Non-fatal injuries in rural Burkina Faso amongst older adults, disease burden and health system responsiveness: a cross-sectional household survey

John Whitaker, Guy Harling, Ali Sie, Mamadou Bountogo, Lisa R Hirschhorn, Jennifer Manne-Goehler, Till Bärnighausen, Justine Davies

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This study aimed to evaluate the epidemiology of injury as well as patient-reported health system responsiveness following injury and how this compares with non-injured patient experience, in older individuals in rural Burkina Faso.

Cross-sectional household survey. Secondary analysis of the CRSN Heidelberg Ageing Study dataset.

Rural Burkina Faso.

3028 adults, over 40, from multiple ethnic groups, were randomly sampled from the 2015 Nouna Health and Demographic Surveillance Site census.

Primary and secondary outcome measures
Primary outcome was incidence of injury. Secondary outcomes were incidence of injury related disability and patient-reported health system responsiveness following injury.

7.7% (232/3028) of the population reported injury in the preceding 12 months. In multivariable analyses, younger age, male sex, highest wealth quintile, an abnormal Generalised Anxiety Disorder score and lower Quality of Life score were all associated with injury. The most common mechanism of injury was being struck or hit by an object, 32.8%. In multivariable analysis, only education was significantly negatively associated with odds of disability (OR 0.407, 95% CI 0.17 to 0.997). Across all survey participants, 3.9% (119/3028) reported their most recent care seeking episode was following injury, rather than for another condition. Positive experience and satisfaction with care were reported following injury, with shorter median wait times (10 vs 20 min, p=0.002) and longer consultation times (20 vs 15 min, p=0.002) than care for another reason. Injured patients were also asked to return to health facilities more often than those seeking care for another reason, 81.4% (95% CI 73.1% to 87.9%) vs 54.8% (95% CI 49.9% to 53.6%).

Injury is an important disease burden in this older adult rural low-income and middle-income country population. Further research could inform preventative strategies, including safer rural farming methods, explore the association between adverse mental health and injury, and strengthen health system readiness to provide quality care.
Original languageEnglish
Article numbere045621
JournalBritish Medical Journal Open
Issue number5
Publication statusPublished - 28 May 2021

Bibliographical note

Funding Information:
Funding Funding Support for the CRSN Heidelberg Aging Study and for TB was provided by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award (no grant number exists) to TB, funded by the German Federal Ministry of Education and Research. GH is supported by a fellowship (210479/Z/18/Z) from both the Wellcome Trust and Royal Society. JM-G was supported by Grant Number T32 AI007433 from the National Institute of Allergy and Infectious Diseases. JW is a serving member of the UK Defence Medical Services.

Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. For numbered affiliations see end of article.


  • Wounds and injuries
  • developing countries
  • health services research
  • epidemiology
  • surveys and questionnaires
  • Burkina Faso/epidemiology
  • Cross-Sectional Studies
  • Humans
  • Cost of Illness
  • Male
  • Rural Population
  • Quality of Life
  • Aged


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