Hand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention.

OBJECTIVES: Hand injuries result in major healthcare costs from lack of productivity and disability. With rapid industrialization, the incidence of hand injuries is expected to rise in low- and middle-income countries (LMICs). However, estimates of burden and validated outcome tools are needed for effective resource allocation in the management of these injuries. STUDY DESIGN: We conducted a systematic review to evaluate the burden of hand injuries in LMICs according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. METHODS: We searched PubMed, Scopus, Embase, Cochrane Library, PAIS International, African Index Medicus, Global Health, IMMEMR, IMSEAR, Wholis and Bdenf, Lilacs, Scielo, WPRIM, and WHO International Clinical Trials Registry Platform to detect eligible articles with no restrictions on length of follow-up, type of hand injury, or date. RESULTS: We included 17 articles after screening 933 eligible articles based on title, abstract, and full-text screening. There was significant heterogeneity and low quality of evidence. All included articles suggest that hand injuries were associated with work limitations for the majority of patients, and residual pain can further limit their activities. Direct and indirect costs related to treatment account for a major healthcare burden with limited evidence on estimates of long-term cost from disability. CONCLUSIONS: The present systematic review highlights the paucity of high-quality data on the epidemiology, management, and burden of hand injuries in LMICs. The data are heterogeneous, and comprehensive metrics are lacking. Because hand injuries can account for a significant proportion of injury-related disability, reducing the overall burden of hand injuries is of utmost importance.

One hundred injured patients a day: multicenter emergency room surveillance of trauma in Pakistan.

OBJECTIVES: Injuries increasingly contribute to the global burden of disease in low- and middle-income countries. This study presents results from a large-scale surveillance study on injury from several urban emergency departments (EDs) in Pakistan. The objective is to document the burden of injuries that present to the healthcare system in Pakistan and to test the feasibility of an ED-based injury and trauma surveillance system. STUDY DESIGN: Cross-sectional study conducted using active surveillance approach. METHODS: This study included EDs of seven tertiary care hospitals in Pakistan. The data were collected between November 2010 and March 2011. All patients presenting with injuries to the participating EDs were enrolled. The study was approved by the Institutional Review Boards of the Johns Hopkins School of Public Health, Aga Khan University, and all participating sites. RESULTS: The study recorded 68,390 patients; 93.8% were from the public hospitals. There were seven male for every three female patients, and 50% were 20-39 years of age. About 69.3% were unintentional injuries. Among injuries with a known mechanism (19,102), 51.1% were road traffic injuries (RTIs) and 17.5% were falls. Female, patients aged 60 years or older, patients transferred by ambulance, patients who had RTIs, and patients with intentional injuries were more likely to be hospitalized. CONCLUSION: The study is the first to use standardized methods for regular collection of multiple ED data in Pakistan. It explored the pattern of injuries and the feasibility to develop and implement facility-based systems for injury and acute illness in countries like Pakistan.

Prevalence of drink driving and speeding in China: a time series analysis from two cities.

OBJECTIVES: To confront the public health challenge imposed by road traffic injuries in China. STUDY DESIGN: A consortium of international partners designed and implemented targeted interventions, such as social media campaigns, advocacy for legislative change and law enforcement training, to reduce the percentage of drink driving and speeding in two Chinese cities, Dalian and Suzhou, from 2010 to 2014. METHODS: Time series models were developed to detect changes in the prevalence of drink driving and speeding using data collected through four years of observational studies. RESULTS: This analysis, based on 15 rounds of data, shows that from May 2011 to November 2014, the percentage of vehicles driving above the speed limit decreased from 31.8% (95% confidence interval [CI]: 29.2-34.5) to 7.4% (95% CI: 7.0-7.9) in Dalian and from 13.5% (95% CI: 11.7-15.5) to 6.9% (95% CI: 6.4-7.4) in Suzhou. Drink driving decreased from 1.7% (95% CI: 1.1-2.4) in January 2011 to 0.5% (95% CI: 0.2-0.9) in November 2014 in Dalian and from 6.4% (95% CI: 5.4-7.4) to 0.5% (95% CI: 0.1-2.4) in Suzhou during approximately the same period. Time series models confirmed declining trends in both risk factors in both cities (P-value: 0.06 for speeding prevalence in Suzhou; all other P-values are below 0.05). Disaggregated by vehicle type, saloon cars and SUVs were more likely to exceed the posted speed limit than other types of vehicles in both cities. The speeding rate was higher where the posted speed limit is lower. In Dalian, more drivers were driving above the posted speed limit on weekdays than on weekends (11.4% vs 6.8%); Suzhou had a similar pattern, but the difference was smaller (14.0% vs 12.2%). CONCLUSION: Despite the challenge in accurately attributing the observed changes to one programme, the substantial reduction in the prevalence of the two risk factors suggests that through coordinated actions, internationally recognized best practices in road safety may be effective in improving road traffic safety in China.

Helmet wearing in Kenya: prevalence, knowledge, attitude, practice and implications.

OBJECTIVES: In light of the increasing prevalence of motorcycles on Kenyan roads, there is a need to address the safety of individuals using this mode of transport. Helmet use has been proven to be effective in preventing head injuries and fatalities in the event of a crash. This study aims to understand the prevalence of helmet use as well as knowledge, attitudes, and practices in two districts in Kenya over a 5-year period (2010-2014). STUDY DESIGN: Observational studies on helmet use at randomly selected locations throughout each district were done every quarter to estimate the prevalence of helmet use. Roadside knowledge, attitude, and practice (KAP) surveys were done two times a year in each district. METHODS: Helmet use among motorcycle drivers and passengers in Thika and Naivasha was assessed through systematic observations at randomly selected locations in the two districts between August 2010 and December 2014. Roadside KAP surveys were administered in both sites to motorcyclists in areas where they stopped, including motorcycle bays, petrol stations and rest areas near the helmet observation sites. Secondary analysis of trauma registries was also used. Negative binomial regressions were used to assess trends of helmet wearing among motorcyclists over time, and logistic regressions were used to analyze associated risk factors as well as association with health outcomes among those admitted to the four hospitals. RESULTS: A total of 256,851 motorcycles were observed in the two target districts during the study period. Overall, prevalence of helmet use among motorcycle drivers in Thika and Naivasha across all periods was 35.12% (95% confidence interval [CI]: 34.87%-35.38%) and 37.42% (95% CI: 37.15%-37.69%) respectively. Prevalence of helmet wearing remained similar after the passage of a traffic amendment bill. These results were not statistically significant in either Thika or in Naivasha. Data from the KAP survey showed that respondents recognized the life-saving effect of wearing a helmet, but many did not always wear a helmet because they found it inconvenient/uncomfortable. Analysis of trauma registry data showed that helmet wearing was associated with a significant reduction in head injuries among motorcyclists (adjusted odds ratio: 0.472, 95% CI: 0.327-0.684). CONCLUSIONS: This study highlights the low prevalence of helmet use and documents the potential reduction in the risk of head injuries to motorcyclists if this risk factor was addressed. The passage of a traffic amendment bill showed negligible impact on helmet use. This highlights the need for a multi-faceted strategy that includes media campaigns and widespread enforcement in addition to legislative change for improving helmet use.

Knowledge, attitudes, and practices around drinking and driving in Cambodia: 2010-2012.

OBJECTIVE: Road traffic injuries are a leading cause of disability and death in Cambodia. Economic development has long been associated with rapid increases in road traffic injuries and fatalities. Drink driving is of particular concern in Cambodia. In 2014, the percentage of fatal crashes involving alcohol rose to 17.5% (n = 381), representing a 34.9% (n = 253) increase from 2012. This study aims to illustrate current knowledge, attitudes and practices (KAP) around drinking and driving in three Cambodian provinces. METHODS: A roadside survey of randomly selected road users (aged 18 years and older) was conducted in Phnom Penh, Kandal, and Kampong Speu, Cambodia, between November 2010 and May 2012. Data were collected for five-day periods every 6 months. A survey was administered to assess prevailing knowledge, attitudes, and practices surrounding drink driving. RESULTS: A total of 1187 road users responded to the KAP survey, the majority (49.6%, n = 585) of whom were from Phnom Penh. Males accounted for 96.2% (n = 1142) of respondents; the majority (63.8%, n = 757) were aged 34 years and younger. Despite the belief that drinking and driving would increase the risk of a crash, a significant proportion of respondents (37.1%, n = 438) reported driving within 2 h of drinking alcohol at least once in the 30 days preceding the survey. This proportion was particularly high among males aged 25-34 years at 49.2% (n = 208). Of those who reported drinking and driving, 76.5% (n = 335) indicated they 'felt conscious enough' to drive at the time and 34.0% (n = 149) reported having 'no other available transportation options'. CONCLUSIONS: This study shows that, in general, drinking and driving remains a problem in Cambodia. A multi-pronged, coordinated approach is needed to effectively address this issue. Such an approach ought to include social marketing and public education campaigns, enhanced enforcement, and programs that either limit the number of drinks to drivers or those that provide alternatives to drinking and driving.

Trends in motorcycle helmet use in Vietnam: results from a four-year study.

OBJECTIVES: Helmet use is a major risk factor for road traffic injuries and fatalities. This study sought to determine the state of helmet use in Ha Nam and Ninh Binh provinces in Vietnam, and ascertain knowledge, attitudes, and practices of helmet use over time. STUDY DESIGN: Observational helmet use studies, and roadside knowledge, attitudes, and practice surveys. METHODS: Data were collected through observational helmet use studies at multiple sites in Ha Nam and Ninh Binh provinces over 14 rounds between June 2011 and December 2014. Six rounds of knowledge, attitude, and practice surveys were administered at gas stations between December 2011 and July 2014. Trend analysis and negative binomial regressions were used to analyze trend data. RESULTS: Between June 2011 and December 2014, 301,981 helmet-use observations were conducted in Ha Nam and Ninh Binh. Correct helmet use increased significantly (P < 0.01) in Ha Nam from 34.3% to 76.9% (P < 0.01), while use in Ninh Binh increased from 68.9% to 72.2% (P > 0.05). CONCLUSION: Helmet use has improved statistically significantly in Ha Nam but not in Ninh Binh. Ceiling effects may have limited the scope of improvements in Ninh Binh province.

Evaluation of a five-year Bloomberg Global Road Safety Program in Turkey.

OBJECTIVE: Turkey was included in the Bloomberg Philanthropies funded Global Road Safety Program (2010-14) with Ankara and Afyonkarahisar (Afyon) selected for interventions to manage speed and encourage seat-belt use. The objectives of this study are to present the monitoring and evaluation findings of seat-belt use and speed in Afyon and Ankara over the five years and to assess overall impact of the program on road traffic injury, and death rates in Turkey. STUDY DESIGN: Quasi-experimental before after without comparison. METHODS: In collaboration with the Middle East Technical University, roadside observations and interviews were coupled with secondary data to monitor changes in risk factors and outcomes at the two intervention sites. RESULTS: The percentage of seat-belt use among drivers and front-seat passengers in Afyon and Ankara increased significantly between 2010 and 2014 with increased self-reported use and preceded by an increase in tickets (fines) for not using seat belts. There were uneven improvements in speed reduction. In Afyon, the average speed increased significantly from 46.3 km/h in 2012 to about 52.7 km/h in 2014 on roads where the speed limits were 50 km/h. In Ankara, the average speed remained less than 55 km/h during the program period (range: 50-54 km/h; P < 0.005) for roads where the speed limits were 50 km/h; however, the average speed on roads with speed limits of 70 km/h decreased significantly from 80.6 km/h in 2012 to 68.44 km/h in 2014 (P < 0.005). CONCLUSION: The program contributed to increase in seat-belt use in Afyon and Ankara and by drawing political attention to the issue can contribute to improvements in road safety. We are optimistic that the visible motivation within Turkey to substantially reduce road traffic injuries will lead to increased program implementation matched with a robust evaluation program, with suitable controls.

Evaluation of the five-year Bloomberg Philanthropies Global Road Safety Program in the Russian Federation.

Road traffic injuries are a leading cause of morbidity and mortality in the world. In Russia, a road safety program was implemented in Lipetskaya and Ivanovskaya oblasts (regions) as part of a 10-country effort funded by Bloomberg Philanthropies. The program was focused on increasing seat belt and child restraint use and reducing speeding. The primary goals of this monitoring and evaluation study are to assess trends in seat belt use, child restraint use, and speed compliance in the two oblasts over the 5 years and to explore the overall impact of the program on road traffic injury and death rates. Primary data via roadside observations and interviews, and secondary data from official government sources were collected and analyzed for this study. Our results indicate significant improvements in seat belt wearing and child seat use rates and in prevalence of speeding in both intervention oblasts. The observations were consistent with the results from the roadside interviews. In Lipetskaya, restraint use by all occupants increased from 52.4% (baseline, October 2010) to 77.4% (final round, October 2014) and child restraint use increased from 20.9% to 54.1% during the same period. In Ivanovskaya, restraint use by all occupants increased from 48% (baseline, April 2012) to 88.7% (final round, October 2014) and child restraint use increased from 20.6% to 89.4% during the same period. In Lipetskaya, the overall prevalence of speeding (vehicles driving above speed limit) declined from 47.0% (baseline, July 2011) to 30.4% (final round, October 2014) and a similar pattern was observed in Ivanovskaya where the prevalence of speeding decreased from 54.6% (baseline, March 2012) to 46.6% (final round, October 2014). Through 2010-2014, the road traffic crash and injury rates per 100,000 population decreased in Lipetskaya oblast (191.5 and 246.9 in 2010 and 170.4 and 208.6 in 2014, respectively) and slightly increased in Ivanovskaya oblast (184.4 and 236.0 in 2010 and 186.7 and 243.4 in 2014, respectively). These road safety improvements are associated with the program that enabled a combined focus on policy reform, legislation, enforcement, advocacy, education, and data collection and use. However, the existence of other road safety efforts, lack of data from comparable regions, and unavailability of risk factor-specific data make it difficult to attribute these changes to the program.

Potential gains in life expectancy by improving road safety in China.

OBJECTIVES: Road traffic injuries (RTI) cause a significant number of injuries and deaths in China every year; the World Health Organization estimated 261,367 deaths due to RTI in 2013. As a result of the ongoing growth of China's economy, road construction and motorisation, RTI are expected to impose a heavy health burden in the future. However, the public and policy makers have not widely perceived RTI as a public health issue commensurate with its consequences, in part, due to a lack of intuitive indicator measuring the health impact. STUDY DESIGN: Employs the cause-eliminating life table technique to provide a measure of the burden of RTI based on data from a nationally representative surveillance system in China. METHODS: Previous studies have used indicators such as event counts, rates and disability-adjusted life years to measure the health impact of RTI; but this study uses potential gains in life expectancy to measure this impact. RESULTS: Eliminating RTI could lead to a gain of 0.52 years in life expectancy in 2012, meaning that on average Chinese people could live a half year more than they would in the presence of RTI. Males have a substantially higher RTI death rate and consequently could have a gain in life expectancy more than twice as large as females (male 0.72 years vs female 0.28 years). The gain in rural areas (0.65 years) is twice that in urban areas (0.32 years). CONCLUSIONS: The significant gain in life expectancy signals the urgency for public actions to improve road safety; the disparity in the burden across regions and sexes indicate a great opportunity for targeted interventions to protect health and save lives.

A comparison of observed and self-reported helmet use and associated factors among motorcyclists in Hyderabad city, India.

OBJECTIVES: India has a high burden of fatal road traffic injuries (RTIs). A large proportion of fatal RTIs in India are among motorcyclists. The overall goal of this study is to assess and compare observed and self-reported prevalence of helmet use; and to identify factors associated with helmet use and over-reporting in Hyderabad city, India. STUDY DESIGN: Roadside knowledge, attitude and practice interviews. METHODS: Six rounds of roadside interviews were conducted with motorcyclists (drivers and pillion riders) between July 2011 and August 2013 using a structured tool developed for this study. Observations on helmet use were recorded and respondents were also asked if they 'always wear a helmet'. Prevalence of helmet use was calculated and a paired t-test was used to compare observed and self-reported helmet use proportions. Unadjusted and adjusted odds ratios were calculated to identify factors associated with helmet use and over-reporting. RESULTS: A total of 4872 respondents participated in the roadside interview. The response rate was 94.4%. The overall observed helmet use was 34.5% and 44.5% of respondents reported that they 'always wear a helmet'. As the observed helmet use increased, the over-reporting of helmet use was found to decrease. However, factors associated with observed and self-reported helmet use are similar. Male gender, youth (≤24 years), a lower level of education and non-ownership of helmet were associated with a higher risk of not wearing helmets. Male gender, youth (≤24 years), no schooling, riding a lower engine capacity motorcycle and using a motorcycle for purposes other than travelling to school/work were associated with over-reporting of helmet use. CONCLUSIONS: Self-reports provide an overestimate of helmet use that lessens as actual helmet use increases. Interviews also allow identification of factors associated with helmet use. Increasing helmet ownership and enhanced enforcement may help increase helmet use.

Comparative analysis of three prehospital emergency medical services organizations in India and Pakistan.

OBJECTIVES: Strengthened emergency medical services (EMS) are urgently required in South Asia to reduce needless death and disability. Several EMS models have been introduced in India and Pakistan, and research on these models can facilitate improvements to EMS in the region. Our objective was to conduct a cross-case comparative analysis of three EMS organizations in India and Pakistan - GVK EMRI, Aman Foundation and Rescue 1122 - in order to draw out similarities and differences in their models. STUDY DESIGN: Case study methodology was used to systematically explore the organizational models of GVK EMRI (Karnataka, India), Aman Foundation (Karachi, Pakistan), and Rescue 1122 (Punjab, Pakistan). METHODS: Qualitative methods - interviews, document review and non-participant observation - were utilized, and using a process of constant comparison, data were analysed across cases according to the WHO health system 'building blocks'. RESULTS: Emergent themes under each health system 'building block' of service delivery, health workforce, medical products and technology, health information systems, leadership and governance, and financing were described. Cross-cutting issues not applicable to any single building block were further identified. CONCLUSIONS: This cross-case comparison, the first of its kind in low- and middle-income countries, highlights key innovations and lessons, and areas of further research across EMS organizations in India, Pakistan and other resource-poor settings.

The challenges of injuries and trauma in Pakistan: an opportunity for concerted action.

Injuries and trauma are a major cause of mortality and morbidity in low and middle income countries (LMICs). In Pakistan, a low income South Asian developing country, they are among the top ten contributors to disease burden and causes of disabilities, with the majority of the burden falling on younger people in the population. This burden of injuries comes with a high social and economic cost. Several distal and proximal determinants, such as poverty, political instability, frequent natural disasters, and the lack of legislation and enforcement of preventive measures, make the Pakistani population susceptible to injuries. Historically, there has been a low level of investment in the prevention of injuries in Pakistan. Data is limited and while a public sector surveillance project has been initiated in one major urban centre, the major sources of information on injuries have been police and hospital records. Given the cost-effectiveness of injury prevention programs and their success in other LMICs, it is essential that the public sector invest in injury prevention through improving national policies and creating a strong evidence-based strategy while collaborating with the private sector to promote injury prevention and mobilizing people to engage in these programs.

Road traffic injuries and data systems in Egypt: addressing the challenges.

OBJECTIVE: Road traffic injuries (RTIs) are a major cause of global mortality and morbidity, killing approximately 1.3 million people and injuring 20 to 50 million each year. The significance of this public health threat is most pronounced in low- and middle-income countries where 90 percent of the world's road traffic-related fatalities take place. Current estimates for Egypt show a road traffic fatality rate of 42 deaths per 100,000 population-one of the highest in the Eastern Mediterranean Region. RTIs are also responsible for 1.8 percent of all deaths and 2.4 percent of all disability-adjusted life years (DALYs) lost in the country. Despite this, studies surrounding this topic are scarce, and reliable data are limited. The overall goal of this article is to define the health impact of RTIs in Egypt and to identify the strengths and weaknesses of each data source for the purpose of improving the current RTI data systems. METHODS: A 2-pronged approach was undertaken to assess the burden of RTIs in Egypt. First, a thorough literature review was performed using PubMed, Embase, ISIS Web of Knowledge, and Scopus databases. Articles pertaining to Egypt and road traffic injuries were selected for screening. With assistance from Egyptian colleagues, a comprehensive exploration of data sources pertaining to RTIs in Egypt was undertaken and secondary data from these sources were procured for analysis. RESULTS: The literature review yielded a total of 20 studies, of which 6 were multi-country and 5 were hospital-based studies. None examined risk factors such as speeding, alcohol, or seat belt use. Secondary data sources were acquired from national hospital-based injury surveillance; a community-based health survey; pre-hospital injury surveillance; the Ministry of Transport; the General Authority for Roads, Bridges and Land Transport; death certificates; and the central agency for public motorization and statistics. Risk factor data are also limited from these sources. CONCLUSION: The results of this article clearly highlight the significant burden that road traffic injuries pose on the health of the Egyptian population. The hospital-based injury surveillance system that has been established in the country and the use of International Classification of Diseases (ICD-10) coding brings the system very closely in line with international guidelines. There is, however, some considerable room for improvement, including the need to extend the coverage of the surveillance system, the inclusion of injury severity scores and disability indicators, and standardization of the sometimes rather disparate sources from various sectors in order to maximally capture the true burden of RTIs.

Potential Risk Estimation Drowning Index for Children (PREDIC): a pilot study from Matlab, Bangladesh.

UNLABELLED: Childhood drowning is a major public health problem that has been neglected in many low- and middle-income countries. In Matlab, rural Bangladesh, more than 40% of child deaths aged 1-4 years are due to drowning. AIM: The main objective of this paper was to develop and evaluate a childhood drowning risk prediction index. METHODOLOGY: A literature review was carried out to document risk factors identified for childhood drowning in Bangladesh. The Newacheck model for special health care needs for children was adapted and applied to construct a childhood drowning risk index called "Potential Risk Estimation Drowning Index for Children" (PREDIC). Finally, the proposed PREDIC Index was applied to childhood drowning deaths and compared with the comparison group from children living in Matlab, Bangladesh. This pilot study used t-tests and Receiver Operating Characteristic (ROC) curve to analyze the results. RESULTS: The PREDIC index was applied to 302 drowning deaths and 624 children 0-4 years old living in Matlab. The results of t-test indicate that the drowned children had a statistically (t=-8.58, p=0.0001) significant higher mean PREDIC score (6.01) than those in comparison group (5.26). Drowning cases had a PREDIC score of 6 or more for 68% of the children however, the comparison group had 43% of the children with score of 6 or more which was statistically significant (t=-7.36, p<0.001). The area under the curve for the Receiver Operating Characteristic curve was 0.662. CONCLUSION: Index score construction was scientifically plausible; and the index is relatively complete, fairly accurate, and practical. The risk index can help identify and target high risk children with drowning prevention programs. PREDIC index needs to be further tested for its accuracy, feasibility and effectiveness in drowning risk reduction in Bangladesh and other countries.

Burden of fall injuries in Pakistan--analysis of the National Injury Survey of Pakistan.

There are no reliable estimates of the burden of fall-related injuries in Pakistan. To assess this burden and develop an epidemiologic profile for these injuries data from the National injury Survey of Pakistan, a cross-sectional population-based survey on injuries, were analysed to determine incidence and relative risks for fall injury. The annual incidence of fall-related injuries was 8.85 per 1000 population per year (95% CI: 6.8-11.3). The mean and median age of individuals injured by falls was 19 years and 10.5 years respectively. Children under the age of 15 years were at a substantially higher risk of fall injuries. Being a student and farmer/labourer/vendorwere associated with a higher risk for falls compared with unemployed. Fall-related injuries are a health burden in Pakistan, especially in children under 15 years of age. This represents a significant loss of healthy life and requires policies to curb this burden in the population.

Childhood drowning and traditional rescue measures: case study from Matlab, Bangladesh.

Recent mortality data indicate that approximately half a million people drown each year worldwide, with more than 97% of such deaths occurring in low-income and middle-income countries. The purpose of this study was to examine verbal autopsy data on the circumstances of childhood drowning in Matlab, Bangladesh. The study analysed 10 years (1996-2005) of data which reported 489 deaths in children under 5 years and recorded preimmersion, immersion and postimmersion events. The data summarised household characteristics, age, gender and time of drowning event. The study also examined traditional rescue methods performed on children who were removed from the water OR found drowning. Of 489 deaths, 57% were aged 1-2 years and had a drowning mortality rate of 521 per 100 000 children. Most drowning events occurred during the morning (68%), in ponds (69%), and while the mother was busy doing household chores (70%). Traditional rescue methods were attempted in 55% of children and the most frequently reported measure was to spin the child over head (35%). Only 3% of families tried to perform resuscitation. Verbal autopsy data for Matlab is a useful resource for childhood injury research in a low-income country. The study is one of the first to publish data on traditional rescue practices performed on drowning children in rural Bangladesh. The findings suggest that interventions should be designed using locally identified risk factors to reduce childhood drowning incidents. Community-based resuscitation techniques and emergency medical systems are needed to improve postimmersion recovery of the child.

Burden of fall injuries in Pakistan - analysis of the National Injury Survey of Pakistan

There are no reliable estimates of the burden of fall-related injuries in Pakistan. To assess this burden and develop an epidemiologic profile for these injuries data from the National Injury Survey of Pakistan, a cross-sectional population-based survey on injuries, were analysed to determine incidence and relative risks for fall injury. The annual incidence of fall-related injuries was 8.85 per 1000 population per year [95% Cl: 6.8-11,3]. The mean and median age of individuals injured by falls was 19 years and 10.5 years respectively. Children under the age of 15 years were at a substantially higher risk of fall injuries. Being a student and farmer/labourer/vendor were associated with a higher risk for falls compared with unemployed. Fall-related injuries are a health burden in Pakistan, especially in children under 15 years of age. This represents a significant loss of healthy life and requires policies to curb this burden in the population

Child supervision practices for drowning prevention in rural Bangladesh: a pilot study of supervision tools.

BACKGROUND: Injuries are an increasing child health concern and have become a leading cause of child mortality in the 1-4 years age group in many developing countries, including Bangladesh. METHODS: Household observations during 9 months of a community-based pilot of two supervision tools-a door barrier and a playpen-designed to assess their community acceptability in rural Bangladesh are reported in this article. RESULTS: Statistical analysis of 2694 observations revealed that children were directly supervised or protected by a preventive tool in 96% of visits. Households with a supervision tool had a significantly lower proportion of observations with the child unsupervised and unprotected than households without a tool. Families that received a playpen had 6.89 times the odds of using it at the time of the visit than families that received a door barrier. CONCLUSIONS: Interventions such as the playpen, when introduced to households through community-based programs, are accepted by parents. Field trials are urgently needed to establish the effectiveness of barrier-based interventions at reducing under-five drowning mortality rates in low-income countries like Bangladesh.