Akm Fazlur Rahman

Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh

BACKGROUND 90% of the global burden of injuries is borne by low-income and middle-income countries (LMICs). However, details of the injury burden in LMICs are less clear because of the scarcity of data and population-based studies. The Saving of Lives from Drowning project, implemented in rural Bangladesh, did a census on 1·2 million people to fill this gap. This Article describes the epidemiology of fatal and non-fatal injuries from the study. METHODS In this study, we used data from the baseline census conducted as part of the Saving of Lives from Drowning (SoLiD) project. The census was implemented in 51 unions from seven purposively sampled rural subdistricts of Bangladesh between June and November, 2013. Sociodemographic, injury mortality, and morbidity information were collected for the whole population in the study area. We analysed the data for descriptive measures of fatal and non-fatal injury outcomes. Age and gender distribution, socioeconomic characteristics, and injury characteristics such as external cause, intent, location, and body part affected were reported for all injury outcomes. FINDINGS The census covered a population of 1 169 593 from 270 387 households and 451 villages. The overall injury mortality rate was 38 deaths per 100 000 population per year, and 104 703 people sustained major non-fatal injuries over a 6-month recall period. Drowning was the leading external cause of injury death for all ages, and falls caused the most number of non-fatal injuries. Fatal injury rates were highest in children aged 1-4 years. Non-fatal injury rates were also highest in children aged 1-4 years and those aged 65 years and older. Males had more fatal and non-fatal injuries than females across all external causes except for burns. Suicide was the leading cause of injury deaths in individuals aged 15-24 years, and more than 50% of the suicides occurred in females. The home environment was the most common location for most injuries. INTERPRETATION The burden of fatal and non-fatal injuries in rural Bangladesh is substantial, accounting for 44 050 deaths and 21 million people suffering major events annually. Targeted approaches addressing drowning in children (especially those aged 1-4 years), falls among the elderly, and suicide among young female adults are urgently needed to reduce injury deaths and morbidity in Bangladesh. FUNDING Bloomberg Philanthropies.

PA 09-6-1378 Monitoring process for a comprehensive drowning reduction project: experience from low-middle-income country

Introduction Injury kills about 300 people each day in Bangladesh. Drowning, suicide, road traffic injuries are the topmost causes of injury mortality. Government and non-government organizations are implementing injury prevention projects in Bangladesh. Effective monitoring is the key to make a program successful. Aim To track down and ensure the quality of injury prevention project activities through a systematic process on a regular basis. Method The study developed a logical framework integrated with targeted project indicators. The indicators are finalized in consultation with donors, academic partners, national and international drowning experts. Base on the indicators, individual monitoring tool was developed for each intervention. Later on project staff were oriented on tools and trained to use the tool on electronic data collection devices. Additionally, to oversee routine activities a Management Information System is being used. Result The tools consisted with some substantial variables, likely project staff and beneficiaries’ competency, safety standards, outcomes of the interventions, drop-out of project staff and beneficiaries, injury incidences and its management. Field supervisors visit intervention sites, activities and used the tools on devices and upload data on regular basis. Central project staff also visited and used the tools in intervention areas according to periodic plan. Through the monitoring data, agreed indicators of the interventions were tracked down towards project goals and ensured quality of the interventions as well as identify loopholes of every stage of the intervention. Monitoring data produced monthly and quarterly reports with the specific outcomes and was shared with implementation team, donors and academic partners. By doing so, the project management and donors took steps to ensure quality of the project. Conclusion and policy implications Due to each project personnel`s involvement, the monitoring process was participatory and ensuring accountability, transparency and maintaining quality of project activities.

PW 2050 Estimating the burden of injuries among urban children in bangladesh from a nationwide survey: evidence for policy implication

Introduction Injuries among urban children has become an emerging public health problem in Bangladesh like other low- and middle-income countries due to epidemiological transition. Despite of huge burden, child injuries could not draw the attention of the policy makers over the last few decades to be a national priority agenda in health sector due to lack of reliable data. Objective Objective of the study was to investigate the epidemiological burden of injuries among urban children in Bangladesh. Methodology A nationwide cross-sectional survey was conducted between March and June 2016. Multi-stage cluster sampling was used to select required number of households. It uses a complex sampling strategy based on probability-proportional-to-size (PPS) methodologies with separate urban and rural samples. After cleaning and validation, data from 2 99 216 household residents including 1 06 233 urban residents was available for analysis of which 33 578 were children aged 0–17 years. 64 data collectors and 16 supervisors were engaged in the study. Data was collected on tablets using a custom data entry program developed for the survey. Once data was transferred to the server, the data was validated, and exported to SPSS v21 for analysis. Results Injury was responsible for 27% of all causes of deaths among urban children (157.4/100,000 children per year). Drowning was the leading cause of mortality (46.7%) followed by electrocution (13.3%), road traffic injuries (6.7%) and suicide (6.7%). Injury mortality was significantly higher among boys (218.5/100,000 boys per year) than girls (92.7/100,000 girls per year). Falls (39.5%, cuts (19.7%) and road traffic injuries (13.6%) were the three leading causes of injury morbidity while cuts, burns and road traffic injuries are the main cause of injury related permanent disability. Conclusion It is the time to act now for developing injury prevention, control and rehabilitation interventions as integral part of developmental efforts in achieving the SDGs targets.

PW 2842 Epidemiology of traumatic head injury- nationally conducted survey findings from bangladesh

Background Traumatic head injury is one of the major cause of mortality, disability and morbidity worldwide. There is scarcity of population based studies in context of Low and middle income countries (LMICs). The aim of this study is to understand the magnitude and causes of traumatic head injury from a nationally representative population based survey. Methodology Bangladesh Health and Injury Survey which was conducted nationally during March- June 2016 among 2 99 216 rural and urban population. By using multi stage cluster sampling method 16 districts and 8 city corporations were selected for this study. Results The annual incidence of head injury found was 814.8/1,00,000 people (95% CI: 782.9 to 847.6) with mortality rate of 23.39/100,000 population (95% CI: 18.38 to 29.38). Among the victims, about 67.3% (95% CI: 65.4 to 69.1) and 32.7% (95% CI: 30.9 to 34.6) were male versus female. Male are 2.05 times greater at risk than the female (RR: 2.052; 95% CI: 1.886 to 2.233). The three leading causes found were transport injury 30.6% (95% CI: 28.7 to 32.4) followed by fall 26.2% (95% CI: 24.4 to 28.0) and violence 14.9% (95% CI: 13.5 to 16.3). Conclusion Traumatic head injury is a considerable cause of death and disability as well as hospital admission in Bangladesh. Male are higher at risk than the female. Road traffic injury, fall and violence are the major causes found to be responsible for head injury. To reduce the impending burden of head injury, national strategies and preventive measures need to be developed.

PW 2064 Epidemiology of road traffic injuries among urban population in bangladesh: finding from a nationwide survey

Background Number of deaths due to road traffic injuries (RTI) is increasing in the urban areas due to rapid urbanization in the low- and middle-income countries including Bangladesh. However, the real burden of RTI among the urban population has neither been recognized nor been addressed properly by the policy makers in Bangladesh due to lack of reliable data. Objective The study aimed at exploring the epidemiological burden of RTI among urban population in Bangladesh. Methodology A nationwide cross-sectional survey was conducted between March and June 2016. Multi-stage cluster sampling was used to select required number of households. It uses a complex sampling strategy based on probability-proportional-to-size (PPS) methodologies with separate urban and rural samples. After cleaning and validation, data from 2 99 216 household residents including 1 06 233 urban residents was available for analysis. 64 data collectors and 16 supervisors were engaged in the study. Data was collected on tablets using a custom data entry program developed for the survey. Once data was transferred to the server, the data was validated, and exported to SPSS v21 for analysis. Results RTI (40.5%) was the leading cause of injury mortality among urban population followed by falls (21.4%) and drowning (19.0%) with a rate of 16.0/100,000 population. More than 70% of all deaths occur on the way to hospital. Almost two-thirds (64.7%) of all died on the urban roads are the people in the most productive age group (25–59 years) and pedestrians (23.5%) were the most vulnerable group. Around 60% of RTI victims received treatment from district level hospitals. Male involvement in road traffic injuries were significantly higher than female in the urban areas. Conclusion Findings of this study could an information base for reducing the toll of RTI among the urban population in a comprehensive way considering their involvement and health care seeking pattern.

PW 2046 Pedestrians are the major concern of road traffic injuries in bangladesh: findings from a nationwide survey

Background In Bangladesh, thousands of pedestrians are dying on the roads every year. However, the real burden of RTI focusing on pedestrian safety has neither been recognized nor been addressed properly by the policy makers in Bangladesh due to lack of reliable data. Objective The study aimed at exploring the current scenario of road traffic injuries and involvement of pedestrians in Bangladesh to generate information-base for the policy makers. Methodology A nationwide cross-sectional survey was conducted between March and June 2016. Multi-stage cluster sampling was used to select required number of households. Sampling strategy was based on probability-proportional-to-size (PPS) methodologies with separate urban and rural samples. Data from 2 99 216 household residents was available for analysis of which 1 00 842 were children aged 0–17 years. 64 data collectors and 16 supervisors were engaged in the study. Data was collected on tablets using a custom data entry program. Once data was transferred to the server, the data was validated, and exported to SPSS v21 for analysis. Results In the year before the survey, an estimate 22 437 deaths were recorded due to road traffic injuries i.e 14.4/100,000 population. Over 3.4 million were injured (2163.7/100,000 population) of which 80 448 were permanently disabled, over 220 each day. Pedestrians comprises around one third of all RTI deaths while a clear male predominance in most age groups for both death and injuries were found. Pedestrians contributed around 14% of the permanent disabilities due to road traffic injuries. Infants, younger children (<9 years) and older people (60+years) became more frequent victims as pedestrians. Conclusion Findings of this study could an insight for the policy makers of Bangladesh and other low- and middle-income countries for future policy guidance. We have to act without any delay to address the alarming involvement of pedestrians in road traffic injuries.

852 Emerging safety challenges of motorcycles on Bangladesh roads

Background Motorcycles are becoming an increasingly popular mode of travel in Bangladesh. There are around 1.3 million registered motorcycles in Bangladesh, representing nearly 55% of total registered motor vehicles. Motorcycles are increasing at an astonishing rate, around 95% during 2009–2015 with fleet growing at a faster rate than other vehicles. Motorcycle crashes are a growing problem resulting from massive increase of motorcycles. Methods To assess the risk factors of motorised two wheelers in Bangladesh, police reported crash data were analysed and International Road Assessment Program (iRAP) methodologies were applied in assessing road environment hazards associated with motorcyclists together with field observation of motorcycle travel behaviour. Results Motorcycle crashes are claiming over 200 deaths annually and nearly 70% occurred in rural areas, mostly attributable to effects of speeding. Predominant crash types are head-on, hit-pedestrian and rear-end, which together account for nearly 86%. Recent iRAP assessment revealed that national highways are mostly 2-star or less for motorcyclists indicating a relatively high level of risks of deaths and injuries. Major risk factors are mostly related to road infrastructure and environmental deficiencies and unsatisfactory driver behaviour and law enforcement. Conclusions Sustained and accelerated reduction in road fatalities involving pedestrians, bicyclists and motorcyclists is clearly a priority, particularly for achieving the target of 50% reduction of deaths by 2020 in Bangladesh. Road fatalities involving motorcycles are unacceptably high. Addressing the safety of motorcycles and the riders is therefore an enormous challenge to transport engineering professionals. It is urgent to conduct in depth research and to develop pragmatic strategies and actions with particular emphasis for wider application of road engineering and environment measures for preventing motorcycle crashes and injuries.