Epidemiology of spinal cord injuries: a reflection of changes in South African society

Abstract

The records of all patients (492 males and 124 females) admitted into a spinal rehabilitation programme over a period of 6 years were reviewed. Most of the patients were in the age group 20-29 years and trauma accounted for 89% of all spinal cord lesions. Gunshot injuries were the commonest (36%), followed by injuries related to motor vehicle accidents (MYA) (25%), stab wounds (20%) and falls from heights (2.4%). Aetiological patterns changed over the 6 year period covered: gunshot injuries increased markedly and stab wounds decreased in number. The records of a medico-legal laboratory in the same geographic region revealed the same trend. Neurological recovery rates were better in patients with stab wounds and nontraumatic lesions than in those with MY A related injuries and gunshot wounds. When compared to similar studies from other countries, our results show a disproportionately high incidence of violent injuries, particularly gunshot wounds, in South African plegic patients. We concluded that the recent sociopolitical changes and especially the general escalation of violence in the country, is reflected in the observed changes in the epidemiology of spinal cord injuries

The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate

“…[71][72][73] Violence-related TSCI occurs in regions of conflict or high availability of weapons (gunshot wounds and stabbings). 7,46,74 The Maps reveal a band of violence through North and South America into Southern Africa and the Middle East. High rates of gunshot injuries are present in the USA and Brazil and the world's highest proportion in the country of South Africa.…”

“…High rates of gunshot injuries are present in the USA and Brazil and the world's highest proportion in the country of South Africa. 46,51,74,75 Greenland (Western Europe) also has a high proportion of violence (self-harm), causing TSCI with high rates of attempted suicide. 14 High suicide rates seem to predominate in Scandinavian countries.…”

Traumatic spinal cord injury in Botswana: characteristics, aetiology and mortality

“…18 In low-and middle-income countries, paraplegia seems to be more common (52-95%), 1,4 which is also reported from Sub-Saharan Africa (70-75%). 5,8 This might be explained by high prehospital mortality with cervical injuries. C1-4 were the most common levels of injury, most likely contributing to the high in-hospital mortality rate.…”

“…8,9 In our study, stabbing was the primary form of violence, with only one gunshot injury. Previous studies from low-or middle-income countries have shown that fall injuries result predominantly from falling from trees or roofs.…”

“…6 In many Sub-Saharan African countries, RTC is still the leading cause. 3,5,7 There are, however, exceptions with violence in South Africa, 8,9 falls in Senegal 10 and collapsing tunnels in one part of Nigeria being common reasons. 11 Acute mortality has, with increased availability and quality of specialised care and acute transportation, decreased to almost zero in parts of the industrialised world.…”