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.     

Unintentional injuries among youth with developmental disabilities in the United States, 2006–2007

We examined unintentional injury among youth with and without developmental disabilities. Our nationally representative sample included 6369 injured youth, aged 0–17 years, who were seen in one of the 63 US hospital emergency rooms that participated in the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) in 2006–2007. Parents or guardians of injured youth were interviewed by telephone after the hospital visit to ascertain disability status. Denominator data were obtained from the National Health Interview Survey. Leading causes of injury were comparable for youth with and without disability. Injury rates (per 100 youth per year) were also comparable [10.4; 95% confidence interval (CI) 7.8, 13.0 and 10.5; 95% CI 8.2, 12.9, for youth with and without disability, respectively]. When examined by specific disability, the rate ratio for youth with learning disabilities versus youth without learning disability was 1.57 (95% CI 1.04, 2.10), which may represent a subgroup for targeted interventions.     

Incidence,patterns and risk factors for injuries among Ugandan children

There is limited epidemiological data on childhood injuries in developing countries. This study assessed the incidence, patterns and risk factors for injuries among children aged 0–5 years in Wakiso District, Uganda. To determine differences, chi-square and Wilcoxon rank sum tests were used. Risk factors were assessed using Poisson regression. Overall, information from 359 children of mean age 32 months (SD: 18.4) was collected. Annual incidence of injuries was 69.8 per 1000 children/year (95% CI 58.8–80.8). One fatal injury due to burns was reported. Incidence of injuries was less associated with being female (IRR: 0.56, 95% CI 0.34–0.90) and increasing age of the caretaker (IRR: 0.96, 95% CI 0.92–0.99). The high incidence of childhood injuries necessitates the need for interventions to reduce injuries among children.     

The association of psychological symptoms with unintentional injuries among retired employees of a university in China

To investigate the association of psychological symptoms with injury risk, psychological symptoms were measured using symptom checklist-90 revised (SCL-90-R) and the unintentional injury information was followed up for 1 year among retired employees at a university in China. The injury rate had a significant difference between groups of raw mean score > or =2.0 and <2.0 for SCL-90-R global factor and subscale factors of obsessive compulsiveness, interpersonal sensitivity, depression and anxiety. After accounting for the factors of daily housework, physical activities, living alone and demographic factors, SCL-90-R global factor (odds ratio (OR) = 1.87, 95% CI: 1.20-2.91) and subscales factors of obsessive compulsiveness (OR = 1.93, 95% CI: 1.31-2.85), interpersonal sensitivity (OR = 2.05, 95% CI: 1.09-3.02), depression (OR = 2.09, 95% CI: 1.40-3.12) and anxiety (OR = 1.58, 95% CI: 1.03-2.44) were still significantly associated with an elevated risk of unintentional injury among the retired employees. In order to reduce the risk of unintentional injuries among the elderly, a psychological health service should be provided in the community.     

Respondents’ recall of injury events: an investigation of recall bias in cross-sectional injury data from the Sudan Household Health Survey 2010

Recall bias is a well-documented limitation of population-based cross-sectional injury surveys. To fill some gaps in this area, we investigated the extent and nature of recall bias in Sudan Household Health Survey (SHHS 2010) injury data. The extent of incomplete recall was measured by comparing the total reported injuries over 12 months with the annualised number of injuries in the four weeks preceding the survey. Multivariable logistic regression was used to investigate the association of socio-demographic variables, injury attributes and interviewee characteristics with differential recall. Relevant interactions were tested. Overall, reported injuries were 33% of the expected. Injuries among children 1–4 years had lower odds of being reported to have occurred earlier than the four weeks preceding the survey than people aged 65 years and over (OR = 0.24, 95% CI 0.12–0.47). Injuries that received inpatient care in the first week were more likely to be recalled than those that did not receive care (OR = 2.07, 95% CI 1.14–3.75). Respondent's age was associated with differential recall. Differential injury recall should be considered when using SHHS 2010 to compare injury occurrence between children under five and older groups or at the level of health care received.     

Injuries sustained during snow removal from roofs resulting in hospital care

Clearing snow from roofs causes serious injuries annually. The aim of this study was to describe injury mechanisms, injury panorama, and injury incidence in connection to this activity. A specific aim was to study the association between snow depth and injury incidence. A total of 95 people were injured during four study periods. The risk of injury is strongly associated with snow depth, and the incidence varied up to 10-fold between the studied winter seasons. The majority of injuries (91; 96%) occurred during leisure time and only four people were injured in the occupational setting. The most common injury mechanism was falling off roofs or ladders of residential homes. Nearly 60% sustained moderate or serious injuries (Maximum Abbreviated Injury Scale [MAIS] 2–3), and fractures accounted for almost half of all injuries. Because roofs of single-family homes in Sweden usually do not require snow removal for heavy snow loads, these injuries may have been both unnecessary and avoidable. Further education is required to advise the public on the risks associated with snow removal from roofs.     

Paediatric head injuries treated in a children's emergency department from Cluj-Napoca,Romania

The aim of the study was to describe paediatric head injuries and identify factors that led to advanced care. Incident cases of head injuries that sought care from December 2008 to October 2010 at Children's Emergency Hospital Cluj-Napoca were evaluated. The main outcome was transfer or admission to advanced care. From a total of 3053 children treated for an injury, 1541 (50.4%) presented with head injury. A total of 960 (62.3%) of the children with a head injury required advanced care treatment. Young children were more likely to suffer a head injury than older children, but a higher proportion of older children required advanced care (70.3%). Children who suffered a head injury as a consequence of road traffic were almost five times more likely to require advanced care (OR: 4.97; 3.09-8.06) than being released. Our results suggest that data on injuries provide evidence-based information on the nature of injuries children are prone to, and what activity, type, and mechanism of injury impact Romanian children.     

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.     

Compulsory child restraint seat law and motor vehicle child occupant deaths and injuries in Japan 1994-2005

The purpose of child restraint seats (CRS) is to reduce the number of individuals killed or injured in motor vehicle (MV) crashes. Japanese Road Traffic Law 17-3-4 (April 2000) specifies a requirement that CRS be used for all children aged 0-5 years. The objective of this evaluation was to determine the legislative impact on fatalities in Japan for the period 1994-2005. Data were obtained from the Institute for Traffic Accident Research and Data Analysis. A time-series Poisson regression model was used to analyse the change (6 years pre/post) in incidence rate ratios of fatality and injury in MV crashes among children ages 0-5 years. Despite increases in CRS use, fatalities failed to decrease significantly after enactment of the law (incidence rate ratio: 0.80; 95% CI: 0.49-1.31). In 2005, 67% of children aged 0-5 years, who were killed as MV occupants were not seated in CRS. Between 2000 and 2005, the lack of CRS led to 43% of front seat passenger deaths, 54% of rear seat deaths, 143 children died in total and 500 + children were seriously injured. It was found that the compulsory CRS law enacted in April 2000 did not result in a statistically significant reduction in child MV occupant fatalities and injuries in Japan.     

Comparing the characteristics of snowboarders injured in a terrain park who present to the ski patrol,the emergency department or both

Ski patrol report forms are a common data source in ski/snowboard research, but it is unclear if those who only present to the emergency department (ED) are systematically different from those who see the ski patrol. To determine the proportion and characteristics of injured snowboarders who bypass the ski patrol before presenting to the ED, three groups of injured snowboarders were compared: presented to the ED only, ski patrol only and ski patrol and ED. Data were collected from ski patrol Accident Report Forms (ARFs), ED medical records and telephone interviews. There were 333 injured snowboarders (ED only: 34, ski patrol only: 107, both: 192). Ability, time of day, snow conditions or drugs/alcohol predicted ED only presentation. Concussions (RRR: 4.66; 95% CI: 1.83, 11.90), sprains/strains (RRR: 4.22; 95% CI: 1.87, 9.49), head/neck (RRR: 2.90; 95% CI: 1.48, 5.78), trunk (RRR: 4.17; 95% CI: 1.92, 9.09) or lower extremity (RRR: 3.65; 95% CI: 1.32, 10.07) injuries were significantly more likely to present to ski patrol only versus ski patrol and ED. In conclusion, snowboarders who presented to the ED only had similar injuries as those who presented to both.     

Does poverty lead to non-fatal unintentional injuries in rural Vietnam?

The aim of this study was to identify associations between poverty at the household level and unintentional injury morbidity. A cohort consisting of 24,874 person-time episodes, representing 24,776 people living in 5,801 households (classified into rich, middle income and poor by local authorities in 1999) was followed during 2000, in order to identify and assess non-fatal unintentional injuries. Incidence rate ratios were calculated using a Poisson regression model. The results showed that poverty was a risk factor for unintentional injuries generally. When looking at different types of injury, poverty was a risk for home, work and "other" injuries, protective for school injuries, while the risk of traffic injuries was not affected. The results also showed that communes in mountainous areas were at higher risk for home, work and other injuries. Overall, poverty was associated with unintentional injury morbidity. However, the relationship varied by sex, age and type of injury. Specifically, poverty increased the risk for children and elderly people being injured at home, and for adults (15-59 years) being affected by work injuries.     

Injury rates and risk-factors associated with eventing: a total cohort study of injury events among adult Swedish eventing athletes

The aim of this study was to examine injury events and risk-factors among Swedish adult eventing athletes. A cross-sectional study design with retrospective recording of 1-year sports-specific exposure and injury data was used. The invited study population consisted of all members of the Swedish Equestrian Federation with eventing as their primary discipline (n = 513). The participation rate was 70.0%. The total 1-year injury prevalence was 26.6%; the specific 1-year prevalence of traumatic injury was 19.3% and of overuse injury 10.9%. The incidence of traumatic injury events was 0.54 injury events/1000 eventing hours (95% confidence interval (CI), 0.35-0.73 injury events/1000 eventing hours) for novices and 0.35 injury events/1000 eventing hours for qualified riders (95% CI, 0.21-0.49 injury events/1000 eventing hours). A total of 27.9% of the traumatic injury events led to severe injuries (causing more than 3 weeks absence from riding). Attitude to risk-taking was the only factor predicting an athlete becoming injured (p = 0.023), and qualification level was the only risk factor for additional injuries among injured riders (p = 0.003). Our results suggest that injury prevention programs in eventing should also give attention to overuse injuries and that care should be taken when eventing athletes are licensed into higher qualification groups.     

学龄前儿童意外伤害流行病学特征及预防对策研究

伤害使儿童、青少年早死或残疾,给家庭和社会带来巨大负担,早死人数的多寡直接影响到人口平均期望寿命的高低.为了解学龄前儿童意外伤害流行病学特征并提出预防干预对策,对武汉市部分城区学龄前儿童意外伤害的发生进行了现场调查研究.经统计分析,儿童的行为特点与意外伤害的发生均存在密切联系;伤害的类型以摔碰伤、车祸、坠落伤及切割伤居前四位.在调研基础上提出了干预和控制学龄前儿童意外伤害的对策.     

Home injuries in Italy: patterns of injury and the most exposed people

Home injuries are a significant public health problem in developed and developing countries. To support future policies for reducing their occurrence and controlling their consequences, this study investigated the home injuries situation in Italy in 1999, using a nation-representative sample. The weighted correspondence analysis showed four different patterns of injury and seven profiles of the people most exposed to them. As results of this study falls were followed by bumps and cuts requiring specialist assistance then burns. Women were the most exposed to burn and fall risks and men to the risk of cuts and bumps. Among the elderly and children, falls and bumps leading to fractures, wounds or other consequences were frequent. The risks were highest for people with a lower level of education. Bumps and cuts were prevalent among unmarried and with the highest education level subjects. These injury risks were higher for young males. Cuts in adults doing do-it-yourself jobs had the worst consequences, while domestic work cuts generally did not need medical treatment. Burns occurred almost exclusively in the kitchen (90%) and did not need specialist assistance. Because home injuries are largely preventable, an efficient public health policy could promote and disseminate home safety culture.     

Road traffic injury among child motorcyclists in Vientiane Capital,Laos: a cross-sectional study using a hospital-based injury surveillance database

This study investigated the distribution of motorcyclists, including drivers and passengers, who were involved in road traffic crashes and admitted to hospital in Vientiane Capital, Laos. The focus was on child motorcycle drivers and passengers under 15 years. A hospital-based injury surveillance database in Vientiane Capital was used. The surveillance was performed in two hospitals. From 1 September to 31 December 2009, 3968 patients were admitted to the participating hospitals with road traffic injuries. Patients under 15 years accounted for 10.8% (427/3968). The majority of patients under 15 years were motorcycle drivers or passengers (71.7%, 306/427). Child motorcyclists including drivers and passengers were less likely to wear a helmet than adults (adjusted odds ratio [OR], 0.3, 95% confidence interval [CI], 0.2–0.5, for children 10–14 years; adjusted OR: 0.1, 95% CI, 0.05–0.4, for children under 10 years). It is suggested that stricter regulation enforcement for child motorcycle drivers and passengers may be needed. In addition, barriers against wearing helmets for motorcycle drivers and passengers in Laos should also be examined in further studies.     

Factors related with unintentional injuries in children with newly diagnosed attention-deficit/hyperactivity disorder

The aim of the present study was to investigate the factors associated with unintentional injury in children newly diagnosed with attention-deficit/hyperactivity disorder (ADHD). One thousand four hundred and thirty children between the ages of 6 and 18 who were diagnosed with ADHD for the first time in child psychiatry outpatient clinics were included in the present study. The socio-demographic information of the children, their developmental histories, chronic physical health conditions, comorbid psychiatric disorders, and information obtained via the Turgay DSM-IV-based Child and Adolescent Disorders Screening and Rating Scale were examined retrospectively. It was determined that 12.8% of the children (n = 183) experienced unintentional injury. It was established that age, male gender, disruptive behavioural problems, and low education levels among mothers were predictive of unintentional injuries. The results of the present study suggest that behavioural problems accompanying ADHD and comorbid psychiatric disorders are important in terms of unintentional injuries.     

Risk factors for injury in community-level football: a cohort study

We investigated the independent effect of commonly postulated risk factors on injury incidence in amateur football (soccer), using a prospective cohort design with follow-up over two seasons. A total of 1702 male and female players aged 13 years or older contributed information on 21,797 player-matches. Confirmed, were the effect of male vs. female sex (injury rate ratios (IRR) = 0.81, 95% confidence interval (CI): 0.67–0.97), older age (increasing IRR gradient), New Zealand European ethnicity (IRR = 0.87, 95% CI: 0.74–1.01), being taller (180–189 cm: IRR = 1.32, 95% CI: 1.06–1.63), previous injury (IRR = 1.32, 95% CI: 1.12–1.57), playing against medical advice (IRR = 1.24, 95% CI: 1.03–1.49), playing while recovering from injury (IRR = 1.40, 95% CI: 1.20–1.49), history of cigarette smoking (IRR = 1.27, 95% CI: 1.00–1.61) and time of season (IRR = 0.97, 95% CI: 0.96–0.98). Female, adult, non-European and taller players could be paid particular attention in injury prevention programmes. The need for effective injury management is reinforced. Adding physical conditioning to pre-season training may be required.     

Trauma epidemiology in Puerto Rico: in-hospital morbidity and mortality from 2002 to 2011

This study aimed to describe the distribution of injury mechanisms and to assess the impact of those mechanisms on the morbidity and mortality of trauma. All patients admitted to Puerto Rico Trauma Hospital (2002–2011) for road-traffic collisions (RTCs, 5,371), gunshot wounds (GSWs, 2,946), falls (2,319), pedestrian accidents (1,652), and stab wounds (SWs, 1,073) were selected. Gunshot victims were 1.19 (95%CI: 1.07–1.33) times as likely as road-traffic victims to have an ISS ≥25. Pedestrians were 1.76 (95%CI: 1.49–2.09) times more likely to have a GCS ≤8 than road-traffic victims were. The risk of dying was 2.64 (95%CI: 2.20–3.16) times higher for gunshot victims and 1.51 (95%CI: 1.23–1.86) times higher for pedestrians compared to patients who had had RTCs. Gunshot victims and pedestrians had the worst clinical outcomes. Accordingly, these patients should receive the most aggressive clinical management. Furthermore, it is imperative to develop public health campaigns on trauma prevention.     

Applying the capture-recapture method to estimate road traffic deaths and injuries in three non-contiguous cities in the Philippines

In establishing goals for the Philippine road safety plan, police data were used. Police reports are likely underreporting. We apply capture-recapture analysis to determine expansion factors and estimate the true incidence. Three cities were visited where data on deaths (2014) and injury (January–March 2014) from hospitals, police and civil registry were collected. Matching was done to generate a final list of injured and dead individuals. The Chapman method was used for estimating the true number of cases. Police data exhibited underreporting in all site. Expansion factors of the police data range from 5.4 to 29× for deaths and 3.2 to 47× for non-fatal injuries. Expansion factors are likely useful to estimate the true incidence of road traffic injuries in areas with weak injury surveillance systems such as the Philippines.