Jagnoor

Unintentional injury mortality in India, 2005: Nationally representative mortality survey of 1.1 million homes

BackgroundUnintentional injuries are an important cause of death in India. However, no reliable nationally representative estimates of unintentional injury deaths are available. Thus, we examined unintentional injury deaths in a nationally representative mortality survey.MethodsTrained field staff interviewed a living relative of those who had died during 2001-03. The verbal autopsy reports were sent to two of the130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved through reconciliation and adjudication. Proportionate cause specific mortality was used to produce national unintentional injury mortality estimates based on United Nations population and death estimates.ResultsIn 2005, unintentional injury caused 648 000 deaths (7% of all deaths; 58/100 000 population). Unintentional injury mortality rates were higher among males than females, and in rural versus urban areas. Road traffic injuries (185 000 deaths; 29% of all unintentional injury deaths), falls (160 000 deaths, 25%) and drowning (73 000 deaths, 11%) were the three leading causes of unintentional injury mortality, with fire-related injury causing 5% of these deaths. The highest unintentional mortality rates were in those aged 70years or older (410/100 000).ConclusionsThese direct estimates of unintentional injury deaths in India (0.6 million) are lower than WHO indirect estimates (0.8 million), but double the estimates which rely on police reports (0.3 million). Importantly, they revise upward the mortality due to falls, particularly in the elderly, and revise downward mortality due to fires. Ongoing monitoring of injury mortality will enable development of evidence based injury prevention programs.

Childhood and adult mortality from unintentional falls in India

OBJECTIVE To estimate fall-related mortality by type of fall in India. METHODS The authors analysed unintentional injury data from the ongoing Million Death Study from 2001-2003 using verbal autopsy and coding of all deaths in accordance with the International statistical classification of diseases and related health problems, tenth revision, in a nationally representative sample of 1.1 million homes throughout the country. FINDINGS Falls accounted for 25% (2003/8023) of all deaths from unintentional injury and were the second leading cause of such deaths. An estimated 160,000 fall-related deaths occurred in India in 2005; of these, nearly 20,000 were in children aged 0-14 years. The unintentional-fall-related mortality rate (MR) per 100,000 population was 14.5 (99% confidence interval, CI: 13.7-15.4). Rates were similar for males and females at 14.9 (99% CI: 13.7-16.0) and 14.2 (99% CI: 13.1-15.4) per 100,000 population, respectively. People aged 70 years or older had the highest mortality rate from unintentional falls (MR: 271.2; 99% CI: 249.0-293.5), and the rate was higher among women (MR: 281; 99% CI: 249.7-311.3). Falls on the same level were the most common among older adults, whereas falls from heights were more common in younger age groups. CONCLUSION In India, unintentional falls are a major public health problem that disproportionately affects older women and children. The contexts in which these falls occur and the resulting morbidity and disability need to be better understood. In India there is an urgent need to develop, test and implement interventions aimed at preventing falls.

Psychological impact of injuries sustained in motor vehicle crashes: Systematic review and meta-analysis

Objective The aim of this meta-analysis was to determine the psychological impact associated with motor vehicle crash (MVC)-related physical injuries. Design Systematic review and meta-analysis. Data sources Multiple search engines included MEDLINE (via OVID), PsycINFO and Embase, and studies were sourced from scientific journals, conference papers and doctoral theses. Study selection A high-yield search strategy was employed. Terms like ‘psychological distress’, ‘depression’, ‘PTSD’ and ‘motor vehicle accident’ were employed. These key words were run primarily and secondary searches were then conducted in association with the major injury types. Studies needed to compare psychological distress in people injured in an MVC with uninjured controls who had not recently experienced an MVC. Data extraction Searches resulted in the identification of 2537 articles, and after eliminating duplicates and studies not meeting inclusion criteria, 24 studies were selected involving 4502 injured participants. These studies were entered into separate meta-analyses for mild to moderate traumatic brain injury (mTBI), whiplash-associated disorder (WAD) and spinal cord injury (SCI). Results Elevated psychological distress was associated with MVC-related injuries with a large summary effect size in WAD (0.90), medium to large effect size in SCI (0.69) and small to medium effect size in mTBI (0.23). No studies meeting inclusion criteria were found for burns, fractures and low back injury. Increased psychological distress remains elevated in SCI, mTBI and WAD for at least 3 years post-MVC. Conclusions Rehabilitation strategies are needed to minimise distress subsequent to MVC-related physical injuries and the scientific robustness of studies requires improvement.

Epidemiological transition in a rural community of northern India: 18-year mortality surveillance using verbal autopsy

Background Information on causes of death is vital for planning of health services. However, vital events registration systems are weak in developing countries. Therefore, verbal autopsy (VA) tools were incorporated in a community-based surveillance system to track causes of death. Method and Findings Trained fieldworker identified all deaths and interviewed a living relative of those who had died during 1992–2009, using VA, in eight villages of Haryana (11 864 populations). These field reports detailing events preceding death were reviewed by two trained physicians, who independently assigned an International Classification of Disease-10 code to each death. Discrepancies were resolved through reconciliation and, if necessary, adjudication. Non-communicable conditions were the leading causes of death (47.6%) followed by communicable diseases including maternal, perinatal and nutritional conditions (34.0%), and injuries (11.4%). Cause of death could not be determined in 6.9% cases. Deaths due to cardiovascular diseases showed a significant rise, whereas deaths due to diarrhoeal diseases have declined (p<0.01). Majority (90.0%) of the deceased had contacted a healthcare provider during illness but only 11.5% were admitted in hospital before death. Conclusion Rising trend of cardiovascular diseases observed in a rural community of Haryana in India calls for reorientation of rural healthcare delivery system for prevention and control of chronic diseases.

Fall related injuries: A retrospective medical review study in North India

INTRODUCTION Falls have been identified as a leading cause of injury-related morbidity and mortality in India. However, very little is known about the context and characteristics of such falls. The aim of this study was to describe the context and characteristics of fall related injuries in patients admitted to hospital for fall injury. METHODS Medical records of patients presenting at the Emergency Department of the Nehru Hospital, Chandigarh, India between March 2008 and February 2009, were reviewed by trained investigators. All injury cases were identified and fall related injury cases were assigned an ICD 10, Chapter XX, External causes of morbidity and mortality code. A review of medical records was conducted to determine the context, nature and site of injury associated with a fall event. RESULTS Ten percent (7049) of hospital emergency presentations were due to injuries, and falls were the second leading cause (20%, 1407). Seventy-six percent of the fall related presentations were in males. More than one third (36%) of the fall related presentations occurred in those aged 0-14 years old. Falls from building or structures (35%, 499) were the leading cause for all ages except for those older than 60 years, where same level falls due to slipping, tripping and stumbling (40%, 57) were predominant. Half of all the falls resulted in head injury. Nearly 10% of patients presenting for fall related injury died. CONCLUSION Fall related injuries are an important contributor to hospital emergency presentations, particularly falls from buildings in children, and slips and trips in older people. Given the high proportion of falls that resulted in head injury and death, there is a significant need to develop appropriate interventions to prevent such falls.

Presence and predictors of persistent pain among persons who sustained an injury in a road traffic crash.

There is a paucity of prospective studies with long follow‐up that have examined a wide range of correlates associated with persistent pain outcomes in persons who sustained a mild or moderate injury in a road traffic crash. This study aimed to establish the independent predictors of pain severity over 24 months.

A qualitative study on the perceptions of preventing falls as a health priority among older people in Northern India

Background In India, fall-related injury morbidity and mortality is an emerging public health problem in older people. Despite awareness of a growing burden, there is a scarcity of literature on effective and acceptable interventions. This study was undertaken to explore the perceptions of older people regarding the risk of falls and understanding of fall prevention programmes. Methods We conducted six focus group discussions (FGDs), comprising single gender for three socio-demographic groups in a north Indian city, Chandigarh, in 2011. FGDs were conducted in local language (Punjabi), recorded, transcribed and translated in English. Two researchers independently conducted thematic analysis. Results Focus group participants were aware of the devastating consequences of fall-related injuries. The predominant reasons for explaining an increased risk of falling was age, uneven surfaces, physical weakness and mental health. There were several other competing health priorities in this population. Preventive measures ranging from individual to government level initiatives were suggested. The experience, knowledge, perceptions and health priorities were diverse among the three socio-demographic groups. However, the feasibility, acceptability and effectiveness for improving balance and strength using yoga in this population needs to be evaluated. Conclusions Careful consideration of health priorities is required for development of falls prevention, particularly among the urban poor. Further, initiatives that foster community engagement, such as participatory action may increase acceptability of initiatives to prevent fall-related injury among older people in India.

Economic Burden of Hospitalization Due to Injuries in North India: A Cohort Study.

There is little documentation of the potential catastrophic effects of injuries on families due to out of pocket (OOP) expenditure for medical care. Patients who were admitted for at least one night in a tertiary care hospital of Chandigarh city due to injury were recruited and were followed-up at 1, 2 and 12 months after discharge to collect information on OOP expenditure. Out of the total 227 patients, 60% (137/227) had sustained road traffic injuries (RTI). The average OOP expenditure per hospitalisation and up to 12 months post discharge was USD 388 (95% CI: 332–441) and USD 1046 (95% CI: 871–1221) respectively. Mean OOP expenditure for RTI and non-RTI cases during hospitalisation was USD 400 (95% CI: 344–456) and USD 369 (95% CI: 313–425) respectively. The prevalence of catastrophic expenditure was 30%, and was significantly higher among those belonging to the lowest income quartile (OR-26.50, 95% CI: 6.70–105.07, p-value: <0.01) and with an inpatient stay greater than 7 days (OR-10.60, 95% CI: 4.21–26.64, p-value: <0.01). High OOP expenditure for treatment of injury puts a significant economic burden on families. Measures aimed at increasing public health spending for prevention of injury and providing financial risk protection are urgently required in India.

Epidemiology of falls among older adults: a cross sectional study from Chandigarh, India

BACKGROUND Fall is an important cause of injury morbidity in older adults. However, epidemiological information on fall is limited in low- and middle-income countries. We investigated the extent, pattern, characteristics, and context of falls in Chandigarh. METHODS A cross sectional survey was carried out among 300 persons (≥60 years), sampled from urban, rural and slums areas of Chandigarh, India from March 2011 to October 2012 using multistage cluster sampling. A pre-tested interview schedule was used and relevant medical examinations were conducted. Multivariable logistic regression was carried out to estimate Odds Ratio (OR) and 95% confidence interval (CI). RESULTS In the past one year, 31% (92/300) respondents reported one or more falls. On an average 0.67 fall episodes occurred/person/year (202/300). Most (68%; 63/92) falls occurred at home; 75% (47/63) occurred while carrying out activities such as toileting, bathing, sleeping and eating etc. Injuries due to falls were reported by 67% (62/92). In these cases, lower extremities, 37% (23/62) were the most common site of injury. Eight percent (5/62) reported fractures. A general physician was consulted by 44% (27/62), and 11% (7/62) utilized emergency services whilst another 11% (7/62) of fall injuries required hospital admission. Risk of fall was higher among females (OR 1.6, 95%CI 1.0-2.8, p 0.068), those taking four or more medicines (OR 2.1, 95%CI 1.2-3.5, p 0.009) and having poor body balance (OR 1.9, 95%CI 1.0-3.4, p 0.037). CONCLUSION Fall injuries were common in older adults of Chandigarh. Large cohort studies are needed to identify risk factors particularly those related to home environment.

Fire-related deaths in India: how accurate are the estimates

www.thelancet.com Vol 374 July 11, 2009 117 Sri Lanka’s brutal, three-decadelong war has come to an end. Although very timely, your May 16 World Report contains some points that are biased and incorrect, and will certainly tarnish the image of Sri Lanka. First, the main reason for the military operations continuing during the country’s biggest festival was to rescue the innocent civilians kept as hostages. This is a legitimate right of the Government of Sri Lanka. The long time taken by the Sri Lankan army to rescue just a 3 km2 area is itself strong evidence of the respect that the army had for the lives of civilians. Heavy artillery and air attacks would have fi nished the job in a matter of a few hours. I agree that there are defi ciencies in the facilities provided for displaced people for obvious reasons. But these defi ciencies are no worse than what the world witnessed, for example, after hurricane Katrina in New Orleans in 2005. This is the biggest ever hostage-rescuing mission in the world, and Sri Lanka is a developing country trying hard to thrive amid terrorism. What we need at this hour is help and positive encouragement.