Mortality due to injuries in Maputo City, Mozambique

Records of all registered deaths due to injuries maintained by the Legal Medicine Department in Maputo City for the period 1 January to 31 December 2000 were reviewed. Among the 1135 registered deaths, road traffic injuries accounted for the most common underlying cause of death (43.7%), followed by firearm discharge (8.7%) and burns (7.8%). For all deaths, skull fracture (21.9%), organ system injury (17.2%) and brain tissue injury (9.3%) were the most important intermediate causes of death and among the immediate causes of death acute anaemia (21.9%) was the most common followed by asphyxia (14.4%) and traumatic shock (12.0%). Overall, most cases were seen in the age group 20-29 years (27.0%) and comprising mainly males (male/female ratio 3.1). The most commonly reported cause for the victims to sustain injuries leading to death were accidents (59.4%), followed by homicides (19.8%), unknown causes (16.1%) and suicides (4.2%). Prevention of road traffic injuries and improved emergency care and health facility-based treatment is needed to reduce injury-related mortality.     

Severity of alcohol-related motor vehicle crashes in British Columbia: case - control study

The objective of the present study was to compare the injury severity and vehicle damage severity rates of alcohol-related crashes with rates of non-alcohol-related crashes in British Columbia (BC). Injury severity rates and vehicle damage severity rates were taken from 2002 Insurance Corporation of British Columbia traffic collision data. The data were computed in order to compare the differences in injury severity and vehicle damage severity rates of alcohol-related vs. non-alcohol-related motor vehicle crashes. Case - control methods were used in this study to analyse the risk of alcohol-related crashes compared to non-alcohol-related crashes in BC. Odds ratios (OR) and 95% CI were calculated to estimate relative risks. In the case - control analysis, the risk of fatal collision was increased for those drinking and driving compared with those driving sober (OR 4.70; 95% CI 3.15 - 7.01). Risk of injury collision was increased for those drinking and driving compared with those driving sober (OR 1.32; 95% CI 1.19 - 1.37). Importantly, the risk of vehicle damage severity was increased for those drinking and driving compared with those driving sober (write-off vehicle OR 4.24; 95% CI 3.70 - 4.86, severely damaged vehicles OR 1.98; 95% CI 1.77 - 2.21). The study reinforces existing literature to suggest that current evidence is sufficient to show an increased risk of injury and fatality to drivers and occupants in alcohol-related crashes. This paper not only emphasizes this well-known relationship, but also such consequences as increased vehicle damage severity. The connection between drinking and severity of motor vehicle crashes is popularly believed and has now received substantial scientific support. There is strong justification for injury prevention experts and policy-makers to step up motor vehicle crash injury prevention advocacy by implementing evidence-based policies to reduce rates of alcohol-impaired driving in the province of BC. Most unintentional injuries in BC are related to motor vehicle crashes. Significant improvements can be made in these statistics by: increasing the use of occupant protection (safety belt and child restraint seats); reducing alcohol-related injuries through multiple strategies including corrections in the physical environment, extensive enforcement of drinking and driving laws and health promotion/education.     

The employer costs of motor vehicle crashes

The latest published estimate of the cost of US motor vehicle crashes to employers is for 1989. This study estimates annual employer costs in 1998-2000. Incidence was estimated with occupational injury data and motor vehicle crash data for 1998-2000. Employer costs were estimated from Federal estimates of crash costs by source of payment using data on the percentage of varied payment streams (e.g. health insurance, sick leave) paid by employers. Motor vehicle crash injuries on and off the job cost employers almost $60 billion annually, including $16.3 billion in fringe benefit costs; $25.2 billion in property damage, workplace disruption and other non-fringe costs; and $18.4 billion in wage-risk premiums. Traffic safety programmes can reduce the fringe benefit bill without reducing the benefits offered to employees. Eliminating alcohol-impaired and unrestrained driving would save employers $15.2 billion annually.     

Clothing-related motorcycle injuries in Pakistan: findings from a surveillance study

This study aims to assess the burden and patterns of clothing-related motorcycle injuries in Karachi, Pakistan. Data were extracted from an ongoing traffic injury surveillance system. In three years (2007–2009), out of 99155 road traffic injury cases there were 986 (0.9%) cases of clothing-related motorcycle injuries. Most cases were females (73.9%) and pillion riders (80.6%). The crashes involving clothing-related injuries were mostly single vehicle (98.5%), and largely resulted in injuries to the external body (60.3%), limbs (51.0%), head (41.5%) and face (35.9%). One-third of injuries were either moderate (26.7%) or severe (10.2%) while 10 (1.01%) deaths were reported. Female gender (11.4%), age ≥ 45 years (19.4%), pillion riding (11.3%) and crashes occurring at intersections (12.3%) were more likely to result in moderate or severe injury as compared to other users (P < 0.001). Injuries due to entanglement of loose fitting clothing in motorcycles are not uncommon in Karachi. Awareness campaigns for prevention of such injuries may involve promotion of appropriate dressing for motorcycle riding including close wrapping of clothes and encouraging installations of covers on the rear wheels and drive chains.     

Epidemiology of yoga-related injuries in Canada from 1991 to 2010: a case series study

The aim is to describe the epidemiology of yoga injuries presenting to select Canadian emergency departments (EDs). Those who presented with a yoga injury to a Canadian ED participating in the Canadian Hospitals Injury Reporting and Prevention Program and had completed a data collection form between 1991 and 2010 were included. Demographic and injury characteristics were tabulated and injury profiles of children were compared to adults. Sixty-six individuals (48 female, 18 male) who sustained 67 injuries were included. The median age was 19 (intraquartile range: 13, 32) and 73% of individuals were injured after 2005 (p = 0.0003). Sprain was the most common injury (23/67, 34%) and the most common body region injured was the lower extremity (27/67, 42%). Significantly more children were injured while being instructed than adults (p = 0.003) but more adults required treatment (p = 0.023). Although yoga-related injuries presenting to an ED are not common, the number of injuries are increasing.     

Road traffic injuries in Thailand: Trends,selected underlying determinants and status of intervention

Injuries and deaths from traffic crashes have become a major public health and socio-economic problem in Thailand. Injuries, fatalities and economic losses due to traffic crashes have increased with the rising level of motorization. This study analyzes hospital-based data compiled by the Ministry of Public Health, data compiled by the National Police Office and data compiled by the traffic engineering division of the Department of Highways, Ministry of Transport and Communications. Analysis reveals that 70% of the people injured or killed in traffic crashes are aged 10-39. Men are at four to five times higher risk of death and injury due to traffic crashes than women. The number and rate of traffic injury in Thailand swung from a record low during the economic recovery in the 1980’s to record a high during the bubble economy, then declined with the economic crisis in 1997. The economic costs were estimated at U.S.$1.6 billion in 1995. An urban-rural difference in traffic injuries has been recorded with a higher rural case-fatality rate. A number of known behavioral risk factors have been identified, i.e., drunk driving, speeding, substance abuse and failure to use helmets and seat belts. However, determinants of behavior need further investigation. Hazardous road locations have also been mapped. Trends of traffic injuries seem to follow trends of economic growth. Without effective policy and implementation programs to control the determinants, it is expected that traffic injuries will increase as the country recovers from economic crisis. A major pitfall to many current government programs is that they incorporate no systematic evaluation. The fragmented structure of road safety authorities further complicates collaboration and coordination. A broad coalition of stakeholders is needed to catalyze policy action.     

Pedestrians: the daily underestimated victims on the road

Traffic-related pedestrian injuries (TRPI) are vulnerable to road users. In this study, we aimed to evaluate the demographic pattern of injury and outcome of TRPI. Patients with TRPI admitted between November 2007 and March 2010 to the only level 1 trauma centre in Qatar were included. A retrospective analysis was based on medical records and Emergency Medical Services run sheets. The spreadsheet included demographic data and pre-hospital transport, service admissions and injuries by system and mortality. Of 4077 patients who were admitted, 420 (10.3%) had TRPI. The mode of transportation included ambulances (91%), private vehicles (6%) and helicopters (3%). The direct dispositions were trauma intensive care units (38%), surgical wards (42%) and operating rooms (17%). Patients were classified according to Injury Severity Score (1–8 in 28%, 9–15 in 25%, 16–24 in 20% and 25–75 in 17% cases). Multisystem injuries were most characteristic. Of 804 injures, injury of extremities was predominant followed by head, thorax and abdomen. The overall mortality was 8%. Pedestrian injuries are a significant cause of serious trauma in Qatar. Motor vehicle/pedestrian interface contributes to this ongoing public health problem. Reducing pedestrian trauma requires recognition of the problem and implementing programmes to mitigate these largely preventable injuries.     

Underreporting,crash severity and fault assignment of minor crashes in China – a study based on self-reported surveys

Unreported minor crashes have importance as a surrogate for more serious crashes that require infrastructure, education, and enforcement strategies; and they still inflict damages. To study factors that influence underreporting, cause, and severity of minor crashes; a survey was performed in Kunming and Beijing to collect self-reported personal characteristics and crash history data of the three major urban road users in China: automobile drivers, bicycle riders and electric bike (e-bike) riders. Underreporting rates of automobile to automobile, automobile to non-motorized vehicle, and non-motorized vehicle to non-motorized vehicle crashes are 56%, 77% and 94%, respectively. Minor crashes with higher reported injury severity levels are more likely to be reported. E-bike riders without a driver's license are more likely to cause crashes. Licensing and education could be an effective way to reduce their crashes. The party that is not at fault in a crash is more likely to sustain high level of injury.     

Costs of unintentional injuries among children in an urban slum community in Kampala city,Uganda

Abstract

Unintentional injuries cause deaths, disabilities, productivity and financial losses and disproportionately affect children in low-income settings yet their cost remains under studied. This study determined the household out-of-pocket expenditure and missed school attendance due to unintentional childhood injuries in a Ugandan slum. We used a cross-sectional household survey design. Data were collected on occurrence and associated costs of unintentional injuries during a one-year period from July 2014 to June 2015. A total of 706 (44.7%) children who had suffered from injuries were reported in the one year period. More male children (N?=?415, 58.7%) suffered injuries than females (N?=?291, 41.2%). The average out-of-pocket expenditure on treating an injury was US $24.1 [standard deviation (SD)?=?±$62.8] and mean school days lost were 25 days (SD?=?±51.8). Road traffic injuries (RTIs) resulted in higher costs [mean difference was US $51.1 (95% CI: $11.4–$90.8)] compared to injuries that, for example, occurred at school. In a Ugandan slum community, unintentional childhood injuries resulted in high out-of-pocket expenditures and missed school attendance. The costs varied widely depending on external causes of the injury. These findings highlight the need to invest in population level injury prevention interventions to reduce injury costs by households.     

Knowledge,attitudes, and practices of family physicians and nurses regarding unintentional injuries among children under 15 years in Cairo,Egypt

Unintentional injuries are a leading cause of death among children, especially in developing countries. Lack of reliable data regarding primary health care professionals' role in childhood unintentional injury prevention hinders the development of effective prevention strategies. A survey of 99 family physicians and nurses from 10 family health centres sought to develop insight into their knowledge, attitudes, and practices regarding unintentional injury prevention for children <15 in Cairo, Egypt. Approximately, 60% were familiar with the terms unintentional injuries and injury prevention. Falls and road traffic crashes were identified as primary causes of childhood injuries by 54.5%. While >90% agreed injury prevention counselling (IPC) could be effective, only 50.5% provided IPC. Lack of time and educational materials were the leading barriers to provision of IPC (91.9% and 85.9%, respectively), while thinking counselling is not part of their clinical duties was the least perceived barrier (9.1%). There is a large disconnect between providers' knowledge, attitudes and practices regarding IPC, more training and provision of counselling tools are essential for improving IPC by Egyptian medical providers.     

Child motor vehicle occupant and pedestrian casualties before and after enactment of Child Restraint Seats Legislation in Japan

Problem. Prevention of injuries to child passengers is a significant public health priority, as motor vehicle-related injuries remain a leading cause of death for children in Japan. The purpose of compulsory child restraint seats legislation in April 2000 was to reduce the number of child passengers killed or injured in motor vehicle crashes.

Methods. The objectives of this preliminary evaluation are to measure the effectiveness, benefits and usage of safety seats for child passengers aged 1–5 years by analysing the child casualty data for the period of 1997–2002. Population and vehicle miles travelled based injury and fatality rates were used to compare before and after legislation trends in child casualties.

Results. Despite overall increases in the use of child restraint seats (as observed by different national surveys), overall casualty rates in motor vehicle occupants in the 1–5 year age group did not change (fatalities and serious injuries) or even increased (minor injuries).

Conclusions. Casualties among restrained children have not decreased since the law came to effect in the year 2000, perhaps because of incorrect usage of the seats. Given that exposure to crash environments is increasing, traffic safety advocates and public health community need to be aware of the importance of child restraints as a means of reducing the likelihood of injury. It is necessary to implement effective community-based child safety seat campaigns to disseminate the information on appropriate restraint use and to increase efforts to enforce the existing legislation.     

Pattern of traffic injuries in Shanghai: implications for control

In China, traffic-related injuries are often treated as transportation issues, called 'accidents'. The objectives of the research are to analyse traffic injury patterns, estimate costs of traffic injuries and provide evidence to develop effective prevention strategies. There were over 1 500 deaths due to traffic-related injuries annually in Shanghai from 1987 to 2003, and it is rising year by year with the rate of growth in motorization. The rates of annual increase are 3.59% in fatalities (from 7.78 to 14.18 per 100000 population) and 10.46% in non-fatalities (from 53.93 to 264.98 per 100000 population) respectively during the period. The analysis of the geographic information system showed that the geographic distribution of traffic injuries in the countryside regions of Shanghai had the highest rates. Labour force groups represented the majority of fatalities (70.97%) and serious traffic injuries (90.51%). The mortality rates were 18.40 per 100000 population and 10.02 per 100000 population in 45-65 year age group and 15-44 year age group respectively; the morbidity rates of serious traffic injuries were 121.60 per 100000 population and 70.46 per 100000 population in the same groups respectively. And females generally showed a lower incidence than males. In general, fatalities and injuries were higher for drivers, bicyclists and pedestrians. Among road traffic injury-related fatalities, 66.8% were attributed to head injuries. Of those with fatal head injuries, bicyclists accounted for 29.8% of the total; pedestrians accounted for 28.3%; motorcyclists accounted for 25.5%. Total traffic injury cost was estimated at least US $645989580 in Shanghai in 2003. Good injury intervention programmes need to be done as soon as possible to effectively reduce traffic injury burden in Shanghai, China.     

A review of national policies and programs to prevent unintentional injuries in the Americas

Injuries are a global public health problem, with injury mortality increasing in many regions. We describe a survey of injury policies and programs in 23 countries in the Americas. Most countries surveyed (87%) perceived unintentional injuries to be a significant public health problem. When asked about actual policy agendas, however, just one-fourth (26%) of the countries ranked unintentional injuries among policy makers’ top five concerns. Approximately half of the countries reported having a national injury prevention strategy, injury prevention coordinator, or consultative group. Virtually all countries with national strategies and consultative groups had established them in the 1990s, suggesting that concern about injuries is both recent and growing. Three-fourths (74%) reported that their country had a surveillance system to monitor injury-related mortality and, to a lesser extent, morbidity. The study’s results suggest that most policies and programs for the prevention and control of unintentional injuries have been developed in the past 10 years, and primarily address motor vehicle injuries. It is essential that current efforts be both broadened and strengthened so that the societal burden of unintentional injuries in the Americas can be reduced.     

Seating position and patterns of severely injured body parts among child passengers in motor vehicle crashes: Japan as a distinct case

ABSTRACT

This study describes injury patterns and outcomes related to the seating position of child passengers involved in motor vehicle crashes in Japan. Using data obtained from a national trauma registry database, we compared the occurrence of injuries by body parts, length of hospital stay and in-hospital deaths between front-seating and rear-seating among children. We analysed 166 children aged 0–5 years and 205 children aged 6–12 years. No significant differences were observed between front- and rear-seating for injured body parts, length of hospital stay or in-hospital deaths in the 0–5-year-old victims. Among those aged 6–12 years, rear-seating was associated with a higher incidence of head and chest injuries but the length of stay or in-hospital deaths did not differ. These findings contrast those of previous studies, which found that rear-seating reduces injury risk, possibly attributed to low age-appropriate restraint use among school-aged children in Japan.     

Pedestrian traffic injuries in Mexico: A country update

Road traffic injuries in general and pedestrian injuries in particular are a major public health problem in Mexico, especially in large urban areas. Analysis of mortality and road crashes at the national level was done using routine data recorded on death certificates. Fatality rates for different age groups were estimated by region for the year 2000. These data were supplemented by a cross-sectional study of pedestrian injuries in Mexico City based on death certificates information for pedestrians who lived and died in Mexico City between 1994 and 1997. Participant observation of physical spaces where crashes occurred was carried out. The spaces were filmed and in-depth interviews of survivors conducted. Road traffic crashes were responsible for approximately 17,500 deaths in Mexico during 2000. The mean age of the victims was 37 years. Mexico lost an average of 30 years of productive life for each individual who died in a traffic crash – 525,000 years in 2000. An estimated 9500 (54.3%) of all fatalities were pedestrians, and for every pedestrian death there were 13 others who sustained nonfatal injuries requiring medical care. The overall crude mortality rate for pedestrian injuries in Mexico City was 7.14 per 100,000 (CI 6.85-7.42). A concentration of deaths was observed in 10 neighborhoods at specific types of street environments. The underlying factors included dangerous crossings and the absence or inadequacy of pedestrian bridges, as well as negative perceptions of road safety by pedestrians. In conclusion, this study demonstrates the importance of elucidating the underlying contextual determinants of pedestrian injuries.     

The association of light trucks and vans with paediatric pedestrian deaths

The hypothesis that relative to cars, light trucks and vans (including sports utility vehicles) are more likely to result in fatal paediatric pedestrian injury was investigated. It was further hypothesized that this increased risk is a result of head injuries. The study sample consisted of 18 117 police records of motor vehicles involved in crashes in which one or more pedestrians aged 5 to 19 years old was injured or killed. Frequencies and case fatality ratios for each vehicle body type were calculated. A logistic regression analysis was conducted, with light truck or van vs. car as the exposure variable and fatal/non-fatal pedestrian injury as the outcome variable. After controlling for driver age, driver gender, vehicle weight, road surface condition and presence of head injury, 5 to 19 year-olds struck by light trucks or vans were more than twice as likely to die than those struck by cars (odds ratio (OR) 2.3; 95% CI 1.4, 3.9). For the 5 to 9 year-old age group, light trucks and vans were four times as likely to be associated with fatal injury (OR 4.2; 95% CI 1.9, 9.5). There was an association between head injury and light trucks and vans (OR 1.2; 95% CI 1.1, 1.3). It was concluded that vehicle body type characteristics play an important role in paediatric pedestrian injury severity and may offer engineering-based opportunities for injury control.     

Child injuries in land vehicles that do not require restraints

Abstract

The goal of this study was to determine the injury profiles of Canadian children who presented to the Emergency Department from 1990 to 2016 due to an injury caused while traveling in a form of land transportation that did not require child restraint. A case series was conducted using data from the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP). Children who were injured while travelling on land transportation for which child restraint is not required, who presented to a Canadian Emergency Department that participates in eCHIRPP between April 1, 1990 to August 29, 2016, were included. Overall, 1856 children sustained 2139 injuries (mean age: 9.8?years (SD 4.5), 45.5% male). The majority of children were injured on a school bus (49.3%). The most commonly injured body part was the head or neck (52.6%). The most common type of injury was a superficial or open wound (33.1%), followed by traumatic brain injury (19.3%). Overall, 39.4% of injuries required no treatment in hospital. Overall, approximately 70 children presented to eCHIRPP EDs per year on a land transportation vehicle that does not require restraints. Biomechanical studies are needed to improve safety on land transportation vehicles that do not require seatbelts.     

Trends in injury-related deaths before and after dissolution of the Union of Soviet Socialist Republics

The relationship of death rates due to injury with the dissolution of the Soviet empire deserves special focus because of the impact of injury deaths on the productive working population between the ages of 15 and 65 years. A retrospective review was performed of annual mortality rates due to intentional and unintentional injuries, using WHO data from 1980 to 2003. Using data from a comparison group in Western Europe, the nations of the former Union of Soviet Socialist Republics (USSR) were studied. Annual death rates were examined using polynomial regression after 3-year moving averages smoothed the plots. The majority of trends in injury-related death noted in the comparison group decreased constantly over time. In contrast, many nations of the former USSR experienced an initial decrease, reaching a nadir in 1985 - 1987, followed by an increase in injury-related deaths. Moreover, many of these nations experienced a subsequent decrease following the dissolution of the USSR in 1991. The monitoring of trends in injury mortality in countries experiencing social and political upheavals is warranted.     

Preventing motor vehicle crash injuries and deaths: science vs. folklore lessons from history

Abstract

Not long after the beginnings of motorization in the early 1900s, deaths and injuries from motor vehicle crashes became a problem in a number of high-income-countries (HIC)s, especially the United States. With the biggest problem the US led early efforts to address this issue, and for six decades these efforts were based on folklore (ie a body of widely held but false or unsubstantiated beliefs). They were not evaluated, but clearly were unsuccessful as crash deaths and injuries continued to rise. It was not until the 1970s that a broader range of countermeasures began to be adopted and was scientifically evaluated, and as a result, crash deaths and injuries declined. This history has important lessons today for many low-and-middle-income countries that have growing numbers of motor vehicle crash deaths and injuries, many of which are pedestrians and motorcyclists. This is because there continue to be advocates for many of the failed approaches (especially educational) that dominated the early efforts in HICs.