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Understanding unintentional childhood home injuries: pilot surveillance data from Karachi, Pakistan
Nukhba Zia, Uzma R Khan, Junaid A Razzak, Prasanthi Puvanachandra, Adnan A Hyder
BMC Research Notes , 2012, DOI: 10.1186/1756-0500-5-37
Abstract: This was a secondary analysis of a childhood unintentional injury surveillance database setup in the emergency department of the Aga Khan Hospital, Karachi, Pakistan for 3 months. The data was collected by interviewing caretakers of children under 12 years of age presenting with an unintentional injury to the emergency departments of the four major tertiary care hospitals of Karachi, Pakistan.The surveillance included 566 injured children of which 409 (72%) injuries had taken place at/around home. Of 409 children, 66% were males and mostly between 5 and 11 years of age. Injuries commonly occurred during play time (51%). Fall (59%), dog bites (11%) and burns (9%) were the commonest mechanisms of injury. The majority of the children (78%) were directly discharged from the emergency room with predicted short term disability (42%). There were 2 deaths in the emergency department both due to falls.Childhood injury surveillance system provides valuable in-depth information on child injuries. The majority of these unintentional childhood injuries occur at home; with falls, dog bites and burns being the most common types of unintentional childhood home injuries. Specific surveillance systems for child injuries can provide new and valuable information for countries like Pakistan.Childhood injury is an important public health issue globally. Over 875,000 children of less than 18 years of age die annually in the world as a result of injuries, 80% of these occur in low- and middle-income countries (LMICs) [1]. According to recent estimates the death rate of unintentional injuries in LMICs is 65 per 100,000 population compared to 35 per 100,000 population in high-income countries (HICs). Similarly, the rate of disability adjusted life years (DALYs) lost due to unintentional injuries in LMIC is 2,398 per 100,000 population compared with 774 per 100,000 population in HICs [2]. Estimates have shown that most of childhood unintentional injuries take place in and around the home, whe
Childhood Unintentional Injuries: Need for a Community-Based Home Injury Risk Assessments in Pakistan  [PDF]
Adnan A. Hyder,Aruna Chandran,Uzma Rahim Khan,Nukhba Zia,Cheng-Ming Huang,Sarah Stewart de Ramirez,Junaid Razzak
International Journal of Pediatrics , 2012, DOI: 10.1155/2012/203204
Abstract: Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for pilot testing in an intervention study. Conclusion. Planning for an innovative, community-based pilot study takes considerable time and effort in a low-income setting like Pakistan. The primary outcome of the pre-testing phase of the study was the development of three important tools geared for low-income housing communities in Pakistan. 1. Background Unintentional injuries are major causes of mortality and morbidity in children, resulting in over 875,000 deaths annually in children <18 years of age [1–3]. Among children <5 years of age, injuries are the leading cause of death after the first birthday. Additionally, millions of children require medical care with hospital admission for nonfatal injuries and are often left with lifelong disabilities [1]. Although unintentional injury is a major contributor to mortality worldwide, the burden is unequally distributed between low- and middle-income countries (LMICs) and high-income countries (HICs). The mortality rate from unintentional injuries in LMIC is nearly double that in HIC (65 versus 35 per 100,000), while the rate of disability-adjusted life-years (DALYs) is three times as high in LMIC as compared with HIC (2,398 versus 774 per 100,000) [4]. The disproportionate burden of unintentional injuries borne by LMIC is due in large part to high risks, inadequate preventive measures, and a lack of access to appropriate and timely medical care [5]. A substantial proportion of childhood unintentional injuries occur in the home, as a result of the relatively long period of time young children spend in the home and the many potential sources of hazards that are present [6]. The nature of childhood injuries occurring in the household has been well described in HICs but they are less well understood in LMICs [7, 8]. However, a recent study in Nigeria found that 92.5% of childhood burns occurred in a domestic setting, suggesting
Disabled persons database after Pakistan floods
Niaz Ullah Khan
Forced Migration Review , 2011,
Abstract: Following the 2010 Pakistan floods, Sightsavers supported a partner organisation to establish a computerised database of people with disabilities and older persons...
Population Attributable Risk of Unintentional Childhood Poisoning in Karachi Pakistan  [PDF]
Bilal Ahmed, Zafar Fatmi, Amna R. Siddiqui
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0026881
Abstract: Background The percentage of unintentional childhood poisoning cases in a given population attributable to specific risk factors (i.e., the population attributable risk) which can be calculated; determination of such risk factors associated with potentially modifiable risk factors, are necessary to focus on the prevention strategies. Methods We calculated PARs, using 120 cases with unintentional poisoning and 360 controls in a hospital based matched case- control study. The risk factors were accessibility to hazardous chemicals and medicines due to unsafe storage, child behavior reported as hyperactive, storage of kerosene and petroleum in soft drink bottles, low socioeconomic class, less education of the mother and the history of previous poisoning. Results The following attributed risks were observed: 12% (95% confidence interval [CI] = 8%–16%) for both chemicals and medicines stored unsafe, 19% (15%–23%) for child reported as hyperactive, 40% (38%–42%) for storage of kerosene and petroleum in soft drink bottles, 48% (42%–54%) for low socioeconomic status, 38% (32%–42%) for no formal mothers education and 5.8% (2%–10%) for history of previous poisoning. 48% of cases for overall study population which could be attributed to at least one of the six risk factors. Among girls, this proportion was 23% and 43% among boys. About half of the unintentional childhood poisoning cases in this Pakistani population could be avoided. Conclusion Exposure to potentially modifiable risk indicators explained about half of the cases of unintentional poisoning among children under five years of age in this Pakistani population, indicating the theoretical scope for prevention of the disease.
Childhood Unintentional Injuries: Need for a Community-Based Home Injury Risk Assessments in Pakistan  [PDF]
Adnan A. Hyder,Aruna Chandran,Uzma Rahim Khan,Nukhba Zia,Cheng-Ming Huang,Sarah Stewart de Ramirez,Junaid Razzak
International Journal of Pediatrics , 2012, DOI: 10.1155/2012/203204
Abstract: Background. A substantial proportion of the annual 875,000 childhood unintentional injury deaths occur in the home. Very few printed tools are available in South Asia for disseminating home injury prevention information. Methods. Three tools were planned: an injury hazard assessment tool appropriate for a developing country setting, an educational pamphlet highlighting strategies for reducing home injury hazards, and an in-home safety tutorial program to be delivered by a trained community health worker. Results. The three tools were successfully developed. Two intervention neighborhoods in Karachi, Pakistan, were mapped. The tools were pretested in this local setting and are now ready for pilot testing in an intervention study. Conclusion. Planning for an innovative, community-based pilot study takes considerable time and effort in a low-income setting like Pakistan. The primary outcome of the pre-testing phase of the study was the development of three important tools geared for low-income housing communities in Pakistan.
Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study
Hyder,Adnan A; Sugerman,David E; Puvanachandra,Prasanthi; Razzak,Junaid; El-Sayed,Hesham; Isaza,Andres; Rahman,Fazlur; Peden,Margie;
Bulletin of the World Health Organization , 2009, DOI: 10.1590/S0042-96862009000500011
Abstract: objective: to determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ed) surveillance data. methods: this pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (gcuis) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected eds in bangladesh, colombia, egypt and pakistan over a 3-4 month period, which varied for each site, in 2007. findings: of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged > 5 years, 32 (2%) were < 1 year old. injuries were especially frequent (34%) during the morning hours. they occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. the mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). there were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries. conclusion: hospitals in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues.
Unintentional injuries in the rural population of Twiserkan, Iran: A cross-sectional study on their incidence, characteristics and preventability
Forouzan Rezapur-Shahkolai, Mohsen Naghavi, Mohammadreza Shokouhi, Lucie Laflamme
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-269
Abstract: An interview-based investigation was undertaken that comprised all unintentional injuries leading to hospitalization (more than 6 hours) or death that had occurred within a twelve month period and that were identified in the files of the 62 "health houses" of the Twiserkan district. For each case, semi-structured interviews were conducted at the households of the injured people (134 injuries affecting 117 households were identified).The incidence rates of fatal and non-fatal injuries were respectively 4.1 and 17.2 per 10 000 person-years and, as expected, men were more affected than women (77.6% of all injury cases). Traffic injuries (in particular among motorcyclists) were as common as home-related injuries but they were far more fatal. Among common suggestions for prevention, people mentioned that the authorities could work on the design and engineering of the infrastructure in and around the village, that the rural health workers could contribute more with local information and education and that the people themselves could consider behaving in a safer manner.Not only domestic injuries but also those in traffic are an important cause of severe and fatal injury among rural people. Health workers may play an important role in injury surveillance and in identifying context-relevant means of prevention that they or other actors may then implement.Injuries constitute an important health problem worldwide and they are one of the major causes of death among people under 45 years old [1,2]. The majority of all injury-related deaths occur in low and middle-income countries [1-4] where knowledge is scarce regarding injury distribution, pattern and prevention [5]. Epidemiological studies have been conducted in some low and middle-income countries but, most often, traffic-related injuries and those occurring in urban settings have been in focus [6-8]. Yet, studies in rural areas have been conducted in countries in various continents, including Asia (Pakistan [9], Bangladesh
ORTHOPEDIC INJURIES AMONG ELDERLY PERSONS;
MUHAMMAD RAZZAQ MALIK,MUHAMMAD ZAFAR IQBAL,MUHAMMAD AZEEM
The Professional Medical Journal , 2011,
Abstract: Background: Pakistan is experiencing a rise in its elderly population leading to increase burden of orthopedic injuries. Withmeager resources and a poor understanding of elderly health problems; Pakistan faces many challenges in caring for its elderly population.Objectives: The objectives of this study were to, “Assess the frequency of orthopedic injuries among elderly persons and the associated riskfactors at Sheikh Zayed Medical College/ Hospital Rahim Yar Khan”. Study design and duration: This was an analytical observational studyconducted among the elderly patients above the age of 60 years, admitted in the Orthopedic Department of Sheikh Zayed Medical College/Hospital Rahim Yar Khan. Methodology: The data was collected regarding the frequency, causes and pattern of orthopedic injuries in elderlypatients admitted in the Orthopedic Department of Sheikh Zayed Hospital / Medical College Rahim Yar Khan. The data regarding age, sex,education, occupation, geographical origin, and mechanism of injury were obtained by questionnaire. The data was analyzed on SPSS version16. Results: There were total 1589 patients admitted in the Orthopedic Unit during the study period. The elderly persons above the age of 60years were 291(18.31%). There were 184(63.24%) males and 107(36.76%) females. The average age was 64.52 years in urban residents and66.34 years in rural residents’ patients. Among the frequency of injuries, the femoral neck and inter-trochanter region were most commonly involved. The proportion of injuries in males it was 44.02% and in females it was higher that was 49.53%. The majority (68.29%) of the elderly persons was dependent and was not satisfied with socio-economic condition and status in the family (p < 0.000). Conclusions: Elderly patients who have experienced trauma are at increased risk of subsequent injury. Interventions to reduce the likelihood of trauma recurrence should focus on those with chronic illnesses and functional impairments.
SOCIO-ECONOMIC PROBLEMS OF PERSONS WITH OLD AGE IN DISTRICT DIR LOWER KHYBER PAKHTUNKHWA PAKISTAN
Hamid Alam,Farman Ali,Umar Daraz,Waqar Ahmad
Academic Research International , 2013,
Abstract: The purpose of this study is to analyze the increasing adversity of old age which has emerged as a global phenomenon. Number of person with old age worldwide is estimated to be around 605 million today. This aging population is posing insurmountable challenges both for the developed as well as developing countries.Pakistan being a developing country is also among countries that accumulate a plethora of aged persons and which are also speculated to be multiplied in thecoming years. Pakistani Society, which is traditionally recognized as an aged honoring society, has also undergone considerable changes in its social structure during the course of the broader modernization process. This change, in one way or the other, has affected the overall status and role of the elderly within the domain ofsocial affairs. In this context, the current study identifies the socio-economicproblems as well as factors responsible for the problems of persons with old age. For the present study 45 respondents were selected through convenience sampling because sampling frame of the persons with old age was not available in the universe. Samples were selected from three villages of Union Council Khungi, District Dir(lower). The quantitative approach has been used in order to analyze the data with the help of frequency and percentage. The quantitative analysis illustrate that persons with old age are facing problems in decision making , denial and verbal abuse, separation from spouse as well as married sons. They have low social status in the community as well as in their families. The persons with old age are facingproblems in health due to expensive medicines and lack of personal money to spend for their health. It has been suggested that proper role of family members, revival of religious values, media and government intervention will promote the status of persons with old age in Pakhtun society.
Ecological approaches to the prevention of unintentional injuries
John P. Allegrante,Dale W. Hanson,David A. Sleet,Ray Marks
Italian Journal of Public Health , 2010, DOI: 10.2427/5724
Abstract: Background: Injury as a cause of significant morbidity and mortality has remained fairly stable in countries with developed economies. Although injury prevention often is conceptualised as a biomedical construct, such a reductionist perspective overlooks the importance of the psychological, environmental, and sociocultural conditions as contributing factors to injury and its consequences. This paper describes the potential of the ecological model for understanding the antecedent causes of unintentional injuries and guiding injury prevention approaches. We review the origins and conceptualise the elements of the ecological model and conclude with some examples of applications of ecological approaches to the prevention of unintentional injury and promotion of community safety. Methods: A review of the English-language literature on the conceptualization of ecological models in public health and injury prevention, including the application of the ecological model in the prevention of falls and road traffic injuries and in the community safety promotion movement. Results: Three dimensions are important in social-ecological systems that comprise key determinants of injuries: 1) the individual and his or her behaviour, 2) the physical environment, and 3) the social environment. Social and environmental determinants have profound impact on population health and in the causation of injuries. Conclusions: Social and environmental determinants of injury should be studied with the same energy, urgency, and intellectual rigor as physical determinants. Application of the ecological model in injury prevention shows the most promise in falls injury prevention, road traffic injury prevention, and community safety promotion.
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