in this subregion.,, The assessment of the basic knowledge of Almajirai on the road regulations and signs revealed an extremely poor understanding. Comparatively, high literacy level and the understanding of traffic rules and regulations has been an essential, fundamental module that is believed to have enhanced the use of road in most civilized society.,,
The injury characteristics of this study were comparable to other children after serious trauma in the available literature.,,,,, About 50% of the greatest trauma was caused by traffic accidents involving pedestrians. The body part that was injured most often was the extremities, followed by the abdomen, the chest, and head and neck.,,,, The severity of some of the injuries sustained, was quite high, often warranting hospital admission, sometimes serious long bone fracture and loss of consciousness. This may be due to high number of poor roads, congested road traffic, nonenforcement of traffic legislations, and poor driving conditions.
The high number of deaths following road crashes worldwide led to the UN General Assembly resolution proclaiming a Decade of Action for Road Safety 2011–2020,, (A/64/255). The Decade of Action for Road Safety 2011–2020, aims to save lives by halting the increasing trends in road traffic deaths and injuries worldwide. It was thought that the implementation of this resolution in sub-Saharan Africa will result in substantial reduction in the high rate of road traffic deaths. However, in this study, the majority of the Almajirai, though agreed that walking along the road will naturally increase one's risk of being involved in an RTA, significant number of them have extremely poor knowledge about road safety. Not many of them were aware of basic traffic rules, regulations, and road signs. They were asked to identify some basic road signs such as zebra crossing, pass sign, no U-turn, T-junction, animal crossing sign, and children crossing sign extremely few could identify and/or explained the full meaning of the road sign. Therefore, these children may constitute an unmet group in the quest to reduce the burden of trauma worldwide, through the Decade of Action for Road Safety 2011–2020 campaign.
Osifo et al. and Sasser et al. reported that lack of organized emergency prehospital services in Nigeria has led most of the RTCs victims to depend only on passers-by and sympathisers providing resuscitation in the field. Therefore, it was not surprising that most victims in this study ended up in traditional healers' shops with varying numbers of them undergoing self-medication, attending to a roadside chemist or notably refuse to go to any place. Most of the victims that were fortunate to have been brought to hospital (deplorable public health centers) are often brought to the hospital by the use of public transport, as has also been reported previously.,,, These findings were so, probably, due to the abject poverty that have characterized most of this group of children and their host(s) (the Mallam).
Late presentation of victims of trauma (more than 12 h after the trauma), self-medication, care by a chemist and traditional healer in most cases were considerable challenges in this study. This, significantly, influenced the morbidity recorded in this study. This has also been expressed and corroborated by the previous reports.,,, It has been reported that in societies where there are an organized trauma rescue teams and emergency prehospital services, the outcome of treatment of similar cases has been good or improved.,,, This often translates into the early presentation of victims (within few hours of trauma) and attainment of prompt attention. Furthermore, previous reports,, have demonstrated the fact that outcomes of trauma correlate well with the timing and appropriateness of medical attention received than the severity of injury sustained. These studies revealed the utmost adverse population impact of trauma and supported greater prioritization and allocation of resources to preventive measures. As previously reported,, injury to the lower limbs was more common than upper limbs. However, in this study, about 13% of the participating children still had physical impairments. These impairments resulted from injuries to the extremities. Half of these children with physical impairments were limited in performing daily activities of life.
Notably, trauma is a significant cause of morbidity and mortality both acutely, following injury and in the long-term. Probably, this was further compounded by the low understanding of the rules and regulations governing the use of roads by the Almajirai. Documenting the overall burden of trauma is necessary to guide the appropriate allocation of limited healthcare and research resources. Enhanced efforts to reduce the burden of trauma should be a priority. Several measures need to be employed in epidemiological trauma research in Zaria. Studies involving municipals must precisely identified high-risk areas and also revealed different environmental mechanisms such as busy motor parks, around market site, and mega shopping complexes. Findings of this nature may increase the awareness of different urban places and better identify high-risk areas. Increased epidemiological understanding is needed to develop targeted primary prevention and effective trauma systems to deal with pediatric trauma in urban areas.
| Conclusion|| |
RTA was a significant cause of injury among the Almajirai in Zaria. The most common injuries were trauma to the extremities closely followed by injury to the torso, head and neck region and extremely few poly-trauma that were compounded by late referral, lack of emergency prehospital services and inadequate treatment received from a traditional healer, roadside chemist. Special attention needs to be paid to this group of children in our society by all road users. There is an urgent need for Federal Roads Safety Corps and other stakeholders that ensure safety roads to re-enforce and ensure compliance to speed limit, particularly within township roads.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2], [Table 3]