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BACKGROUND: Road safety for older adults should receive more attention in low-income and middle-income countries with rapidly ageing populations. METHODS: Using injury surveillance data from Khon Kaen Regional Hospital in northeastern Thailand, we calculated the proportion of older adults in the total number of patients who were fatally and non-fatally injured in road traffic crashes in each year from 2001 to 2020 and the proportion of road user type in the fatal and non-fatal patients by age groups for the entire study period to examine the extent to which older adults were involved in the crashes and with what mode of transportation. RESULTS: During the 20-year period, there were 5046 fatal and 180 353 non-fatal patients of whom 509 (10%) and 6087 (3%) were aged 65 years or older, respectively. From 2001 to 2020, this proportion increased from 3% to 20% among the fatal patients and from 1% to 6% among the non-fatal patients. Of the fatal and non-fatal patients aged 65 years or older, 50% and 54% were involved in road traffic crashes while driving motorcycles and 28% and 22% while riding bicycles or walking, respectively. Compared with patients aged 65-74 years, those aged 75 years or older tended to be bicyclists or pedestrians in the crashes, though as high as 40% of them were motorcycle drivers. CONCLUSION: Older adults are increasingly injured in road traffic crashes as vulnerable road users in Thailand. Therefore, road safety efforts should consider their presence on the road.
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BACKGROUND: Endometriosis is a multifaceted gynecological condition that poses diagnostic challenges and affects a significant number of women worldwide, leading to pain, infertility, and a reduction in patient quality of life (QoL). Traditional diagnostic methods, such as the revised American Society for Reproductive Medicine (r-ASRM) classification, have limitations, particularly in preoperative settings. The Numerical Multi-Scoring System of Endometriosis (NMS-E) has been proposed to address these shortcomings by providing a comprehensive preoperative diagnostic tool that integrates findings from pelvic examinations and transvaginal ultrasonography. METHODS: This retrospective study aims to validate the effectiveness of the NMS-E in predicting surgical outcomes and correlating with the severity of endometriosis. Data from 111 patients at Nippon Medical School Hospital were analyzed to determine the correlation between NMS-E scores, including E-score-a severity indicator-traditional scoring systems, surgical duration, blood loss, and clinical symptoms. This study also examined the need to refine parameters for deep endometriosis within the NMS-E to enhance its predictive accuracy for disease severity. RESULTS: The mean age of the patient cohort was 35.1 years, with the majority experiencing symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. A statistically significant positive correlation was observed between the NMS-E's E-score and the severity of endometriosis, particularly in predicting surgical duration (Spearman correlation coefficient: 0.724, p < 0.01) and blood loss (coefficient: 0.400, p < 0.01). The NMS-E E-score also correlated strongly with the r-ASRM scores (coefficient: 0.758, p < 0.01), exhibiting a slightly more excellent predictive value for surgical duration than the r-ASRM scores alone. Refinements in the methodology for scoring endometriotic nodules in uterine conditions improved the predictive accuracy for surgical duration (coefficient: 0.752, p < 0.01). CONCLUSIONS: Our findings suggest that the NMS-E represents a valuable preoperative diagnostic tool for endometriosis, effectively correlating with the disease's severity and surgical outcomes. Incorporating the NMS-E into clinical practice could significantly enhance the management of endometriosis by addressing current diagnostic limitations and guiding surgical planning.
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OBJECTIVE: To examine the association between home safety hazards and unintentional poisoning in children in Mongolia. METHODS: We conducted a case-control study using structured questionnaires to investigate safety behaviours, safety equipment use, and home hazards in households with or without children aged 0-5 years who had suffered from poisoning at home (i.e., cases and controls). We recruited 190 cases (105 medicinal and 84 non-medicinal poisonings, and one each) at the National Center for Maternal and Child Health and 379 controls in the communities between 1 March and 30 October 2021. RESULTS: There were large differences between cases' and controls' households in safety behaviours and home hazards: the failure to store all medicines out of reach of children (68% of cases vs. 25% of controls), the failure to store all medicines safely (out of reach, locked or non-existent) (61% vs. 22%), the failure to put all medicines away immediately after use (77% vs. 43%), the presence of things that a child could climb on to reach high surfaces (82% vs. 67%), the presence of medicines transferred into different containers (28% vs. 9%) and the presence of household products transferred into different containers (28% vs. 16%). These home safety hazards were strongly associated with poisoning after controlling for confounders. CONCLUSION: Children's risk of unintentional poisoning was strongly associated with the unsafe storage of potentially poisonous agents by caregivers and home hazards. Since unsafe storage is widespread, a fail-safe approach such as child-resistant closure of medicines and household products should be considered.
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Intoxicación , Equipos de Seguridad , Humanos , Lactante , Estudios de Casos y Controles , Mongolia , Familia , Encuestas y Cuestionarios , Intoxicación/epidemiologíaRESUMEN
BACKGROUND: In Japan, older drivers have been encouraged to surrender their driving licenses for traffic safety despite the potential adverse social and health outcomes of driving cessation. We reconsidered such policies and social pressure by comparing the risk of at-fault motor vehicle collisions (MVCs) across the age groups of drivers. METHODS: Using the national data of police-reported MVCs that occurred between 2016 and 2020, we examined the number of at-fault MVCs per licensed driver (MVC rate) and the number of fatally and non-fatally injured persons per at-fault MVC by the sex and age groups of at-fault drivers. RESULTS: The MVC rate of older drivers was higher than that of middle-aged drivers but lower than that of young drivers. The number of injured persons among the collided counterparts (collided car occupants, motorcyclists, bicyclists, and pedestrians) per MVC caused by older drivers was not greater than that by drivers in other age groups. In fatal MVCs caused by older drivers, drivers themselves or their passengers tend to be killed rather than their collided counterparts. Overall, the results were mostly consistent between male and female drivers. CONCLUSIONS: The risk of at-fault MVCs increased with the advancing age of drivers after middle age; however, this risk among older drivers did not exceed that among young drivers, without posing a high risk of injuries to their collided counterparts.
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Objective: To examine trends in the incidence of carbon monoxide poisoning before and after a ban on domestic use of raw coal in Ulaanbaatar, Mongolia. Methods: Using injury surveillance data and population estimates, we calculated the incidence per 100 000 person-years of fatal and non-fatal domestic carbon monoxide poisoning before (May 2017 to April 2019) and after (May 2019 to April 2022) the ban in May 2019. We analysed data by age and sex, and compared areas not subjected to the ban with districts where domestic use of raw coal was banned and replaced with refined coal briquettes. Findings: We obtained complete data on 2247 people with carbon monoxide poisoning during the study period in a population of around 3 million people. In districts with the ban, there were 33 fatal and 151 non-fatal carbon monoxide poisonings before the ban, and 91 fatal and 1633 non-fatal carbon monoxide poisonings after the ban. The annual incidence of poisoning increased in districts with the ban, from 7.2 and 6.4 per 100 000 person-years in the two 12-month periods before the ban to 38.9, 42.0 and 40.1 per 100 000 in the three 12-month periods after the ban. The incidence of poisoning remained high after the ban, despite efforts to educate the public about the correct use of briquettes and the importance of ventilation. The incidence of carbon monoxide poisoning also increased slightly in areas without the ban. Conclusion: Efforts are needed to investigate heating practices among households using briquettes, and to determine factors causing high carbon monoxide concentrations at home.
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Intoxicación por Monóxido de Carbono , Humanos , Intoxicación por Monóxido de Carbono/epidemiología , Intoxicación por Monóxido de Carbono/prevención & control , Intoxicación por Monóxido de Carbono/etiología , Mongolia/epidemiología , Incidencia , Carbón MineralRESUMEN
In Indonesia, school feeding programs have not been established nationally due to the government's limited budget. To examine the possibility of copayment for school feeding programs, parents' intentions to use the school feeding programs and their willingness to pay (WTP) for these programs should be considered. We conducted an online questionnaire survey among the parents of junior high school students in all five public junior high schools in the Kepanjen District of Malang Regency, East Java Province, Indonesia. We used the contingent valuation method to elicit parents' WTP for school feeding and calculated the price elasticity of school feeding. Factors associated with the WTP were examined using logistic regression analysis. Of the 940 participants, 90% intended to use school feeding programs, and 30% were willing to pay Rp 15,000 (USD 1.05) or higher per meal. Of the 944 students (participants' children), all but two students consumed meals or snacks at school, with 74% consuming foods three or more times daily. Higher WTP for school feeding was associated with frequent food consumption at school, higher income, and a better perception of meals at school. In contrast, lower WTP was associated with more household members. Most parents intended to use school feeding programs with certain WTP irrespective of the price of school feeding. Therefore, school feeding in Indonesia might be expanded through copayment.
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Renta , Instituciones Académicas , Niño , Humanos , Indonesia , Encuestas y Cuestionarios , PadresRESUMEN
Endometriosis-associated pain is an essential factor in deciding surgical indications of endometriosis. However, there is no quantitative method to diagnose the intensity of local pain in endometriosis (especially deep endometriosis). This study aims to examine the clinical significance of the pain score, a preoperative diagnostic scoring system for endometriotic pain that can be performed only with pelvic examination, devised for the above purpose. The data from 131 patients from a previous study were included and evaluated using the pain score. This score measures the pain intensity in each of the seven areas of the uterus and its surroundings via a pelvic examination using a numeric rating scale (NRS) which contains 10 points. The maximum value was then defined as the max pain score. This study investigated the relationship between the pain score and clinical symptoms of endometriosis or endometriotic lesions related to deep endometriosis. The preoperative max pain score was 5.93 ± 2.6, which significantly decreased to 3.08 ± 2.0 postoperatively (p = 7.70 × 10-20). Regarding preoperative pain scores for each area, those of the uterine cervix, pouch of Douglas, and left and right uterosacral ligament areas were high (4.52, 4.04, 3.75, and 3.63, respectively). All scores decreased significantly after surgery (2.02, 1.88, 1.75, and 1.75, respectively). The correlations between the max pain score and dysmenorrhea, dyspareunia, perimenstrual dyschezia (pain with defecation), and chronic pelvic pain were 0.329, 0.453, 0.253, and 0.239, respectively, and were strongest with dyspareunia. Regarding the pain score of each area, the combination of the pain score of the pouch of Douglas area and the VAS score of dyspareunia showed the strongest correlation (0.379). The max pain score in the group with deep endometriosis (endometrial nodules) was 7.07 ± 2.4, which was significantly higher than the 4.97 ± 2.3 score obtained in the group without (p = 1.71 × 10-6). The pain score can indicate the intensity of endometriotic pain, especially dyspareunia. A local high value of this score could suggest the presence of deep endometriosis, depicted as endometriotic nodules at that site. Therefore, this method could help develop surgical strategies for deep endometriosis.
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Objectives: The objective of this study was to assess the potential risk factors for abscess development in patients with endometrioma who present with an acute abdomen. Materials and Methods: We retrospectively reviewed the records of 51 patients who underwent emergency surgery for acute abdomen involving an endometrioma at our hospital between April 2011 and August 2021. The patients were divided into an infected group (n = 22) and a control group (n = 29). We analyzed patient characteristics; imaging findings; clinical data, including bacterial cultures; and perioperative outcomes to assess for differences between groups. Results: Patients in the infected group were significantly older than those in the control group (P = 0.03). They were more likely to have a history of endometriosis surgery (P = 0.04) and more likely to have undergone transvaginal manipulation within 3 months of presentation (P = 0.01). Body temperature on the day of admission was significantly higher in the infected group (P = 0.007), as were C-reactive protein levels on the day of admission and before surgery (P < 0.001; P = 0.018) and the white blood cell count on the day of admission (P = 0.016). Preoperative imaging showed significant thickening of the tumor wall (P < 0.001) and an enhanced contrast effect (P < 0.001) in the infected group. Conclusion: We identified several factors that suggest abscess in patients with an acute abdomen who have a complication of pathologically confirmed endometriosis. A recent vaginal procedure is a particular risk factor for abscess development in patients with endometriomas.
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BACKGROUND: We examined whether the policy amendment from March 2017 for a cognitive screening test for older drivers at driver's license renewal was associated with the decreased risk of motor vehicle collisions for drivers and the increased risk of injuries for pedestrians and cyclists among older people. METHODS: This was a controlled interrupted time-series study. We used police-reported data on the number of collisions as drivers and injuries as pedestrians and cyclists among people aged 70 years or older in Japan from July 2012 to December 2019. As the outcome measures, we used the ratio of the monthly number of collisions per population among drivers of three groups aged 75 years or older (75-79, 80-84, and ≥85 years), who were targeted or exposed by the policy, to that among drivers aged 70 to 74 years, who were unaffected or unexposed by the policy and would serve as controls. The ratio of pedestrian and cyclist injuries was also calculated, as previous studies have shown a concomitant increase in these injuries after the introduction of cognitive screening for driver's licenses. RESULTS: During the study period, there were 602,885 collisions as drivers and 196,889 injuries as pedestrians and cyclists among people aged 70 years or older. After the policy amendment in March 2017, collisions decreased among male drivers, and injuries increased among some age subgroups in both sexes. Cumulative estimated changes in the numbers of collisions and injuries from March 2017 to December 2019 were -3670 (95% confidence interval: -5125, -2104) and 959 (95% confidence interval: 24, 1834), respectively. CONCLUSIONS: Following the policy amendment, there was a decrease in motor vehicle collisions as drivers and an increase in road injuries as pedestrians and cyclists among older people.
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Accidentes de Tránsito , Concesión de Licencias , Femenino , Humanos , Masculino , Anciano , Accidentes de Tránsito/prevención & control , Pruebas Neuropsicológicas , Análisis de Series de Tiempo Interrumpido , Vehículos a MotorRESUMEN
BACKGROUND: Accurate diagnosis of retroflexed uterus in daily practice is essential because this condition is related to pelvic pain and deep endometriosis. Uterine flexion can be measured by transvaginal ultrasonography (TVUS), a cost-effective primary test, but the accuracy required for diagnosing retroflexed uterus is unclear. This study assessed the accuracy of TVUS for diagnosis of retroflexed uterus in patients with endometriosis and compared it with that of magnetic resonance imaging (MRI) -the gold standard for measuring the uterine axis. METHODS: The study included 123 patients who underwent endometriosis surgery in our department between 2012 and 2017. Uterine flexion angles were measured by retrospectively examining TVUS and MRI images, and the correlation was analyzed. Analysis of anteverted and retroverted uterine subgroups identified aspects of diagnosing uterine flexion with TVUS. RESULTS: Uterine flexion angles on TVUS were strongly positively correlated (r = 0.86) with MRI results. Additionally, TVUS yielded no false-positive diagnoses and 28 false-negative diagnoses of retroflexion. All false-negative diagnoses occurred in patients with anteverted retroflexed uteruses. CONCLUSIONS: TVUS was generally accurate for measuring uterine flexion angle, as indicated by its strong correlation with MRI. Misdiagnosis of anteverted retroflexed uterus was a limitation of using TVUS for retroflexion diagnosis.
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Endometriosis , Retroversión Uterina , Femenino , Humanos , Endometriosis/diagnóstico , Endometriosis/patología , Endometriosis/cirugía , Ultrasonografía/métodos , Estudios Retrospectivos , Sensibilidad y Especificidad , Imagen por Resonancia Magnética/métodosAsunto(s)
Industria del Tabaco , Productos de Tabaco , Humanos , Publicidad , Japón , Dispositivos para Fumar , MercadotecníaRESUMEN
BACKGROUND: Since 2011, commercial truck drivers have been required to take alcohol breath tests at the beginning and end of their working hours due to their employers' legal obligations. However, non-commercial truck drivers are not required to do so. We examined whether alcohol-related crashes had decreased after 2011 among commercial truck drivers. METHODS: Using police data, we conducted a joinpoint regression analysis to examine the trend in the proportion of alcohol-related crashes from 1995 through 2020 caused by commercial truck drivers (who were subjected to alcohol breath testing) and non-commercial truck drivers (who were not subjected to testing). The annual percentage change in this trend was also estimated. RESULTS: During the 26-year study period, truck drivers caused 1,846,321 at-fault crashes, and 0.4% of the crashes involved intoxicated driving. A significant decreasing trend in the proportion of alcohol-related crashes was identified among both commercial and non-commercial truck drivers in the 2000s, during which several legal amendments were made against drunk driving. The annual percentage change was -13.5% from 2001 to 2012 among commercial truck drivers, and -14.9% from 2001 to 2011 among non-commercial truck drivers. No decreasing trend was observed afterwards, despite the introduction of mandatory alcohol breath testing in 2011. CONCLUSION: The effect of mandatory alcohol breath testing on reducing alcohol-related crashes among commercial truck drivers was not evident.
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Accidentes de Tránsito , Conducción de Automóvil , Humanos , Accidentes de Tránsito/prevención & control , Japón , Etanol , Pruebas Respiratorias , Vehículos a MotorRESUMEN
This study aimed to examine how the associations between surrendering driving licence and changes in self-rated health and social interactions among older adults differ by the years elapsed since surrendering and the number of public transportation systems (PTS) in the neighbourhood. We used the 2013 and 2016 survey data from the Japan Gerontological Evaluation Study targeting residents aged ≥65 years in 30 municipalities in Japan. Two-waves longitudinal data from 4894 older adults were evaluated. Based on the difference-in-differences method, the interaction terms of respondents' driving status, which was the categorical exposure variable representing respondents' driving status for three years during the study period, and a dummy variable of year (2016) were used as explanatory variables in logistic regression analyses to examine changes in outcomes (poor self-rated health and infrequent meeting with friends) between 2013 and 2016 by driving status during this period. Analyses were stratified based on neighbourhood PTS ('more PTS' and 'fewer PTS' groups). We found that, while surrendering licence within three years was associated with increased probability of poor self-rated health in more PTS group, the confidence interval was large. Although surrendering licence within three years was associated with decreased social interactions, this association weakened if licence was surrendered more than three years ago. These associations were not markedly affected by neighbourhood PTS. Our findings suggested that, regardless of neighbourhood PTS, support and care to promote social interactions at or shortly after surrendering licence may be beneficial to the well-being of older adults who lost their driving licence.
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Conducción de Automóvil , Pueblos del Este de Asia , Humanos , Anciano , Estudios Longitudinales , Transportes , Encuestas y Cuestionarios , JapónRESUMEN
OBJECTIVE: To evaluate the effects of child burn prevention campaigns on medically attended burn injuries in Ulaanbaatar, Mongolia. METHODS: We conducted an interrupted time-series analysis using data on patients aged<5 years who were treated for burn injuries at the Emergency Department of the National Trauma and Orthopaedic Center from January 2009 to December 2018. Since the campaigns focused on scald prevention, we calculated the monthly rate of scald injuries per 10 000 children aged<5 years by sex and injury severity, regressing it on the number of months after January 2009 (the beginning of the study), after June 2014 (the first nationwide campaign started) and after January 2017 (the second facility-based campaign started). RESULTS: During the 10-year study period, there were 23 459 patients, of whom 18 433 (79%) were treated for scald injuries, including 6920 severe injuries. The monthly rate of overall scald injuries started to decrease after the first campaign, with a relative change of -32% at the end of the intervention. However, the rate started increasing before the initiation of the second campaign; this trend continued during and after the campaign. The rate of severe scald injuries did not show any significant changes throughout the study period. The results were consistent for both sexes. CONCLUSIONS: The nationwide burn prevention campaign was effective in reducing non-severe burn injuries among young children. Since the campaign was primarily aimed at increasing public awareness of child burn injury risks, further interventions should be considered with passive measures to prevent severe burn injuries.
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Quemaduras , Quemaduras/epidemiología , Quemaduras/prevención & control , Niño , Preescolar , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Análisis de Series de Tiempo Interrumpido , Masculino , Mongolia/epidemiologíaRESUMEN
BACKGROUND: Road traffic injury has long been regarded as a "time-dependent disease." However, shortening the prehospital time might not improve the outcome in developing countries given the current quality of in-hospital care. We aimed to examine the relationship between the prehospital time and 24-h mortality among road traffic victims in Laos. METHODS: A prospective observational study was conducted using the trauma registry data on traffic-injured patients who were transported by ambulance to a trauma center in the capital city of Laos from May 2018 to April 2019. The analysis focused on patients with non-mild conditions, whose outcomes could be affected by the prehospital time. To examine the relationship between a prehospital time of <60 min and 24-h mortality, a generalized estimating equation model was used incorporating the inverse probability weights utilizing the propensity score for the prehospital time. RESULTS: Of 701 patients, 73% were men, 91% were riding 2- or 3-wheel motor vehicles during the crash, and 68% had a prehospital time of <60 min. A total of 35 patients died within 24 h after the crash. Compared with those who survived, individuals who died tended to have head and torso injuries. The proportions of 24-h mortality were 4.7% and 5.4% in patients whose prehospital time was <60 min and ≥60 min, respectively. No significant relationship was found between the prehospital time and 24-h mortality. CONCLUSION: A shorter prehospital time was not associated with the 24-h survival among road traffic victims in Laos.
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Servicios Médicos de Urgencia , Heridas y Lesiones , Accidentes de Tránsito , Ambulancias , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Laos/epidemiología , Masculino , Centros Traumatológicos , Heridas y Lesiones/terapiaRESUMEN
BACKGROUND: Modal shifts in transport may reduce overall road injuries. Cyclist junior high school students are at a high risk of road injuries while commuting in Japan, and injuries among junior high school students could be reduced if the cyclists switch to other transport modes. METHODS: We estimated the change in the incidence of road deaths and serious injuries while commuting in months with heavy snowfall, when cyclists are likely to switch to other transport modes. Using police data on the monthly number of road injuries while commuting among junior high school students in Japan between 2004 and 2013 and corresponding population statistics and snowfall data, we calculated the monthly injury rate (number of deaths and serious injuries divided by population) at the prefecture level. We conducted Poisson regression analysis to estimate the change in the rate in months with a snowfall of ≥100 cm, compared to months without snowfall. RESULTS: A total of 3,164 deaths and serious injuries occurred during 2004 to 2013. The injury rate among cyclists was almost zero in months with a snowfall of ≥100 cm. That among cyclists and pedestrians in these months was reduced by 68% (95% confidence interval, 43-82%). CONCLUSION: In months with heavy snowfall, road injuries while commuting were reduced due to the near-elimination of cycling injuries among junior high school students in Japan. Switching from cycling to other transport modes would reduce overall road injuries among this population, and inducing modal shifts can be an important tool for road safety.
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Accidentes de Tránsito , Heridas y Lesiones , Ciclismo/lesiones , Humanos , Japón/epidemiología , Nieve , Estudiantes , Transportes , Caminata , Heridas y Lesiones/epidemiologíaRESUMEN
The majority of pediatric burns in Mongolia occur within the home, particularly in the spaces dedicated to cooking. This makes home environment modification a priority for injury prevention. Many of these injuries are caused by electric appliances used in traditional tent-like dwellings (called a ger). In the present study, we designed and provided a context appropriate kitchen rack to 50 households with children aged 0-3 years living in gers and investigated parental views on the acceptability of the rack and willingness-to-pay (WTP) through face-to-face structured individual and group interviews and the contingent valuation method. We used the DCchoice package of R to estimate the median WTP and its 95% confidence interval by the household income, previous experience of childhood burn injury, and the number of children in the household. There was a total of 89 children aged <5 years in the 50 households, with a total of 59 burn experiences since birth including 29 treated at inpatient facilities. The median WTP was MNT 106,000 (about USD 37). The WTP appeared to be higher for the households with a higher income, more severe child burn experiences, and a greater number of children in the household. In the group interviews conducted after 4-6 weeks of routine use, the participants indicated that the use of the rack had resulted in a less stressful cooking environment, and the kitchen rack was described as a positive contribution to the reduction of risk to their young children. Whilst there were some suggestions for minor modifications, the rack was well accepted as a means of child burn prevention by the parents of infants and toddlers in Mongolia.
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Quemaduras , Quemaduras/etiología , Quemaduras/prevención & control , Niño , Preescolar , Culinaria , Humanos , Renta , Lactante , PadresRESUMEN
Child burn injuries in Mongolia are often caused by electric cooking appliances used on the floor or low table in traditional tent-like dwellings (called a ger) which have no separate kitchen. To prevent these injuries, we developed a context-specific kitchen rack to make electric appliances inaccessible to children, and the rack was provided to 50 families with children aged 0-3 years living in gers for a pilot test. In the present study, we investigated their opinions about the rack after they used it for about 10 months through semi-structured interviews, their willingness-to-pay (WTP) for the rack using a contingent valuation method, and their preference for potential modifications of the rack using best-worst scaling. The estimated median WTP was about USD 40 (which was higher than USD 37 at the baseline when they started to use the rack). The highest priority of modifications of the rack was to enclose the lower section of the rack with doors (which was originally open without doors to reduce the production cost). A few families did not use the rack in winter because they used heating stoves instead of electric appliances for cooking, but we found a unanimous view that the rack reduces burn injuries to children, which may be reflected in their increased WTP for the rack. These findings would guide us to make our burn prevention efforts more relevant to real-life situations and socially acceptable in Mongolia.