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Review of gunshot fatalities in the Northern part of Ghana; a 6 year forensic

autopsy based study

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DOI: 10.1016/j.jflm.2019.101889

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Contents lists available at ScienceDirect

Journal of Forensic and Legal Medicine

journal homepage: http://www.elsevier.com/locate/yjflm

Review of gunshot fatalities in the Northern part of Ghana; a 6 year forensic

autopsy based study
P.P.S. Ossei a, *, N. Niako a, W.G. Ayibor b, E. Asante a, K.F. Safo a, A.S. Mensah a, E. Owusu a, K.
L. Appiah a
a
Department of Pathology, KSMD, Kwame Nkrumah University of Science and Technology, Kumasi and Komfo Anokye Teaching Hospital, Ghana
b
Department of Molecular Medicine, KSMD, Kwame Nkrumah University of Science and Technology, Ghana

A R T I C L E I N F O A B S T R A C T

Keywords: Studies on firearm fatalities in some parts of Ghana have been reported. However, the incidence and pattern of
Forensic autopsy firearm fatalities in the Northern sector of Ghana have fled the spotlight. This study aimed at reporting the
Firearms incidence and pattern of gunshot fatalities autopsied within 2008 and 2013 year. There were 82(91.1%) male
Cause of death
and 8(8.9%) female victims of gunshot deaths during the study period with an average of 15 cases annually.
Age
Where 60(66.7%) of the victims aged within 21–40; years resembling the pattern observed in several parts of the
Pattern of gunshot incidence
world. A significant number 28(31.1%) of the victims died of multiple shots or dispersed pellets affecting several
parts of the body, followed by a single shot to the chest 18(20.0%), abdomen 17(18.9%), head 14(15.6%).
Collectively, entry sites like the neck and upper limb among others accounted for 13(14.4%). Robbery accounted
for 44(48.9%) followed by homicides 14(15.6%) cases. Recovered pellets, nature and legal status of firearm
involved were also examined, and like in several developing countries, country-made guns played a substantial
role in the firearm fatalities with calls to strengthen laws governing gun acquisition and use in the country.

1. Introduction
Ghana has remained stealthy on the global radar as far as firearm-
related deaths are concerned, with Brazil and the US leading with
43,000 and 37,200 death toll respectively as of 2016.1 However, ac­
counts within the country are brimful of firearm casualties making an
eerie cradle for both civilians and law enforcers. Reports surmise an
increase in the acquisition and use of illegal firearms and ammunition in
the country2,3 with calls to amend the Arms and Ammunition Act-1972
(NRCD9) which governs the ownership and use of arms and ammunition
in the country. The National Small Arms Commission (NSAC) in 2016 in
a report estimated that there could be more than 1.1 million illegal
firearms in the wrong hands. The article continued with an estimated 2.3
million weapons in civilian hands, with only 1.2 million registered.4
While access to firearms is a necessary precondition for firearm injury,
assessing this relationship presents a Gordian knot, partly because data
on the total number and distribution of legal and illegal arms within
civilian populations are limited,1 particularly in developing countries.
The menace of firearms in civilian hands is better understood in light
of the Geneva Declaration on Armed Violence and Development 2006.
Which stated that 90% of violent deaths occurred outside the confines of
conflict.5 Globally, firearms have been the lethal means in; 40 and 44%
of all homicides in 2014 and 2016 respectively.6 In Ghana, like several
African communities and developing world, the causes of gunshot in­
juries include hunting, political unrest, armed robbery, religious crisis,
military violence and communal clashes among others.7–10 In Nigeria,
the influx of ordnance during the civil war made firearms readily
accessible, with accompanying increased post-war arm violence.11 The
harrowing realities of gunshot injuries could be devastating, particularly
when vital organs are affected, and could result in instant death. Clinical
treatment of persons who survive such injuries could be eye-watering,
particularly when the injuries are to the chest, spine or head.12,13 This
study aims to give a forensic report on the incidence of gunshot fatal­
ities, pattern and nature of weapons used.
2. Method
This retrospective study was undertaken at the Komfo Anokye
Teaching Hospital (KATH) in Kumasi, Ghana. It is one of the three
principal referral hospitals in the country, it arguably serves the largest

* Corresponding author. Department of Pathology, KSMD/KATH, Kumasi, Ghana.

E-mail addresses: drsampene1@gmail.com, possei.chs@knust.edu.gh (P.P.S. Ossei).

https://doi.org/10.1016/j.jflm.2019.101889
Received 11 October 2019; Received in revised form 15 November 2019; Accepted 13 December 2019
Available online 14 December 2019
1752-928X/© 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
P.P.S. Ossei et al. Journal of Forensic and Legal Medicine 69 (2020) 101889

Table 1 The time plot below shows the pattern of annual gunshot deaths and
Age distribution of gunshot injured victims. the location of the wound over the study period. The year 2009 had the
Age (years) Sex Type of firearm Total (%) highest recorded deaths with 28 cases that year, followed by 14 in the
year 2012 in that order.
F M Smooth- Riffled bore
bore
4. Discussion
11–20 0 7 6 1 7 7.8
21–30 2 27 25 4 29 32.2
31–40 5 26 28 3 31 34.4 This study showed an average of 15 gunshot deaths annually, where
41–50 0 14 11 3 14 15.6 the majority of the victims 60 (66.7%) were in the 21–40 year age group
51–60 0 5 5 0 5 5.6 and males were the dominant victims accounting for 91.1% of all gun­
61–70 0 2 0 2 2 2.2
shot deaths, whereas females were only involved in 8.9% of the cases.
>70 1 1 2 0 2 2.2
Total (%) 8 82 (91.1) 77 (85.6) 13 (14.4) 90 100 This pattern is generally reported in several developed and developing
(8.9) countries like; the US,14 Nigeria,15 South Africa,16 India17 and
Switzerland18 UK,19 and Germany20 have all demonstrated similar de­
mographic results. Akapo et al. in their study conducted in the central
geographic and demographic area in terms of population; the hospital region of Ghana nonetheless showed similar results. In his report, 60% of
serves the Ashanti, Brong Ahafo and parts of the Eastern and Western all the gunshot deaths affected those within 18–44 years of age with 8
regions of the country. The data was organized and analyzed using (20%) within the 13 months-17 years.8 Contrasting the 7 (7.8%) gunshot
Microsoft Excel and GraphPad Prism 8. deaths noted among the 11–20 years cohort in this study, where 3 were
In this study, Autopsies performed by certified forensic pathologists due to social unrest, while 4 of them were due to the negligence of
at the Department of Pathology, Komfo Anokye Teaching Hospital, were parents. Literature findings posit that firearm-related mortality among
reviewed from January 2008 to December 2013. Within these six years, children is increasing at alarming rates. A study on the trend of mortality
a total of 5359 autopsies were performed out of which 90 (1.7%) among school children in the US surmises that firearm-related deaths
comprised of firearms fatalities. The age, sex, type of gun and setting of among minors reached epidemic proportions among 5 to 14 year-olds in
gunshot fatalities of these cases were checked from the inquest form 2009 and 15 to 18 year-olds in 2014.21 Similarly, of the 20,360 deaths
from the medicolegal autopsy archives for the present study. Subse­ among children and adolescents in the United States, Cunningham et al.
quently, police reports were reviewed to ascertain the proportion of the (2016) showed that of all the causes of death among children,
firearms deemed legal or illegal.

3. Results Table 2
Site of firearm injury.
From the analysis, the mean and median age of the gunshot victims
Location of injury n (%)
in the current study stood at 34 years 156 days. (34.42 years) and 32
years 183 days (32.5 years) respectively. As noted in Table 1. The ma­ Multiple sites 28 31.1
Chest 18 20.0
jority of the victims were males with a ratio of 10.25:1 to females. Abdomen 17 18.9
A significant number of the fatalities were due to robbery (48.9%), Head 14 15.6
followed by homicides (15.6%) as shown in Fig. 1. The commonest entry Other
site in this study were those affecting multiple parts of the body 28 Upper limb 5 5.6
Buttock 3 3.3
(31.1%), followed by those to the chest 18(20.0%) then to the abdomen
Thigh 2 2.2
and head accounting for 17(18.9%) and 14(15.6%) respectively. Entry Neck 2 2.2
sites such as the upper limb, neck, and buttock among others collectively Vertebra 1 1.1
account for 13 (14.4%) as demonstrated in Table 2. Total 90 100

Fig. 1. Distribution of circumstances of gunshot.

2
P.P.S. Ossei et al.
Fig. 2. Yearly trend of annual incidence and wound location from the year 2008–2013.
firearm-related injury was the second most common cause22
Ranking first among all the causes of gunshot deaths in this study is
armed robbery related. Given the nation’s checkered history of high
youth unemployment,23 the accompanying desperation to make ends
meet makes robbery luring. A similar pattern of gunshot deaths is
mentioned in developing countries like Nigeria7,24 as well.
Subsequently, 14 people were the victims of homicidal attacks
(15.6%) where 4 of the assailants were unapprehended, making firearms
one of the convenient means of killing and escaping at large in our re­
gion. A report on the trend of the medicolegal manner of deaths in the
region ranked gunshot second of all homicides in 2015.25 The propor­
tion and pattern of homicidal deaths in this report are dwarfed by
Nigeria 69.7%,15 Germany 33.3%,26 and the United States 65%.27
Deaths due to backfiring during hunting accounted for 10% of deaths,
reports showed that 9 of these cases happened in rural areas, and one
occurred while hunting game in a reserved park. Deaths of unsuspecting
victims due to accidental discharge, social unrest and unsecured
collectively account for 23 (25.6%) deaths.
Among others, forensic autopsy findings showed that Smooth-bore
firearms was the means of 77(85.6%) deaths with 13(14.4%) being a
Rifled-bore firearms. The nature of the wound inflicted by a firearm
provides a piece of significant forensic evidence to ascertain the type of
gun used, suicide from homicide, and even help deduce the distance
within which the firearm was fired. For instance, the compact mass of
the bullet emerging from the muzzle of a Smooth-bore firearms begins to
disperse, the divergence increases as distance lengthens, greatly modi­
fying the appearance of the wound inflicted.28 Further examination
revealed that all shots/bullets were fired within an estimated range of
1–35 m. While the manufacture of arms is prohibited under the NRCD 9
and Act 118 of 1962, Police reports showed that nearly 58(75%) were
home/locally made, and were the major means employed in heists.
Homemade guns, like in all developing countries is a substantial means
of firearms and firearm-related injuries.,7,17 the number of pellets
retrieved ranged widely between 1 and 25. The victims who sustained an
injury in places like the upper limb, buttock, and thigh either died of
hemorrhagic shock or septicemia in some cases. In one of the cases,
irregular projectiles like unhusked rice were shot at a close range in the
face of the victim. Twenty-eight (31.1%) of the victims died due to
gunshot injuries to multiple parts of the body, eighteen (20.0%) to the
3
Journal of Forensic and Legal Medicine 69 (2020) 101889
chest, seventeen (18.9%) were shot in the abdomen and fourteen
(15.6%) to the head. With rare body parts like neck and vertebra cate­
gorized under other accounts for thirteen (14.4%) deaths.
From the yearly trend of gunshot mortality shown in Fig. 2. The
annual cases increased to 28 cases in 2009 from 12 cases in the year
2008. Subsequently, the yearly total dropped to 12 in 2010 and then 11
in 2011 with a steady rise to 15 and then 13 in 2012 and 2013 in that
order. While these annual trends has been shown, inadequate literature
exist to establish whether this trend has remained the same over the
years prior to this study or not.
5. Conclusion
In conclusion, the study showed 15 annual gunshot deaths, of which
males were the preponderant group. More than half of the victims were
in their youthful age and armed robbery related gunshot deaths were the
leading cause of death. Our results showed that the majority of the
firearms involved were country made, reiterating the need to reinforce
the laws governing the acquisition of firearms in the country, especially
in the hands of the youth since they were the dominant age group
usually affected most.
Acknowledgements
Special gratitude to the Authorities and workers at the records unit of
the Department of Pathology, Komfo Anokye Teaching Hospital and the
Ashanti regional Police unit for the provision of information on coro­
ner’s inquest forms.
References
1. Naghavi M, Marczak LB, Kutz M, et al. Global mortality from firearms, 1990-2016.
JAMA. 2018;320(8):792–814.
2. Sebastian S. Review gun acquisition laws. Graphic online. https://www.graphic.
com.gh/daily-graphic-editorials/review-gun-acquisition-laws.html#; 2013.
Accessed September 22, 2019.
3. Adu Alice. Small Arms & Light Weapons Ghana’s Struggle with Illegal Guns. 2017.
4. Seth J Bokpe. 1,300 Guns burnt but 1.1 million firearms in wrong hands — Small
Arms Commission. Graphic online https://www.graphic.com.gh/news/general
-news/1-300-guns-burnt-but-1-1-million-firearms-in-wrong-hands-small-arms
-commission.html; 2016, Jul 11. Accessed September 11, 2019, 2016.
P.P.S. Ossei et al.
5. The Geneva Declaration on Armed Violence and Development; 2006. http://www.gene
vadeclaration.org/home.html. Accessed September 2, 2019.
6. Evoy Claire Mc, Hideg Gergely. Global Violent Deaths, Small Arms Survey. Small Arms
Survey, Graduate Institute of International and Development Studies, Geneva. 2017.
7. Ogunlusi JD, Oginni LM, Ikem IC, et al. Gunshot injuries in a Nigerian hospital. Niger
J Orthop Trauma. 2006;5(2):34–37.
8. Akakpo PK, Awlavi K, Agyarko-Wiredu F, Derkyi-Kwarteng L. A 6 Year analysis of
fatal gunshot injuries in the central region of Ghana. J Forensic Crime Stud. 2018;2:
302.
9. Aderounmu AO, Fadiora SO, Adesunkanmi AR, Agbakwuru EA, Oluwadiya KS,
Adetunji OS. The pattern of gunshot injuries in a communal clash as seen in two
Nigerian teaching hospitals. J Trauma. 2003;55:626–630.
10. Garba ES, Ukwenya AY. Sectarian religious crises in Kaduna, Nigeria: 30 cases of
abdominal gunshot injuries. South Med J. 2002;95(10):1228.
11. Eze UO, Akang EEU, Odesanmi WO. Pattern of gunshot deaths in a Nigerian Tertiary
Health Institution. Internet J. Med. Update E-J. 2016;11(2):25–28.
12. Cook PJ, Lawrence BA, Ludwig J, Miller TR. The medical costs of gunshot injuries in
the United States. J Am Med Assoc. 1999;282:447–454.
13. Smith W, Simmonds JO, Alam ZS, Grant RE. Spinal cord injury caused by gunshot
wounds: the cost of rehabilitation. Clin Orthop Relat Res. 2003;408:145–151.
14. Ikeda RM, Gorwitz R, James SP, Powell KE, Mercy JA. Trends in fatal firearm-related
injuries, United States, 1962–1993. Am J Prev Med. 1997;13(5):396–400.
15. Onuminya JE, Ohwowhiagbese E. Pattern of civilian gunshot injuries in Irrua,
Nigeria. S Afr J Surg. 2005;43(4):170–172.
View publication stats
Journal of Forensic and Legal Medicine 69 (2020) 101889
16. Meel BL. Firearm fatalities in the Transkei region of South Africa, 1993–2004. S Afr
Med J. 2005;95(12):963–967.
17. Kohli Anil, Aggarwal Neeraj. Firearm Fatalities in Delhi, India. vol. 8. Tokyo, Japan:
Legal medicine; 2006:264–268. https://doi.org/10.1016/j.legalmed.2006.06.001.
18. La Harpe R, Mohamed NB, Burkhardt S. Gunshot deaths in Geneva, Switzerland:
2001 to 2010. Am J Forensic Med Pathol. 2013;34(3):248–252.
19. Rouse D, Dunn L. Firearm fatalities. Forensic Sci Int. 1992;56(1):59–64.
20. Karger B, Billeb E, Koops E. Accidental firearm fatalities. Forensic and preventive
implications. Int J Leg Med. 2002;116(6):350–353.
21. Rubenstein A, Wood SK, Levine RS, Hennekens CH. Alarming trends in mortality
from firearms among United States schoolchildren. Am J Med. 2019;132(8).
22. Cunningham RM, Walton MA, Carter PM. The major causes of death in children and
adolescents in the United States. N Engl J Med. 2018;379(25):2468–2475.
23. Amankrah JY. Ghana Decent Work Statistical Indicators: Fact Finding Study. Geneva:
ILO Working Paper, ILO; 2005.
24. Thomas MO, Giwa SO, Adekoya-Cole TO. Arterial injuries in civilian practice in
Lagos, Nigeria. Niger J Clin Pract. 2005;8:65–68.
25. Ossei PPS, Agyeman-Duah E. Trend of medicolegal manner of deaths in Ghana: a
forensic autopsy-based study. Ann Int Med Dent Res. 2017;3(4):PT56–PT61.
26. Koops E, Flüs K, Lockemann U, Püschel K. Fatal gunshot injuries in Hamburg 1966-
1991. Archiv fur Kriminologie. 1994;193(1-2):14–22.
27. Guileyardo JM, Carmody TJ, Lene WJ, Stone IC. Racial and ethnic patterns in
firearms deaths. Am J Forensic Med Pathol. 1994;15(4):328–330.
28. Saukko Pekka, Knight Bernard. Knight’s Forensic Pathology. 3ed.. Abingdon, Oxon:
CRC Press; 2004:245–278.