Epidemiology and Patient-Reported Outcomes of Polytraumatised Patients Involved in Road Traffic Accidents in Namibia.

Abstract

Introduction: Road Traffic Accidents (RTAs) are a leading cause of death and disability among children and young adults aged 5–29 years, with many Low- and Middle-income Countries (LMICs) bearing a disproportionate burden. Polytrauma, defined as an Injury Severity Score (ISS) ≥ 15, carries significant clinical and socioeconomic consequences, yet the epidemiology and long-term outcomes of polytrauma remain underexplored in Namibia. This study examined the prevalence and epidemiological profile of persons aged 5–29 years with polytrauma (ISS ≥ 15) involved in RTAs in Namibia from 2019 to 2022 and assessed patient-reported outcomes (Health-Related Quality of Life (HRQoL)) following RTA-related polytrauma. Methods: A dual-phase design was employed. Phase 1 involved a retrospective review of cases drawn from the MVA Fund database. Cases meeting the inclusion criteria were RTA victims aged 5–29 years who sustained polytrauma (ISS ≥15) between 2019 and 2022 and completed the six-month rehabilitation milestone, regardless of survival status. Data on injury severity, crash type, transport mode, and demographics were analysed using descriptive and inferential statistics. Phase 2 consisted of a cross-sectional survey of survivors from the cohort which met the Phase 1 inclusion criteria. Data were collected using the EQ-5D-5L instrument, supplemented by a demographic data form, to capture participants' characteristics and HRQoL across five domains: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Survivors were recruited through convenience sampling for telephonic interviews, with proxy consent obtained for minors. All data were anonymised, validated and archived in accordance with institutional protocols, and ethical approval was obtained before implementation. Results: For Phase 1, 150 cases (26.0%) sustained polytrauma among the 559 RTA patients reviewed. The majority were male (62.7%), with prevalence highest in the 25-29 year age group. Regional distribution showed Khomas (22.7%) and Otjozondjupa (21.3%) contributing the largest proportions of cases. Ambulance services were the predominant mode of transport (75.3%), though notable regional disparities in emergency response were observed. The linear regression analysis revealed that head/neck and extremity injuries were most frequent, while thoracic and abdominal injuries emerged as the strongest predictors of trauma severity. Rollover (42.0%) and pedestrian vehicle accidents (23.3%) were identified as significant contributors to higher ISS scores. vi During phase 2, 90 survivors (60% of eligible cases) participated in the survey. Socioeconomic data indicated high unemployment (31.1%) and low educational attainment (42.2% less than high school) among participants. EQ-5D-5L responses showed moderate self-rated health (EQ-VAS mean, 69.9), with pain/discomfort (82.0%, slight to extreme) and anxiety/depression (56.6%, slight to extreme) as the most affected domains. Pearson's correlation analysis demonstrated that greater functional limitations were associated with lower EQ-VAS scores. Multiple linear regression further indicated that demographic and clinical variables did not significantly predict HRQoL outcomes, highlighting the role of contextual and social factors in shaping recovery trajectories. Conclusion: This thesis integrates clinical severity scoring with patient-reported HRQol outcomes in Namibia, demonstrating that recovery following an RTA is shaped less by anatomical injury patterns than by socioeconomic vulnerability. While thoracic/abdominal and head/neck injuries predict initial clinical severity, regression analysis showed that recovery trajectories were not explained by demographic or clinical variables alone. Instead, contextual and socioeconomic factors, such as high unemployment, low educational attainment, rural residence, and gendered social roles, appear central to long-term outcomes. The study recommends anatomically guided triage, development of a national trauma registry incorporating social indicators, strengthened rural emergency systems and community-based, gender-sensitive rehabilitation to promote equitable trauma care and improved recovery outcomes.