Children have a unique profile of risks for injuries because they are unable to recognize and avoid many potential risks on their own [15, 16]. In this study, the peak age incidence was 6–8 years which is in agreement with other studies done elsewhere [17, 18]. High incidence of injuries in this age group reflects lack of coordination and unawareness of dangerous substances. In addition, this is the school-age group and is usually involved in road traffic accidents as they rush through heavy traffic to and from their schools. These school-age group children are usually very active and are often less supervised than pre-school age children. This observation calls for an improved school transportation system.
In our study, males were more affected than females with a male to female ratio of 2.3:1 which is in agreement with other studies . The reasons for the male preponderance in our study may be attributed to the overactive nature of male children as compared to the females.
The presence of pre-existing illness has been reported to have an impact on the outcome of paediatric injury patients . In the present study, no patient had pre-existing illness.
Circumstances of injury
With regard to the time injury, most of injuries in the present study occurred during the day which is in agreement with that of other studies [17, 21]. Increased rate of injuries during the day can be explained by increased traffic jams as well as increased human activities in the city during the day time. Knowing the time of injury in trauma patient is important for prevention strategies.
The majority of paediatric injury in this study occurred at home, which is in agreement with other studies done elsewhere [21, 22]. This finding is at variant with an Iranian study which reported streets as the most common place of occurrence of paediatric injuries . The finding that most of paediatric injuries occurred at home demonstrates the important role of parental supervision as a key factor in child safety.
In this study, all paediatric injury patients sustained unintentional injuries resulting from road traffic accidents, falls, burns and foreign body inhalation/ingestion. There were no cases of intentional injuries. However, the lack of intentional injuries in our study may actually be an underestimate and the magnitude of the problem may not be apparent because many cases are not reported for fear of been arrested by police. Therefore, paediatric forensic examination should be performed if a child is likely to suffer from abuse, neglect or intentional injury.
Road traffic accidents have been reported to be the commonest cause of blunt paediatric injuries in most studies as supported by the present study . In contrast to our findings, a study in Malawi reported fall from height as the most common cause of paediatric injuries . A study in Kenya reported that burn injuries as the most frequent cause of paediatric injuries . High incidence of road traffic accidents in our study may be attributed to recklessness and negligence of the driver, poor maintenance of vehicles, driving under the influence of alcohol or drugs and complete disregard of traffic laws. Improvement in road conditions, prevention of overloading of commuter vehicles, maintenance of vehicles and encouraging enforcement of traffic laws will decrease the frequency and extent of these injuries. In agreement with other studies [25, 26], motorcycle (71.2%) was responsible for the majority of road traffic accidents. The prevalence of motorcycle injuries in this study is higher than that reported previously at the same centre by Chalya et al. reflecting increase in the magnitude of the problem in our setting. Motorcycle use is becoming popular in Tanzania as it has become a cheaper and easier means of transportation in most cities. However their use is characterized by non-helmet use by riders and their passengers, passenger overload, lack of certified driver training and valid licensing, over speed and reckless driving, poor regulation and law enforcement and possible use of alcohol and drugs. In this study, pedestrians (84.7%) accounted for the majority of road traffic victims, which is in keeping with other study done elsewhere . High incidence of pedestrians among children has been attributed to their developmental and behavior limitations in complex traffic situations [10, 11]. Pedestrians aged 10 years and below are particularly vulnerable because of their small physical size and underdeveloped abilities to dealing with traffic situations, both cognitive (attention focus, interpreting signs) and perceptual (locating sounds, judging speed, peripheral vision) . Children under the age of 10 years do not have the ability to cross roads without adult help.
Injuries related to foreign bodies in the aerodigestive tract was the second most common cause of paediatric injuries in our locality as previously reported by Gilyoma and Chalya  at the same centre. In agreement with other studies [27–29], our study found that foreign bodies in the esophagus was more prevalent than in the bronchus, ear or nose. In this study, we could not establish the reason for this anatomical distribution. Several factors contribute to high incidence of aerodigestive tract foreign bodies in this age group including social factors (e.g. carelessness of parents, children’s habit of putting objects in their mouth, crying/playing during eating) and anatomical factors (e.g. absent of molar teeth, inadequate control of deglutition) have been mentioned in literature [30, 31].
The prehospital care of injured paediatric patients is the most important factor in determining the ultimate outcome after injury . In our study, only 7.3% of patients had pre-hospital care. The lack of advanced pre-hospital care in most developing countries like Tanzania and ineffective ambulance system for transportation of patients to hospitals are a major challenges in providing care for paediatric injury patients in these countries and have contributed significantly to poor outcome of these patients due to delay in definitive treatment.
The majority of patients in our study reported to the A & E department within 24 hours of injury, which is in keeping with other reports [17, 21]. Our experience shows that early presentation is common with very young children, and when there are more serious symptoms of severe injury, thus compelling the frightened patients or parents to seek medical attention. Late presentation is more common in asymptomatic and mild cases. Gilyoma and Chalya  in their experiences with endoscopic procedures for removal of foreign bodies of the aerodigestive tract at Bugando Medical Centre found that the majority of patients mainly children presented to the A & E department within 24 hours of inhalation/ingestion of foreign.
Waiting time in emergency departments may be attributable to many factors and may stretch up to three hours before completion of all necessary procedures, even in developed countries . This study found that the majority of the patients (83.3%) were attended to within 6 hours of arrival at the A & E Department. Lambe et al.  reported a lower mean waiting time of 56 minutes in California, USA. Review of emergency department administration has been demonstrated to improve efficiency in care delivery . A waiting time of 30 minutes for a general outpatient clinic is considered reasonable but should be even shorter for emergency visits .
In agreement with previous studies [17, 18], the present study found that the head and the musculoskeletal (extremities) were the most common body region injured and the former accounted for most of the deaths and admission to intensive care. Higher incidence of head injuries in most previous studies as well as our study may be attributed to the disproportionately large head and weak neck musculature in children that puts them at particular risk for contre-coup brain injuries even at low velocity injury . Our high figure of musculoskeletal injuries affecting mainly the lower limbs is attributable to the large number of pedestrians. Pedestrians are unprotected road users and therefore they are highly exposed to high risk of limb injuries .
The type of injuries in this study is comparable with what is reported in other studies [17, 21, 36]. In the present study, open wounds (i.e. bruises, abrasions, lacerations, cut wounds, burn wounds etc.), foreign bodies and fractures were the most common type of injuries sustained.
A number of scoring systems have been developed to facilitate consistent trauma triage, severity evaluation, management and prognostication . Paediatric Trauma Score (PTS) is one of trauma scores designed to accurately assess injury severity and extent of injury, aid with the prediction of survival and subsequent morbidity . The PTS was devised specifically for the triage of paediatric trauma patients . The PTS is calculated as the sum of individual scores from six clinical variables including weight, airway, systolic blood pressure (SBP), central nervous system (CNS) status (level of consciousness), presence of an open wound, and skeletal injuries [39, 40]. According to Paediatric Trauma Score (PTS), the majority of patients in this study sustained mild injuries accounting for 56.7% of cases. The Glasgow coma scale (GCS) was developed as a means of assessing a patient’s level of consciousness by assigning coded values for three behavioral responses [14, 39, 40]. In this study, the GCS indicated that most of the patients sustained moderate head injury.
Most of our patients were treated surgically, which is in agreement with other similar studies [41, 42]. The high incidence of surgical treatment in our study is attributable to the high incidence of injuries that required surgical intervention. In this study, endoscopic removal of aerodigestive foreign bodies, treatment of fractures and wound debridement were the most frequent surgical procedure performed. Regarding endoscopic removal of aerodigestive foreign bodies, oesophagoscopy for removal of foreign bodies was the most common procedure performed as reported earlier by Gilyoma and Chalya .
The presence of complications has an impact on the final outcome of patients presenting with paediatric injuries as supported by the present study [43, 44]. The pattern of complications in the present study is similar to what was reported by others [17, 23, 36]. Early recognition and management of complications following paediatric injury is of paramount in reducing the morbidity and mortality resulting from this form of trauma.
The length of hospital stay (LOS) has been reported to be an important measure of morbidity among trauma patients and has an impact on patient’s final outcome [43, 44]. Prolonged duration of hospital stay is associated with unacceptable burden on hospital resources as well as on increased costs of health care . In the present study, the overall average LOS in the present study was higher than that reported by others [3, 21]. The reasons for prolonged LOS in our study according to multivariate logistic regression analysis included young patient’s age, delayed presentation and presence of complications.
The current study had a mortality rate of 12.7%, which is higher than that reported by others [46–48]. Factors responsible for high mortality in our study included burn injuries, severe head injuries, severe injuries and multiple injuries. Addressing these factors responsible for high mortality in our patients is mandatory to be able to reduce mortality associated with these injuries.