Cost-effectiveness of mandatory bicycle helmet use to prevent traumatic brain injuries and death.

BACKGROUND: Traumatic brain injury (TBI) is the main cause of mortality and severe morbidity in cyclists admitted to Dutch emergency departments (EDs). Although the use of bicycle helmets is an effective way of preventing TBI, this is uncommon in the Netherlands. An option to increase its use is through a legal enforcement. However, little is known about the cost-effectiveness of such mandatory use of helmets in the Dutch context. The current study aimed to assess the cost-effectiveness of a law that enforces helmet use to reduce TBI and TBI-related mortality. METHODS: The cost-effectiveness was estimated through decision tree modelling. In this study, wearing bicycle helmets enforced by law was compared with the current situation of infrequent voluntary helmet use. The total Dutch cycling population, consisting of 13.5 million people, was included in the model. Model data and parameters were obtained from Statistics Netherlands, the National Road Traffic Database, Dutch Injury Surveillance System, and literature. Effects included were numbers of TBI, death, and disability-adjusted life years (DALY). Costs included were healthcare costs, costs of productivity losses, and helmet costs. Sensitivity analysis was performed to assess which parameter had the largest influence on the incremental cost-effectiveness ratio (ICER). RESULTS: The intervention would lead to an estimated reduction of 2942 cases of TBI and 46 deaths. Overall, the incremental costs per 1) death averted, 2) per TBI averted, and 3) per DALY averted were estimated at 1) € 2,002,766, 2) € 31,028 and 3) € 28,465, respectively. Most favorable were the incremental costs per DALY in the 65+ age group: € 17,775. CONCLUSIONS: The overall costs per DALY averted surpassed the Dutch willingness to pay threshold value of € 20,000 for cost-effectiveness of preventive interventions. However, the cost per DALY averted for the elderly was below this threshold, indicating that in this age group largest effects can be reached. If the price of a helmet would reduce by 20%, which is non-hypothetical in a situation of large-scale purchases and use of these helmets, the introduction of this regulation would result in an intervention that is almost cost-effective in all age groups.

[Analysis of the determinants of cost savings in traffic accidents on interurban roads in Spain]. / Análisis de los factores determinantes del ahorro de costes en accidentes de tráfico en la red de carreteras de España.

OBJECTIVE: The increase in traffic accidents depends on multiple factors; it generates an economic and public health problem that must be analyzed jointly by agents involved in road safety. The aim of the work was to quantify the effect of various factors in the cost savings due to traffic accidents on interurban roads in Spain. METHODS: It was analyzed, through a lineal regression with panel data model and in the period 2000-2017, how different factors affected cost savings due to the risk of mortality or injury avoided on Spanish interurban roads. RESULTS: A 1% increase in traffic volume led to a reduction in costs per MVKT (million vehiclekilometres travelled) of €162.46 referring to the risk of mortality, €115.32 for serious injuries and €10.10 for mild injuries. This increase in unemployment caused a cost reduction of €31.43, €10.76 and €0.98, respectively. The same increase in the investment in replacement implied a reduction of these costs of €11 for any risk. A 1% increase in the ageing index led to an increase in costs of €276.83 in terms of mortality risk and €257.49 in terms of injury. Foreign tourism generated a cost of more than €40 for any risk. A 1% increase in GDP per capita led to an increase in costs of €155.50, €138.09 and €8.21 for defined risks. The points driving license led to an increase in costs of €785.50 per MVKR when referring to mortality risks. CONCLUSIONS: Determining factors for cost savings: motorization rate, unemployment rate and investment in replacement interurban roads. Determining factors that increased costs: expiry of the effect of the penalty - points driving licence, ageing index of the population, increase in GDP or proportion of foreign travelers.

OBJETIVO: El incremento de los accidentes de tráfico depende de múltiples factores, generando un problema económico y de salud pública que debe ser analizado conjuntamente por los agentes intervinientes en la seguridad vial. El objetivo del trabajo fue cuantificar el efecto de diversos factores determinantes en el ahorro de costes por accidentes de tráfico en vías interurbanas en España. METODOS: Se analizó, a través de un análisis de regresión mediante datos de panel referidos al período 2000-2017, cómo afectaban diferentes factores al ahorro de costes por cada riesgo de mortalidad o lesividad evitado en las vías interurbanas españolas. RESULTADOS: El aumento del 1% del volumen de tráfico conllevó una reducción de costes por MVKR (millón de vehículos-kilómetros recorridos) de 162,46€ refiriéndonos al riesgo de mortalidad, 115,32€ para lesividad grave y 10,10€ para leve. El aumento en el desempleo supuso una reducción de costes de 31,43€, 10,76€ y 0,98€, respectivamente. Idéntico incremento de la inversión en la reposición implicó una reducción de estos costes de 11€ para cualquier riesgo. El aumento del 1% del índice de envejecimiento comportó un aumento de costes de 276,83€ hablando del riesgo de mortalidad y de 257,49€ si hablamos de lesividad. El turismo extranjero generó un coste superior a los 40€ para cualquier riesgo. El aumento del 1% del Producto Interior Bruto (PIB) per cápita conllevó un aumento de costes de 155,50€, 138,09€ y 8,21€ para los riesgos anteriormente definidos. El permiso de conducción por puntos condujo a un incremento de costes de 785,50€ por MVKR al referirnos a los riesgos de mortalidad. CONCLUSIONES: Los factores condicionantes del ahorro de costes son el volumen de tráfico, la tasa de paro y la inversión en reposición. Los factores condicionantes del incremento de costes son la caducidad del efecto del permiso de conducción por puntos, el índice de envejecimiento, el incremento del PIB y la proporción de conductores extranjeros.

Net-societal and net-private benefits of some existing vehicle crash avoidance technologies.

Most light-duty vehicle crashes occur due to human error. Many of these crashes could be avoided or made less severe with the aid of crash avoidance technologies. These technologies can assist the driver in maintaining control of the vehicle when a possibly dangerous situation arises by issuing alerts to the driver and in a few cases, responding to the situation itself. This paper estimates the societal and private benefits and costs associated with three crash avoidance technologies, blind-spot monitoring, lane departure warning, and forward-collision warning, for all light duty passenger vehicles in the U.S. for the year 2015. The three technologies could collectively prevent up to 1.6 million crashes each year including 7200 fatal crashes. In this paper, the authors estimated the net-societal benefits to the overall society from avoiding the cost of the crashes while also estimating the private share of those benefits that are directly affecting the crash victims. For the first generation warning systems, net-societal benefits and net-private benefits are positive. Moreover, the newer generation of improved warning systems and active braking should make net benefits even more advantageous.

Economic evaluations of strategies to prevent sports and recreational injury among children and adolescents: a systematic review.

OBJECTIVE: To identify, summarise and critically assess studies reporting costs and consequences of sport and recreation injury prevention strategies among children and adolescents. DESIGN: Systematic review. METHODS AND DATA SOURCES: We searched MEDLINE (Ovid), EMBASE, CINAHL, Pubmed, Econlit and SPORTDiscus and PEDE. Included studies were peer reviewed full economic evaluations or cost analyses of sport/recreation injury prevention among children and adolescents≤18 years of age. The Pediatric Quality Appraisal Questionnaire was used for quality assessment. RESULTS: The initial search yielded 1896 unique records; eight studies met inclusion criteria. Six studies were related to injury prevention in the context of recreation, two were related to sports. For recreation studies in cycling and swimming: costs per head injury averted was US$3109 to $228 197; costs per hospitalisation avoided was US$3526 to 872 794; cost per life saved/death avoided was US$3531 to $103 518 154. Sport interventions in hockey and soccer were cost saving (fewer injuries and lower costs). Global quality assessments ranged from poor to good. Important limitations included short time horizons and intermediate outcome measures. CONCLUSIONS: Few rigorous economic evaluations related to sport and recreation injury prevention have been conducted. The range of estimates and variation in outcomes used preclude specific conclusions; however, where strategies both improve health and are cost saving, implementation should be prioritised. Future economic evaluations should incorporate time horizons sufficient to capture changes in long-term health and use utility-based outcome measures in order to capture individual preferences for changes in health states and facilitate comparison across intervention types.

Cost-effectiveness of raising alcohol excise taxes to reduce the injury burden of road traffic crashes.

BACKGROUND: Alcohol is an important risk factor for road transport injuries. We aimed to determine if raising alcohol taxes would be a cost-effective intervention strategy for reducing this burden. METHODS: We modelled the effect of a one-off increase in alcohol excise tax (NZ$0.15 (US$0.10)/standard drink) on alcohol consumption in New Zealand, using price elasticities to determine change in on-trade and off-trade sales of beer, cider, wine, spirits and ready-to-drink products. We simulated change in alcohol-attributable motor vehicle and motorcycle injuries, by age, sex and ethnicity, over the lifetime of the current population, and from changes in injuries, we determined changes in costs of health care, productivity, crime and vehicle damage. RESULTS: The modelled increase in tax led to a net 4.3% reduction in pure alcohol consumption and a 27% increase in excise tax revenue. Lifetime population health improved by 640 quality-adjusted life years (95% uncertainty interval: 450 to 860) and costs of treating transport injuries reduced by NZ$3.6 million ($0.88 million to $6.8 million), although this was countered by a $3.8 million ($2.9 million to $4.8 million) increase in costs of treating other diseases. Health care costs were far outweighed by a $240 million ($130 to $370 million) reduction in lost productivity, crime and vehicle damage costs. Cost-effectiveness was not highly sensitive to price elasticity values, discount rates or time horizons for measurement of outcomes. CONCLUSION: Raising alcohol excise tax in this high-income country would be highly cost-effective and could lead to substantial cost-savings for society.

The impact of vessel speed reduction on port accidents.

Reduced-speed zones (RSZs) have been designated across the world to control emissions from ships and prevent mammal strikes. While some studies have examined the effectiveness of speed reduction on emissions and mammal preservation, few have analyzed the effects of reduced ship speed on vessel safety. Those few studies have not yet measured the relationship between vessel speed and accidents by using real accident data. To fill this gap in the literature, this study estimates the impact of vessel speed reduction on vessel damages, casualties and frequency of vessel accidents. Accidents in RSZ ports were compared to non-RSZ ports by using U.S. Coast Guard data to capture the speed reduction effects. The results show that speed reduction influenced accident frequency as a result of two factors, the fuel price and the RSZ designation. Every $10 increase in the fuel price led to a 10.3% decrease in the number of accidents, and the RSZ designation reduced vessel accidents by 47.9%. However, the results do not clarify the exact impact of speed reduction on accident casualty.

Análisis de los factores determinantes del ahorro de costes en accidentes de tráfico en la red de carreteras de España / Analysis of the determinants of cost savings in traffic accidents on interurban roads in Spain

OBJETIVO: El incremento de los accidentes de tráfico depende de múltiples factores, generando un problema económico y de salud pública que debe ser analizado conjuntamente por los agentes intervinientes en la seguridad vial. El objetivo del trabajo fue cuantificar el efecto de diversos factores determinantes en el ahorro de costes por accidentes de tráfico en vías interurbanas en España. MÉTODOS: Se analizó, a través de un análisis de regresión mediante datos de panel referidos al período 2000-2017, cómo afectaban diferentes factores al ahorro de costes por cada riesgo de mortalidad o lesividad evitado en las vías interurbanas españolas. RESULTADOS: El aumento del 1% del volumen de tráfico conllevó una reducción de costes por MVKR (millón de vehículos-kilómetros recorridos) de 162,46€ refiriéndonos al riesgo de mortalidad, 115,32€ para lesividad grave y 10,10€ para leve. El aumento en el desempleo supuso una reducción de costes de 31,43€, 10,76€ y 0,98€, respectivamente. Idéntico incremento de la inversión en la reposición implicó una reducción de estos costes de 11€ para cualquier riesgo. El aumento del 1% del índice de envejecimiento comportó un aumento de costes de 276,83€ hablando del riesgo de mortalidad y de 257,49€ si hablamos de lesividad. El turismo extranjero generó un coste superior a los 40€ para cualquier riesgo. El aumento del 1% del Producto Interior Bruto (PIB) per cápita conllevó un aumento de costes de 155,50€, 138,09€ y 8,21€ para los riesgos anteriormente definidos. El permiso de conducción por puntos condujo a un incremento de costes de 785,50€ por MVKR al referirnos a los riesgos de mortalidad. CONCLUSIONES: Los factores condicionantes del ahorro de costes son el volumen de tráfico, la tasa de paro y la inversión en reposición. Los factores condicionantes del incremento de costes son la caducidad del efecto del permiso de conducción por puntos, el índice de envejecimiento, el incremento del PIB y la proporción de conductores extranjeros

OBJECTIVE: The increase in traffic accidents depends on multiple factors; it generates an economic and public health problem that must be analyzed jointly by agents involved in road safety. The aim of the work was to quantify the effect of various factors in the cost savings due to traffic accidents on interurban roads in Spain. METHODS: It was analyzed, through a lineal regression with panel data model and in the period 2000-2017, how different factors affected cost savings due to the risk of mortality or injury avoided on Spanish interurban roads. RESULTS: A 1% increase in traffic volume led to a reduction in costs per MVKT (million vehiclekilometres travelled) of €162.46 referring to the risk of mortality, €115.32 for serious injuries and €10.10 for mild injuries. This increase in unemployment caused a cost reduction of €31.43, €10.76 and €0.98, respectively. The same increase in the investment in replacement implied a reduction of these costs of €11 for any risk. A 1% increase in the ageing index led to an increase in costs of €276.83 in terms of mortality risk and €257.49 in terms of injury. Foreign tourism generated a cost of more than €40 for any risk. A 1% increase in GDP per capita led to an increase in costs of €155.50, €138.09 and €8.21 for defined risks. The points driving license led to an increase in costs of €785.50 per MVKR when referring to mortality risks. CONCLUSIONS: Determining factors for cost savings: motorization rate, unemployment rate and investment in replacement interurban roads. Determining factors that increased costs: expiry of the effect of the penalty - points driving licence, ageing index of the population, increase in GDP or proportion of foreign travelers

Effectiveness of an app-based intervention for unintentional injury among caregivers of preschoolers: protocol for a cluster randomized controlled trial.

BACKGROUND: Each year, over 15,000 preschoolers die from unintentional injuries in China. Many interventions proven to work in other nations have not been implemented nationwide in China. The rapid popularity of smartphones offers an opportunity to overcome this limitation and disseminate evidence-based interventions to the large population of China. This study aims to assess the effectiveness of an app-based intervention for caregivers of preschoolers to prevent unintentional injury among young Chinese children. METHOD: A single-blinded, 6-month, parallel-group cluster randomized controlled trial with 1:1 allocation ratio will be conducted in Changsha, China. In total, 2626 caregivers of preschoolers ages 3-6 years old who own a smartphone will be recruited from 20 preschools. Clusters will be randomized at the preschool level and allocated to either the control group (routine education plus app-based parenting education excluding unintentional injury prevention) or the intervention group (routine education plus app-based parenting education including unintentional injury prevention). The app-based injury prevention program was developed based on the Theory of Planned Behavior, the Haddon Matrix, the Mobile Learning framework, and a needs assessment. Data collection will be conducted at baseline, 3-month, and 6-month follow-up via app-based survey plus printed questionnaire survey. The primary outcome measure is unintentional injury incidence among preschoolers in the past 3 months. Secondary outcome measures include economic losses due to unintentional injury in the past 3 months, the Incremental Cost-Effectiveness Ratios (ICERs), and parent's attitudes and behaviors concerning supervision to prevent preschooler unintentional injury in the past week. An intention-to-treat approach will be used to evaluate outcome measures. Chi-square tests will examine differences for outcome measures between groups at each time point and generalized estimation equations (GEE) will test the overall effectiveness of the app-based intervention. Missing outcome data will be imputed using the Expectation Maximization algorithm (EM). DISCUSSION: This trial will examine evidence concerning the effectiveness of an innovative app-based intervention for caregivers of Chinese preschoolers. If effective, the app-based intervention could offer an effective population-based intervention option to cost-effectively promote unintentional injury prevention in countries and regions where injury control is under-supported. TRIAL REGISTRATION: ChiCTR-IOR-17010438 . Registered 15 January 2017.

The impact of urban speed reduction programmes on health system cost and utilities.

BACKGROUND: Vehicle speed changes impact the probability of injuring a pedestrian in ways that differ from the way that it impacts the probability of a collision or of death. Therefore, return on investment in speed reduction programmes has complex and unpredictable manifests. The objective of this study is to analyse the impact of motor vehicle speed reduction on the collision-related morbidity and mortality rates of urban pedestrians. METHODS AND FINDINGS: We created a simple way to estimate the public health impacts of traffic speed changes using a Markov model. Our outcome measures include the cost of injury, quality-adjusted life years (QALYs) gained and probability of death and injury due to a road traffic collision. Our two-way sensitivity analysis of speed, both before the implementation of a speed reduction programme and after, shows that, due to key differences in the probability of injury compared with the probability of death, speed reduction programmes may decrease the probability of death while leaving the probability of injury unchanged. The net result of this difference may lead to an increase in injury costs due to the implementation of a speed reduction programme. We find that even small investments in speed reductions have the potential to produce gains in QALYs. CONCLUSIONS: Our reported costs, effects and incremental cost-effectiveness ratios may assist urban governments and stakeholders to rethink the value of local traffic calming programmes and to implement speed limits that would shift the trade-off to become between minor injuries and no injuries, rather than severe injuries and fatalities.

The effects of feedback and incentive-based insurance on driving behaviours: study approach and protocols.

BACKGROUND: Road injury is the leading cause of death for young people, with human error a contributing factor in many crash events. This research is the first experimental study to examine the extent to which direct feedback and incentive-based insurance modifies a driver's behaviour. The study applies in-vehicle telematics and will link the information obtained from the technology directly to personalised safety messaging and personal injury and property damage insurance premiums. METHODS: The study has two stages. The first stage involves laboratory experiments using a state-of-the-art driving simulator. These experiments will test the effects of various monetary incentives on unsafe driving behaviours. The second stage builds on these experiments and involves a randomised control trial to test the effects of both direct feedback (safety messaging) and monetary incentives on driving behaviour. DISCUSSION: Assuming a positive finding associated with the monetary incentive-based approach, the study will dramatically influence the personal injury and property damage insurance industry. In addition, the findings will also illustrate the role that in-vehicle telematics can play in providing direct feedback to young/novice drivers in relation to their driving behaviours which has the potential to transform road safety.

Preventing deaths and injuries from house fires: a cost-benefit analysis of a community-based smoke alarm installation programme.

BACKGROUND: Operation Installation (OI), a community-based smoke alarm installation programme in Dallas, Texas, targets houses in high-risk urban census tracts. Residents of houses that received OI installation (or programme houses) had 68% fewer medically treated house fire injuries (non-fatal and fatal) compared with residents of non-programme houses over an average of 5.2 years of follow-up during an effectiveness evaluation conducted from 2001 to 2011. OBJECTIVE: To estimate the cost-benefit of OI. METHODS: A mathematical model incorporated programme cost and effectiveness data as directly observed in OI. The estimated cost per smoke alarm installed was based on a retrospective analysis of OI expenditures from administrative records, 2006-2011. Injury incidence assumptions for a population that had the OI programme compared with the same population without the OI programme was based on the previous OI effectiveness study, 2001-2011. Unit costs for medical care and lost productivity associated with fire injuries were from a national public database. RESULTS: From a combined payers' perspective limited to direct programme and medical costs, the estimated incremental cost per fire injury averted through the OI installation programme was $128,800 (2013 US$). When a conservative estimate of lost productivity among victims was included, the incremental cost per fire injury averted was negative, suggesting long-term cost savings from the programme. The OI programme from 2001 to 2011 resulted in an estimated net savings of $3.8 million, or a $3.21 return on investment for every dollar spent on the programme using a societal cost perspective. CONCLUSIONS: Community smoke alarm installation programmes could be cost-beneficial in high-fire-risk neighbourhoods.

Improvement of the performance of animal crossing warning signs.

INTRODUCTION: Animal-vehicle collisions (AVCs) can result in serious injury and death to drivers, animals' death, and significant economic costs. However, the cost effectiveness of the majority of AVC mitigation measures is a significant issue. METHOD: A mobile-based data collection effort was deployed to measure signs under the Utah Department of Transportation's (UDOT) jurisdiction. The crash data were obtained from the UDOT risk management database. ArcGIS was employed to link these two data sets and extract animal-related crashes and signs. An algorithm was developed to process the data and identify AVCs that occurred within sign recognition distance. Kernel density estimation (KDE) technique was applied to identify potential crash hotspots. RESULTS: Only 2% of AVCs occurred within the recognition distance of animal crossing signs. Almost 58% of animal-related crashes took place on the Interstate and U.S. highways, wherein only 30% of animal crossing signs were installed. State routes with a higher average number of signs experienced a lower number of AVCs per mile. The differences between AVCs that occurred within versus outside of sign recognition distance were not statistically significant regarding crash severity, time of crash, weather condition, driver age, vehicle speed, and type of animal. It is more likely that drivers become accustomed to deer crossing signs than cow signs. CONCLUSIONS: Based on the historical crash data and landscape structure, with attention given to the low cost safety improvement methods, a combination of different types of AVC mitigation measures can be developed to reduce the number of animal-related crashes. After an in-depth analysis of AVC data, warning traffic signs, coupled with other low cost mitigation countermeasures can be successfully placed in areas with higher priority or in critical areas. Practical applications: The findings of this study assist transportation agencies in developing more efficient mitigation measures against AVCs.

[Hands well - all's well : Prevention campaign of the Austrian General Accident Insurance Institution (AUVA) to reduce hand injuries]. / Hände gut ­ Alles gut : Die Präventionskampagne der österreichischen Allgemeinen Unfallversicherungsanstalt (AUVA) zur Reduzierung von Handverletzungen.

Overall, 41% of all work-related accidents lead to a hand injury. In the younger generation, the incidence rate even rises to 50%. In Austria, these accidents result in approximately half a million sick leave days per annum, an average of 12.5 days per accident. In comparison, leisure-time hand injuries show a significantly higher accident rate: 60% of hand injuries occur during leisure time. Far fewer safety measures are taken and a lack of adequate training and a disregard for safety recommendations are observed.This large number of hand injuries led to the launch of a campaign in Austria in 2014-2015 called "Hände gut - Alles Gut", (Hands well - all's well). This campaign was aimed at reducing the costs, a sum of 309 million Euros, incurred solely from work-related hand accidents, by at least 5-10%.These exorbitantly high costs are not only due to severe hand trauma, most result from a multitude of slight and superficial wounds.

Keeping an eye on at-risk patients remotely.

Sitter pay ranges from $11 to $40 an hour, while the cost to use AvaSure is under $3 an hour per patient, Brad Playford said.

Cost intensity of identifying contraindications to driving a company car through psychological tests on the basis of real-world data in Poland.

OBJECTIVE: The study objective was to determine the cost intensity of identifying contraindications to fleet car driving in preventive care. BACKGROUND: The objective of a psychological examination is to identify impaired psychomotor function as well as any intellectual, cognitive or emotional incapacities, which may seriously impede safety. METHOD: Real-world data were collected from the healthcare provider in Poland. A total of 8111 anonymous records from psychomotor tests performed between January 1 and December 31, 2012 were analysed. RESULTS: The number needed to screen to identify one person with contraindications to driving was 737. An individual examination costs PLN 150, thus the estimated cost of identifying one case was PLN 110,550 (EUR 25,000). The average number of tests in a small enterprise with 20-50 fleet cars was estimated at 5-25 in a 5-year period and their cost at PLN 3750 (PLN 750 annually). CONCLUSION: Health check-ups include ophthalmological and neurological consultations; therefore, psychological examination of fleet car drivers may be considered excessive due to cost and limited preventive value. High costs may be burdensome mainly to larger companies. APPLICATION: A final decision regarding necessity of psychological testing should be preceded by medical assessment of the risk of work accidents.

The relationships between OHS prevention costs, safety performance, employee satisfaction and accident costs.

Little is known about the costs of safety. A literature review conducted for this study indicates there is a lack of survey-based research dealing with the effects of occupational health and safety (OHS) prevention costs. To close this gap in the literature, this study investigates the interwoven relationships between OHS prevention costs, employee satisfaction, OHS performance and accident costs. Data were collected from 159 OHS management system 18001-certified firms operating in Turkey and analyzed through structural equation modeling. The findings indicate that OHS prevention costs have a significant positive effect on safety performance, employee satisfaction and accident costs savings; employee satisfaction has a significant positive effect on accident costs savings; and occupational safety performance has a significant positive effect on employee satisfaction and accident costs savings. Also, the results indicate that safety performance and employee satisfaction leverage the relationship between prevention costs and accident costs.

Mortuary based injury surveillance for low-mid income countries: process evaluation of pilot studies.

OBJECTIVE: Globally, injury is the fourth major cause of death and the third leading contributor to Disability Adjusted Life Years lost due to health conditions, with the greatest burden borne by low-middle income countries (LMICs) where injury data is scarce. In the absence of effective vital registration systems, mortuaries have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish strategic injury prevention policies and programs. This evaluation sought to assess the feasibility of implementing a standardised fatal injury data collection process to systematically collect relevant fatal injury data from mortuaries. The process evaluation is described. METHODS: A manual including a one page data collection form, coding guide, data dictionary, data entry and analysis program was developed through World Health Organization and Monash University Australia collaboration, with technical advice from an International Advisory Group. The data collection component was piloted in multiple mortuaries, in five LMICs (Egypt, India, Sri-Lanka, Tanzania and Zambia). Process evaluation was based on a questionnaire completed by each country's Principal Investigator. RESULTS: Questionnaires were completed for data collections in urban and rural mortuaries between September 2010 and February 2011. Of the 1795 reported fatal injury cases registered in the participating mortuaries, road traffic injury accounted for the highest proportion of cases, ranging from 22% to 87%. Other causes included burns, poisoning, drowning and falls. Positive system attributes were feasibility, acceptability, usefulness, timeliness, and simplicity and data field completeness. Some limitations included short duration of the pilot studies, limited injury data collector training and apparent underreporting of cases to the medico-legal system or mortuaries. CONCLUSION: The mortuary has been shown to be a potential data source for identifying injury deaths and their circumstances and monitoring injury trends and risk factors in LMICs. However, further piloting is needed, including in rural areas and training of forensic pathologists and data-recorders to overcome some of the difficulties experienced in the pilot countries. The key to attracting ongoing funding and support from governments and donors in LMICs for fatal injury surveillance lies in further demonstrating the usefulness of collected data.

The effectiveness of different interventions to promote poison prevention behaviours in households with children: a network meta-analysis.

BACKGROUND: There is evidence from 2 previous meta-analyses that interventions to promote poison prevention behaviours are effective in increasing a range of poison prevention practices in households with children. The published meta-analyses compared any intervention against a "usual care or no intervention" which potentially limits the usefulness of the analysis to decision makers. We aim to use network meta-analysis to simultaneously evaluate the effectiveness of different interventions to increase prevalence of safe storage of i) Medicines only, ii) Other household products only, iii) Poisons (both medicines and non-medicines), iv) Poisonous plants; and v) Possession of poison control centre (PCC) telephone number in households with children. METHODS: Data on the effectiveness of poison prevention interventions was extracted from primary studies identified in 2 newly-undertaken systematic reviews. Effect estimates were pooled across studies using a random effects network meta-analysis model. RESULTS: 28 of the 47 primary studies identified were included in the analysis. Compared to usual care intervention, the intervention with education and low cost/free equipment elements was most effective in promoting safe storage of medicines (odds ratio 2.51, 95% credible interval 1.01 to 6.00) while interventions with education, low cost/free equipment, home safety inspection and fitting components were most effective in promoting safe storage of other household products (2.52, 1.12 to 7.13), safe storage of poisons (11.10, 1.60 to 141.50) and possession of PCC number (38.82, 2.19 to 687.10). No one intervention package was more effective than the others in promoting safe storage of poisonous plants. CONCLUSION: The most effective interventions varied by poison prevention practice, but education alone was not the most effective intervention for any poison prevention practice. Commissioners and providers of poison prevention interventions should tailor the interventions they commission or provide to the poison prevention practices they wish to promote. HIGHLIGHTS: Network meta-analysis is useful for comparing multiple injury-prevention interventions. More intensive poison prevention interventions were more effective than education alone. Education and low cost/free equipment was most effective in promoting safe storage of medicines. Education, low cost/free equipment, home safety inspection and fitting was most effective in promoting safe storage of household products and poisons. Education, low cost/free equipment and home inspection were most effective in promoting possession of a poison control centre number. None of the intervention packages was more effective than the others in promoting safe storage of poisonous plants.