Post-road accident psychological trauma and barriers to care among survivors at Kisii level five hospital, Kisii County, Kenya

Abstract

Road traffic injuries, (RTIs) are a recognized cause of physical injuries, disabilities, mental trauma and death making it an important public health problem. Globally, RTIs are projected to become the third leading cause of loss of healthy life and disease burden by 2030, yet health care systems are inadequately prepared for this challenge. Kenya is one of the countries with high RTI burden, with over 3,000 people dying annually and survivors exerting huge burden on the health care system. Therefore, the study recruited 191 in and out patients RTI survivors to study psychological trauma and barriers to care. Physical injuries of RTIs are known. However, the burden of psychological trauma and barriers to care in Kisii County are largely unknown. This was a cross-sectional hospital based study targeting survivors above 18 years of age. The Hospital was purposefully chosen as it serves as the hospital of choice for RTI trauma care. Kisii County was chosen because it has 8 of the II major accident black-spots in Nyanza. The study focused on documenting social demographic characteristics, psychological trauma and barriers to trauma care as well as establishing the relationship between sociodemographics and psychological trauma. Data were collected by use of interview schedule and observational checklist. It was entered into MS Excel database and analyzed using SPSS version 15.0 statistical software. Linear chi-square was used to test for levels of significance. Thematic analysis for qualitative data used interpretative phenomenological analysis based on personal constructs theory. More males than females suffered the blunt of road accidents at 67% and 33%, respectively. Majority were aged 21-49 years old, a population that was economically productive. 70% were married; 68% had at least secondary school level of education; 52% were in informal and 18% formal employment. Overall, survivors experienced various psychological traumas: 94% had flashbacks and horrific memories; 91% had travel anxiety and panicky tendencies; 87% insomnia and 86% exhibited avoidance to board automobiles. Equally, survivors encountered various barriers to trauma care, with 89% transported to hospital in public transport; 80.1 (Yo received trauma care from lay persons. Cumulatively, 78% had trauma services delayed; 70% sold investments and 56% borrowed to pay for trauma care. Chisquare tests showed that avoidance behavior and travel anxiety were more significant in out-patient than in-patients; (t = 3.8, df = 1, P = 0.00 I). It also showed that RTI psychological trauma was significant in survivors with at least secondary level of education compared to primary level; (X2 = 4.1, df=1 and p = 0.001). Altogether, RTIs are major health and economic burdens. Overall, married, economically active men aged 21-49 suffered the blunt of RTIs. These study results will stimulate interest for further research in RTI psychological trauma in other regions. Kisii County and elsewhere will use data to develop RTI trauma care policy. Ministry of Health will utilize the data for health promotion. Eventually, RTI Trauma care will be optimized thus improved health care for injury survivors.