Household economic impact of road traffic injury versus routine emergencies in a low-income country

Hani Mowafi*, Brian Rice, Rashida Nambaziira, Gloria Nirere, Robert Wongoda, Matthew James, GECC Writing Group, Mark Bisanzo, Lori Post

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction: Road traffic injuries (RTIs) are increasing and have disproportionate impact on residents of low- and middle-income countries (LMICs) where 90% of deaths occur. RTIs are a leading cause of death for those aged 15 – 29 years with costs estimated to be up to 3% of GDP. Despite this fact, little primary research has been done on the household economic impact of these events. Methods: From July to October 2016, 860 consecutive emergency department patients were enrolled and followed up at 6-8 weeks to assess the household financial impacts of these emergency presentations. At follow-up, patients were queried regarding health status, lost wages or schooling, household costs incurred due to their injury or illness, and assets sold. Results: 860 patients were enrolled and 675 patients (78%) completed follow-up surveys. Of those, 660 had a confirmed reason for visit - 303 (45%) road traffic injuries, 357 (53%) other emergency presentations (non-RTI) - encompassing medical presentations and other types of injury, and reason for visit was missing for 15 patients (2%). More than 90% of RTI patients were working or in school prior to their injury. In the economically productive ages (15-44 years) RTI predominated (70%) vs non-RTI (39%). RTI patients were more likely to report residual disability (78.2% RTI vs 68.1% non-RTI, p=0.004). All emergency patients reported difficulty paying for basic needs (food, housing and medical expenses). More than ⅓ of emergency patients reported having to sell assets in order to meet basic needs after their illness or injury. Despite similar hospital costs and fewer lost days of work for both patients and caregivers, the mean financial impact on households of RTI patients was 37% more than for non-RTI patients. These costs equalled between 6-16 weeks of income for patients based on their occupation type and median reported pre-hospitalization income. Discussion: Ugandan emergency care patients suffered significant personal and household economic hardship. In addition to the need for policy and infrastructural changes to improve road safety, these findings highlight the need for basic emergency care systems to secure economic gains in vulnerable households and prevent medical impoverishment of marginal communities.

Original languageEnglish (US)
Pages (from-to)2657-2664
Number of pages8
Issue number9
StatePublished - Sep 2021


  • Economic impact
  • Emergency
  • Injury
  • Low- and middle-income countries
  • Road traffic

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine


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