Neuropathological Patterns of Homicidal Head Injuries: A One-Year Prospective Autopsy-Based Study in Nairobi,Kenya

Abstract

Background: Traumatic brain injury (TBI) is a leading global cause of death and disability. Sub-Saharan Africa bears a disproportionately high TBI-related mortality, with homicide contributing significantly, yet data on the region's neuropathological patterns of homicidal head trauma remain limited. Objective: To describe the mechanisms of injury, demographic characteristics, and neuropathological patterns of homicidal head injuries in Nairobi, Kenya. Materials and Methods: This prospective descriptive study was conducted over one year at Nairobi City Mortuary (July 1, 2009-June 30, 2010). Data on age, biological sex, and circumstances of death were obtained from police reports and identification documents. All violent deaths undergoing medicolegal autopsy were reviewed, and cases with confirmed homicidal head injuries were analyzed. Autopsy findings, including skull fractures and intracranial injuries, were documented, entered into Statistical Package for the Social Sciences, and summarized using frequencies, percentages, means, and standard deviations. Results: During the one-year study, 2278 cases of violent death were examined, of which 1060 (46.5%) involved head injuries. Among these, 630 cases (59.4%) were confirmed as homicidal. The mean age of victims was 26.9 ± 9.4 years, with the 20 to 29 year age group representing the largest proportion (46.1%). Males predominated, accounting for 96.1% of cases. The leading mechanism of injury was gunshot (50.3%), followed by blunt force trauma (46.7%) and sharp force injuries (3.0%). Skull fractures occurred in all victims, most commonly involving the frontal bone (23.2%). Brain contusions (19.7%), lacerations (18.6%), and epidural hematomas (15.2%) were the most frequent intracranial injuries. Conclusion: Homicidal head injuries represent a substantial proportion of violent deaths in Nairobi and predominantly affect young adult males. Characteristic neuropathological patterns observed during autopsy include multiple skull fractures and intracranial hemorrhages associated primarily with firearm and blunt force trauma.