International Journal of Injury Control and Safety

Promotion

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Patterns of pre-hospital events and management

of motorcycle-related injuries in a tropical setting

Olufunso Simisola Aduayi, Victor Adovi Aduayi & Edward Oluwole Komolafe

To cite this article: Olufunso Simisola Aduayi, Victor Adovi Aduayi & Edward Oluwole Komolafe
(2016): Patterns of pre-hospital events and management of motorcycle-related injuries
in a tropical setting, International Journal of Injury Control and Safety Promotion, DOI:
10.1080/17457300.2016.1213300

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Published online: 09 Aug 2016.

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International Journal of Injury Control and Safety Promotion, 2016
http://dx.doi.org/10.1080/17457300.2016.1213300

Patterns of pre-hospital events and management of motorcycle-related injuries

in a tropical setting
Olufunso Simisola Aduayia, Victor Adovi Aduayib* and Edward Oluwole Komolafec
a
Department of Radiology, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria; bDepartment of Epidemiology and
Community Health, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria; cDepartment of Surgery, Obafemi Awolowo
University Teaching Hospitals Complex, Ile-Ife, Nigeria
(Received 3 February 2016; accepted 21 June 2016)

This study sought to highlight associated factors and evaluate outcomes of motorcycle-related injuries (MCRI) among
adults managed in a university teaching hospital in south-western Nigeria. The study was a cross-sectional descriptive
study of 150 adult patients presenting with MCRI at the adult accident and emergency unit of the hospital. Information on
the use of helmet, alcohol intake, number of pillion passengers, type of collision and time of arrival at hospital was
collected. Patients were followed up and questionnaires were completed after discharge, referral or death. The male to
female ratio was 4:1 with patients aged 20 29 years (n D 44, 29.3%) having the highest incidence of MCRI. Only 4
(2.7%) patients used helmet at the time of injury. About one-third of the patients (n D 59, 39.3%) arrived at the hospital
within 1 6 hours after injury. The limbs were the most frequently involved site of injury, hence orthopaedic procedures
constituted the highest number of interventions. Mortality rate was 10.7% (16 out of 150) with head injury being the
leading cause. MCRI requires more emphasis on preventive measures. This will play a crucial role in the reduction of the
associated morbidity and mortality.
Keywords: motorcycle; helmet; road traffic accident

Introduction 2004; Cawich et al., 2009; Galukande, Jombwe, Fualal, &

The increase in the use of motorcycles popularly called
‘okada’ in Nigeria has resulted in a rise in motorcycle-
related injuries (MCRI) which are often life altering or
life threatening. MCRI constitutes a major but neglected
emerging public health problem in developing countries
and contributes significantly to overall road traffic injuries
(RTI) (Chalya et al., 2010; Nantulya & Reich, 2002;
Oluwadiya et al., 2009; Organization, 2002; Solagberu
et al., 2006). Even in developed countries with low
morbidity and mortality rates from motorcycle injuries,
the risk of dying for every kilometre travelled from a
motorcycle crash is 20 times higher than from a motor
vehicle crash (Asogwa, 1999). With the most vulnerable
road users being pedestrians, cyclists and riders of motor-
cycle (Roge, El Zufari, Vienne, & Ndiaye, 2015), recent
trends suggest that by 2030 road traffic deaths will
become the fifth leading cause of death unless urgent
action is taken (Mathers & Loncar, 2006). During
2008 2010, the number of motorcycle injuries was about
70% 80% of all accidents, and this figure tends to
increase each year. While mortality in motorcycle crashes
is largely due to head injury, limb injury is the leading
cause of morbidity (Alicioglu, Yalniz, Eskin, & Yilmaz,
Gakwaya, 2009; Naddumba, 2004; Nzegwu, Aligbe,
Banjo, Akhiwui, & Nzegwu, 2008; Oluwadiya, Oginni,
Olasinde, & Fadiora, 2004; Solagberu et al., 2006).
Several factors determine the degree of morbidity and
mortality patterns following motorbike-related accidents
such as use of protective helmets, site of injury, type and
mechanism of collusion and injury-medical care interval
(Boniface, Museru, Kiloloma, & Munthali, 2016). Other
commonly described motorcycle accidents are single-bike
accidents, left-turn collisions, speeding and riding under
the influence of drugs and/or alcohol as described by
National Highway Traffic Safety Administration
(NHTSA) (Haas, Mattson, Jones, & Morris, 2013).
Sometimes road hazards cause a bike to hit an
obstruction and the driver to lose control of the vehicle,
especially if the driver is speeding. Roughly 37 percent
of the motorcyclists killed in motorcycle crashes in
Texas in 2011 were riding intoxicated, according to
NHTSA (Haas et al., 2013; Turner, Higgins, & Geedi-
pally, 2013). These accidents can be attributed to the
fact that motorcycles are often hard to spot in dense
traffic. Further, some motorists may misjudge a
motorcycle’s distance or speed from the intersection, or

*Corresponding author. Email: adovi.aduayi@eksu.edu.ng

Ó 2016 Informa UK Limited, trading as Taylor & Francis Group

2 O.S Aduayi et al.

may simply try to rush through the intersection hoping Table 1. Socio-demographic characteristics of patients.
to beat the motorcycle. Characteristics Frequency (N D 150) Percentage (%)
This study highlights the pre-hospital events and fac-
tors that were associated with MCRI and evaluates the Age (in years)
management outcomes in an adult Nigerian population <20 5 3.3
presenting for trauma care in a tertiary health care facility. 20 29 44 29.3
30 39 32 21.3
40 49 24 16.0
Methodology 50 59 17 11.3
This is a cross-sectional descriptive study conducted at 60 28 18.7
Obafemi Awolowo University Teaching Hospital, Ile-Ife Sex
in south-western Nigeria. Approval for the study was Male 119 79.3
obtained from the hospital Ethics Committee. Female 31 20.7
The study population consisted of 150 patients pre- Occupation
senting with motorcycle-related injuries at the adult acci- Commercial motorcyclist 25 16.7
dent and emergency unit of the hospital. The patients Farmer/hunter 23 15.3
were recruited into the study, prospectively, within a year. Artisan 20 13.3
Victims of RTI from other causes and unconscious vic- Private business/trader 19 12.7
tims with no relative or eye witness to volunteer informa- Student 17 11.3
tion were excluded from the study. After obtaining Civil servant 16 10.7
informed consent, relevant information was collected Unemployed/retiree 13 8.7
using a structured questionnaire. This included bio data, Clerk/security officer 9 6.0
the use of helmet, intake of alcohol, type of motorcycle, Health worker 8 5.3
number of passengers on motorcycle, type of collision,
time of occurrence, mode of transportation to the hospital
and time of arrival at hospital. Patients were followed up
from the time of presentation till discharge from the hos- (35.7%) motorcyclists admitted to taking alcohol on the
pital, referral or death. The management of patients, final day of occurrence, four (28.6%) denied alcohol intake
outcome, length of hospital stays and available post-mor- while it could not be ascertained in five patients (35.7%).
tem findings for mortality cases were documented. Most of the accidents occurred in the afternoon
Descriptive and bivariate analyses were carried out as (n D 77, 51.3%). The most common form of collision was
appropriate. Socio-demographic and other relevant varia- motorcycle vehicle (n D 84, 56.0%). The injury-arrival
bles (age, occupation, education, marital status, etc.) were interval showed that about one-third of the study popula-
presented in frequencies and proportions using tables and tion arrived at the health care facility within 1 6 hours
charts. Summary statistics generated means and standard (n D 59, 39.3%) after injury (Table 2).
deviation. Statistical Package for Social Sciences (SPSS) The mode of transportation to the hospital was mainly
for windows version 16.0 was used to analyse the data. by cars (n D 102, 68%) followed by motorcycles (n D 19,
12.7%), ambulance (n D 17, 11.3%), taxi (n D 5, 3.3%),
Federal Road Safety Corps vehicle (n D 5, 3.3%) and
Results police vehicle (n D 2, 1.3%).
The age range of the study participants was 18 93 years The limbs (upper and lower limbs combined) were the
(mean age 41.22 § 36.10 years) and age group most frequently involved site of injury (Table 3), hence
20 29 years had the highest incidence (29.3%) of MCRI. orthopaedic interventions were the most common forms
There were more males (n D 119, 79.3%) than females of management instituted (Table 4).
(n D 31, 20.7%) with a male to female ratio of 4:1. Multiple injuries were found in about one-third of the
In terms of occupation, commercial motorcyclists and study participants (n D 52, 34.7%). Management out-
farmers were more frequently involved (Table 1). comes showed that majority of the patients (n D 116,
Based on the patient’s position in relation to the 77%) were discharged home alive while mortality was
motorcycle at the time of injury, there were three catego- 10.7% (16 out of 150). Comparing the outcomes between
ries of victims made up of 74 (49.3%) motorcycle riders, the victims, it was observed that the mortality and residual
55 (36.7%) pillion passengers and 21(14%) pedestrians. pathologies such as hemiplegia and persistent vegetative
About 48 (32%) of the patients admitted to taking alcohol state were highest among the motorcycle riders (Table 5).
on the day of injury, 36 (24%) denied and it could not be The length of hospital stay for all the study participants
ascertained in 66 (44%) of cases. Among the lone motor- ranged from a few hours to 245 days with a mean of 24 §
cycle crashes which involved only motorcycle riders, five 36.10 days.
 International Journal of Injury Control and Safety Promotion 3

Table 2. Features surrounding patients’ injury. Table 4. Patient management.

Features N (%) Management

Number of pillion passengers on motorcycle Backslab/plaster of paris (POP) 28 17.8

None 64 42.7 Open reduction and internal fixation (ORIF) 25 15.9
1 62 41.3 Intensive care unit (ICU) admission 20 12.7
2 14 9.3 External fixation 11 7.0
3 3 2.0 Wound debridement/exploration 11 7.0
Not ascertained 7 4.7 Skin traction 13 8.2
Use of helmet Craniotomy 7 4.5
No 125 83.3 Elevation of depressed skull fracture 5 3.2
Not applicable (pedestrians) 21 14.0 Transtibial Steinnman’s pin/skeletal traction 9 5.7
Yes 4 2.7 Evacuation of dead fetus 4 2.5
Collar and cuff 4 2.5
Type of collision Reduction of dislocation 4 2.5
Motorcycle vehicle 84 56.0 Limb amputation 3 2.1
Motorcycle motorcycle 25 16.7 Chest tube drainage 3 2.1
Motorcycle pedestrian 25 16.7 Laparatomy/repair of ruptured internal viscus 2 1.3
Lone motorcycle 14 9.3 Gardner Well’s traction 2 1.3
Motorcycle animal (dog, goat) 2 1.3 Wound/skin grafting 1 0.6
Time of occurrence Laminectomy/spinal surgery 1 0.6
Morning 23 15.3 Scrotal exploration 1 0.6
Afternoon 77 51.3 Thoracolumbar jacket 1 0.6
Evening 45 30.0 Elbow reconstruction 1 0.6
Night 5 3.3 Hysterectomy 1 0.6
Injury-arrival interval
<1 hour 10 6.7
Head injury was the most common cause of mortality,
1 6 hours 59 39.3
accounting for 50% of cases and majority (75%) of the
6 24 hours 35 23.3
mortalities occurred within two weeks of hospital admis-
24 48 hours 13 8.7
sion (Table 7).
>48 hours 33 22.0
Sixteen of the patients died, eight had post-mortem
findings available. Seven out of the eight patients had
For cases of mortality a greater percentage were severe head injury as the primary cause of death while
males, riders were more involved, the highest number of one had multiple injuries comprising fifth cervical spine
deaths occurred among the commercial motorcyclists, and fracture, comminuted midshaft femoral fracture and pul-
motorcycle vehicle collision was responsible for the monary oedema. Two out of the seven patients with
highest number of fatalities (Table 6). severe head injury also had associated chest injuries, one
of which was complicated by bronchopneumonia. Post-
mortem findings in the head included subgaleal haemor-
Table 3. Sites of injury.
rhage, cranial vault fractures which commonly involved
Site N (%) the parietal, temporal and frontal bones; subdural
Head 84 36.5
Right lower limb 38 16.5 Table 5. Outcome of admissions.
Left lower limb 36 15.7
Total Motorcyclist Passenger Pedestrian
Left upper limb 14 6.1
Outcome N (%) N (%) N (%) N (%)
Right upper limb 10 4.3
Maxillofacial 9 3.9 Discharged home alive 116 (77.0) 54 (73.0) 47 (85.5) 15 (71.4)
Pelvis 9 3.9 Died 16 (11.0) 8 (10.8) 4 (7.3) 4 (19.0)
Chest 8 3.5 Discharged home with 7 (5.0) 4 (5.4) 2 (3.6) 1 (4.8)
residual pathologies
Abdomen 8 3.5
Discharged against 5 (3.0) 4 (5.4) 1 (4.8)
Ocular 7 3.0 medical advice
Spine 6 2.6 Referred to other hospitals 6 (4.0) 4 (5.4 2 (3.6)
Scrotum 1 0.4 Total 150 74 55 21
4 O.S Aduayi et al.

Table 6. Characteristics of mortality cases. hematoma, intraparenchymal bleeds, subarachnoid hae-

Characteristics N (%)
morrhage, cerebral contusions and cerebral oedema. Chest
findings at post-mortem include massive hemothorax and
Age multiple rib fractures.
20 29 4 25.0
30 39 1 6.3
40 49 3 18.8 Discussion
50 59 1 6.3 Motorcycle-related injuries constitute a major health bur-
60 69 5 31.3 den in Nigeria today. About 8 in 10 patients in this study
70 79 2 12.5 were males, of which majority was in their second and
third decades of life. Similar findings by Chalya et al. also
Sex
showed a peak incidence of 21 30 years among partici-
Male 11 68.8
pants (Alicioglu et al., 2004; Chalya et al., 2010;
Female 5 31.3
Galukande et al., 2009; Naddumba, 2004; Solagberu
Occupation et al., 2006). This may not be unconnected with the high
Commercial motorcyclist 4 25.0 unemployment rate in Nigeria. In addition, convenience,
Trader 3 18.8 agility, ability to access difficult terrains, minimal fuel
Unemployed/retiree 3 18.8 consumption, maintenance and relatively low purchase
Clerk/security officer 2 12.5 price are among several reasons contributing to the popu-
Farmer 1 6.3 larity of motorcycles (Odiwuor, Nyamusi, & Odero,
Student 1 6.3 2015). Males within this age group are also known to be
Civil servant 1 6.3 single, adventurous (Asaleye, Famurewa, Komolafe,
Artisan 1 6.3 Komolafe, & Amusa, 2005), consume a lot of alcohol and
generally have a reckless disposition to life. Alcohol
Patient category
intake prior to riding was confirmed only in 32% of cases
Rider 8 50.0
in this study. This finding is consistent with the report of
Pillion passenger 4 25.0
the NHTSA stating that about 37% of motorcyclists in
Pedestrian 4 25.0
Texas, USA were under the influence of alcohol (Turner
Type of collision et al., 2013). This, however, may be a far cry from the
Motorcycle vehicle 10 62.5 actual as motorcycle riders may not wish to admit to rid-
Motorcycle pedestrian 4 25.0 ing under the influence of alcohol for fear of possible
Lone motorcycle 2 12.5 legal implications. There were more motorcycle riders
than pillion passengers and pedestrians in this study and
the motorcyclists were all males. This trend was also
observed by Chiang et al. in Singapore as well as
Solagberu and Oluwadiya in Nigeria in their works on
motorcycle related injuries (Chiang, Cheng, Zhang, & Teo,
2014; Oluwadiya et al., 2004; Solagberu et al., 2006).
Table 7. Injury sites and length of hospital stay for mortality Likewise, motorcycle vehicle collision accounted for half
cases. (56%) of the accidents. This was also reported by
Characteristics Number Percentages Chiang et al., Solagberu et al. and Dongo et al. who
looked at the various patterns of collision in motorcy-
Injury site cle-related accidents (Chiang et al., 2014; Dongo et al.,
Head 14 50.0 2013; Solagberu et al., 2006). Vehicles have been
Lower limb 5 17.8 reported to contribute majority of motorcycle accidents
Chest 4 14.3 mainly due to their inability to detect or recognize them
Abdomen 2 7.1 in traffic. Collision between motorcycle and free roam-
Spine 2 7.1 ing animals was reported in this study, though not com-
Pelvis 1 3.6 mon, this is a call for concern in our environment.
Length of hospital stay Faulty equipment may also cause a biker to lose con-
7 days (a week) 6 37.5 trol. Speeding and riding under the influence of alcohol
8 15 days 6 37.5 lead to many preventable accidents. For instance,
16 21 days 2 12.5 speeding while approaching road bends may cause a
22 28 days 1 6.3 rider to lose control of the bike or misjudge the bend,
>28 days (44 days) 1 6.3 take too wide a turn and end up on the path of oncom-
ing traffic.
 International Journal of Injury Control and Safety Promotion
The use of helmet by both the cyclist and the pillion
passenger has been reported to significantly reduce the
incidence of fatal head injury (Chalya et al., 2010; Coben,
Steiner, & Miller, 2007; Ichikawa, Chadbunchachai, &
Marui, 2003; Nantulya & Reich, 2002; Ohajinwa, Sango-
wawa, & Omotade, 2010; Solagberu et al., 2006). How-
ever; the use of crash helmets is still very unpopular in
Nigeria (Dongo et al., 2013; Oluwadiya et al., 2009). In
this study, 96% of patients did not use helmet at the time
of injury. This is comparable to findings by Fong et al.
(2015), Rice et al. (2016) and Dongo et al. (2013) that
reported a low prevalence of helmet use. Nzegwu et al.
(2008) in Benin Andrews, Kobusingye, and Lett (1999) in
Kampala also reported low incidence of helmet use. The
contrary was observed from Tanzania with 22.7% helmet
use reported by Chalya et al. (2010). Hung, Stevenson,
and Ivers (2006) reported 29.94% in Vietnam, Catherine,
Franz, Penny, and Lisa (2008) reported a 53% compliance
of patients with helmet use in Australia. The non-compli-
ance with helmet use has been attributed to ignorance,
inadequate information, nonchalant attitude, disposition
to lawlessness and insufficient law enforcement to ensure
compliance as some of the factors responsible (Fong
et al., 2015; Haqverdi, Seyedabrishami, & Groeger, 2015).
Limb injury was the most common cause of morbidity
and this also explains why orthopaedic interventions con-
stituted a significant proportion of the management. Head
injury was the most common cause of mortality; this is in
conformity with earlier research findings (Alicioglu et al.,
2004; Chalya et al., 2010; Dongo et al., 2013; Nantulya &
Reich, 2002; Nzegwu et al., 2008; Oluwadiya et al., 2009;
Solagberu et al., 2006). The mortality rate in this study
was 10.7% (16 out of 150) .This was found to be higher
than 3.5% reported by Oluwadiya and less than 16.7%
reported by Chalya in Tanzania (Chalya et al., 2010;
Oluwadiya et al., 2004).
Amnesia in some patients with relatives or care givers
not having complete facts about the incidents constituted
some limitations.
In conclusion, advocacy on preventive measures, law
enforcement and behavioural change among motorcycle
users is necessary. Motorcycles may also be replaced with
tricycles in areas where they constitute a significant per-
centage of the means of transportation, in order to reduce
the associated morbidity and mortality.
Disclosure statement
No potential conflict of interest was reported by the authors.
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