Dentofacial injuries in commercial motorcycle accidents in Cameroon : pattern and cost implication of care

Objective: To assess the pattern of dentofacial injuries in commercial motorcycle accidents among riders and passengers in Cameroon. Methods: This was a hospital based study conducted in 6 out of 10 regional capitals in the months of December 2011 to September 2012. Analyzed information included age, gender, residence, role on the motorcycle (rider or passenger), type, pattern and month of injury, cost, duration and patient’s perception about the cost of treatment. Results: A total of 387 patients were studied with majority of the patients being 21-30 years (39.8%), males (63.8%), passengers (57.3%) and urban dwellers (85.8%). Most of the injuries occurred in December (20.7%), January (19.4%) and February (20.2%). Soft tissue injuries were most frequent (91.2%) followed by trauma to the teeth (83.5%), of which 62.3% were tooth loss. Mandibular fracture was commoner than maxillary fracture; (45% versus 25.3%). A total of 44.2% of patients received their treatment as in-patients. The treatment of the dentofacial injuries among 64.3% of the patients lasted for more than a month. A total of 51.9% of the patients spent 100,000 francs ($200) or more for their treatment. More than half (51.4%) of the patients perceived the cost of treatment as expensive. Conclusion: Dentofacial injuries in commercial motorcycle accidents necessitated hospital admission and lengthy treatment time with high attendant cost. Preventing these injuries will serves as a form of poverty reduction as money that will be used by the victim to better their life is not used to correct deformities or treat injuries.


Introduction
2][3][4][5][6] The unavailability of organized urban public transport coupled with strict rules and crackdown on non-road worthy vehicles in Cameroonsince 2010, created a deficiency in urban transport.Hence commercial motorcycle popularly known as bendsikin and okada/achaba in French and English speaking Cameroon respectively has become a com mon means of transportation in major cities in the country.The low cost of purchase, fuel consumption and easy maintenance has continued to favour an increase in motorcycle transportation.

Corresponding author:
Agbor Michael Ashu Emmanuel Faculty of dentistry Universite des Montagnes B P. 208 bagante-Cameroon Email:agborasm@yahoo.com increased utilization of motorcycle transportation is rooted on the fast nature of motorcycles which reduces time wasted in traffic congestion within the poor road networks, unplanned urban transportation with the added advantage of closer access to areas of residence and business.The increased use of motorcycle is accompanied with increased road traffic accidents.This is related to the poor regulation and disorganized nature of this means of transportation and whose operators lack formal road traffic instruction.
Dentofacial injuries that commonly occur in motorcycle accidents pose significant psychological, functional and aesthetic problems to both riders and passengers. 7tudies on dentofacial injuries in motorcycle accidents show that injuries occur as single vehicle collision with an object, another vehicle or falls. 8,9Seasonal variation in maxillofacial injuries resulting from road accidents has been reported in hospital based studies. 10,11These have been attributed to the increased opportunities for outdoor activities and increased travel due to good weather during the months of November to February making up the dry season.In contrast there is decreased travel with greater pre caution due to visibility and terrain problems during rainy season.The assessment of dentofacial injuries in commercial motorcycle accidents in Cameroon is expected to generate baseline information that may interest policy formulation and also assist in the development of preventive programmes.The objective of the study was to assess the pattern of dentofacial injuries in commercial motorcycle accidents among riders and passengers in Cameroon.

Methods and Materials
This was a hospital based study conducted in 6 out of 10 regional capitals of Cameroon in the months of December 2011 to September 2012.Douala, Yaounde, Garoua, Ngaoundere, Bamenda and Buea are the capital of Littoral, Centre, North, Adamawa, Northwest and Southwest, respectively.These areas capitals have large numbers of commercial motorcycles estimated above 3000 with a high population using this means of transportation. 12is study was of 387 cases of dentofacial injuries attained from commercial motorcycle accidents who sought treatment at hospitals and dental clinics.Information collected from the participants included age, gender, area of residence and perception about the cost of treatment.Other data with reference to type of injury, month and duration of injury were obtained from case notes of patients available at the units.The patient information was kept confidential.Only cases of dentofacial injuries from commercial motorcycle riders and their passengers were studied, injuries of this nature from other sources were excluded.Data collected was analyzed using a computer software program Epi-Info 3.1.2.Ethical clearance for this study was obtained from the Ministry of Higher Education and Scientific Research of Cameroon.

Discussion
The majority of dentofacial injury cases found in this study were young adults in the age range of 21 to 40 years.This is similar to findings of studies reported from Kuala Lumpur, Malaysia 8 and Taipei, Taiwan. 13he active nature of group which involves movement from place to place as part of job seeking, going to work or delivering services encourage their use of commercial motorcycle, a fast and cost-effective mode of transportation in developing countries. 11In this study, more males than females were affected.The higher male than female dentofacial injuries experience has been reported in several other studies. 4,8,9,11,14 erhaps, as breadwinners for many families tend to be men, their mobility is therefore more and thereby exposed to the associated risks.This may support the observed gender trend.Furthermore, motorcycle riders were predominantly males also contributing to the larger number of males than females found with injuries.
The larger proportion of victims were from urban settings.This shows that injuries of this nature occur mainly in urban settings where there are intense economic activities with a busy road network motivating the urban dwellers to use commercial motorcycle transport.Alicioğlu et al. 7 noted that increase in motorcycle accidents occur in parallel with the increasing number of motorcyclists.A significant increase in motorcyclerelated maxillofacial injuries has been observed in most urban and suburban centres of the neighbouring country, Nigeria. 15The frequent traffic jams due to a poor road network in most urban and suburban centres of developing countries made motorcycles, a popular mode of transportation with the ability to pass through narrow ways.The increased use of motorcycle is accompanied with increased road traffic accidents which are related to the poor regulation and disorganized nature of this means of transportation and whose operators lack formal road traffic instruction.This was moreso confirmed as more developed regions, Centre-128 (36.3%) and Littoral-101 (28.6%) regions were the leading regions with the studied dentofacial injuries.
In contrast to Oginni et al. ( 2006) 9 study among Nigerian intracity road users, it was found that passengers were more commonly victims of the motorcycle accidents.This can be explained by the fact that motorcycle passengers have slightly higher chances of sustaining dentofacial injuries from commercial motorcycle accident due their lesser visibility of anterior view than the riders with eventual reduction of effective dentofacial injury accident preventive movement.
In terms of the general pattern of injuries seen in previous related studies 8,11,16,17 , the mandible was more affected than the maxilla in this study.Identification of mandible as the most common facial bone involved in fracture due to it's prominence has been documented.It is notable a large number of soft tissue injuries occurred in this study which is in consonance with the findings of previous studies in Nigeria, Brazil and Malayasia. 8,18,19Motorcycle accidents are associated with abrasions, laceration of skin, lip, buccal and lingual mucosa, and soft tissue avulsion with different mechanism of injuries like falls, burns, unexpected teeth closure on tongue or lip, collision between rider and passenger, collision with parts of the motorcycle and stationary objects.Avulsion has been reported as the most common dentoalveolar injury in motorcycle accidents 18 meaning that commercial motorcycle ac cidents do contribute to tooth loss in Cameroon.
In evaluating the severity of the injuries with respect to hospital admission and treatment duration, it was founded that 44.2% had hospital admission and more than half of them completed the treatment for their dentofacial injuries after one month.This implies that dentofacial injuries from commercial motorcycle accidents are severe, needing interventions of dental surgeons to correct and restore the injured dentofacial areas.Hospitalization for up to 150 days for care of motorcycle accident related injuries has been reported. 7he high rate of hospital admission and long duration of treatment found in this study reveals that dentofa-81 cial injuries from motorcycle accidents impose a heavy financial burden on the victims and their families.It thereby means that preventing these injuries will serve as a form of poverty reduction as the money that will be used by the victim to better their life is not used to correct deformities or treat injuries.
The months of December through to February registered the highest number of dentofacial injury cases.This could be due to fact that these are periods of festivities and intensive economic activity in this study area with multiple public and religious holidays increasing movement and accidents.The heightening of the prevalence of alcohol use while riding during this period is a contributory explanation20 for the seasonal variation in the prevalence of commercial motorcycle-related dentofacial injuries in Cameroon.The limitations of this research include the fact that use of protective gear like helmets and comparison to other causes of dentofacial injuries were not assessed.

Conclusion
Dentofacial injuries in commercial motorcycle accidents constitute serious injuries necessitating hospital admission and long treatment time with attendant cost.Preventing these injuries will serves as a form of poverty reduction as money that will be used by the victim to better their life is not used to correct deformities or treat injuries.Furthermore, this supports the need for training of maxillofacial surgeons by Cameroonian government to ensure the quality care among affected individuals.