Margaret M. Peden

The epidemiology of drowning worldwide

The purpose of this analysis was to quantify the magnitude of death and disability from drowning and near-drowning worldwide and to provide epidemiological data on which to base prevention efforts. All data are from the Global Burden of Disease 2000 (Version 1) estimates in which deaths and disabilities are based on the WHO International Classification of Diseases. Extrapolations were made by age, sex, and WHO region. The six WHO regions of the world were further divided into high-income, and low- and middle-income based on the 1998 World Development indicators. According to the GBD 2000 data, an estimated 449,000 people drowned worldwide (7.4 per 100,000 population) and a further 1.3 million Disability Adjusted Life Years (DALYs) were lost as a result of premature death or disability from drowning. 97% of drownings occurred in low- and middle-income countries. Although 38% of drownings occurred in the Western Pacific Region, Africa had the highest drowning mortality rate (13.1 per 100,000 population). Males had higher drowning mortality rates than females for all ages and in all regions. Children under the age of 5 years had the highest drowning mortality rate for both sexes in all of the WHO regions except for Africa, where children aged 5 to 14 years had the highest mortality rate. World-wide, for children under the age of 15 years, drowning accounted for a higher mortality rate than any other cause of injury. Drowning is a significant problem worldwide particularly for children under the age of 15 years. Low- and middle-income countries have the highest rates of drowning and account for more than 90% of such fatalities. Primary prevention efforts should thus be focused on these countries where many children who cannot swim drown in large bodies of water.

Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study

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 >or= 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.

Guidelines for conducting community surveys on injuries and violence

Global mortality data indicate that in 2002 an estimated 5.2 million people died as a result of some form of injury. This number, however, does not reflect the numerous individuals who are non-fatally injured, many of whom suffer lifelong health consequences and disabilities. Combined data from high-income countries, such as Australia, the Netherlands, Sweden and the United States, indicate that in these countries for every person killed by injury, approximately 30 times as many people are hospitalized and roughly 300 times as many are treated in hospital emergency rooms and then discharged. When disability resulting from injury is also taken into consideration, injuries represent an even more significant public health problem. Developing countries account for approximately 90% of all injury fatalities world-wide. It is in these environments where the least has been done to prevent injuries. This is because of the lack of visibility of the problem, multisectorality and a lack of ownership and a failure to realize that injuries can be prevented through organized efforts of society. The present paper reports on the development of guidelines for conducting community surveys, which will contribute to increasing the visibility of the injury problem, especially in lowand middle-income countries, by providing a reliable methodology for their documentation. In many lowand middle-income countries vital statistics and routine health information may be lacking or, at best, patchy. Furthermore, in these settings demographic data may be incomplete or out of date, because it has been some years since a population census has been held. This situation may be compounded by the effects of wars, which lead to large population displacements, as has happened in countries of subSaharan Africa. Additionally, in post-conflict conditions the problem of injuries may be greater due to the ready availability of firearms and the loss of social cohesion in local and displaced populations. Routine health service information may be incomplete or inaccurate and reliance on it may lead to underestimates of the numbers of injured people seeking treatment in hospitals and other health facilities. As a result of a combination of these factors, estimates of the burden of injuries in lowand middle-income countries may be unreliable. Estimates for these countries are often based on projections from countries with more comprehensive injury data or on projections from population laboratories. Community-based, household surveys are one way of obtaining data on injury occurrence and deaths; in some settings such surveys also provide a means of collecting baseline population denominator data, necessary for the calculation of prevalence or incidence rates and that otherwise would not be available. In less resourced environments, a community survey to assess injuries can be a stand-alone method for the surveillance of injuries or a valuable adjunct to hospital-based injury surveillance systems. Adequate data about types of injuries, their causes and consequences are vital to understanding the scale and nature of the local injury problem and, subsequently, the implementation and evaluation of effective prevention programmes. Reliable information on injuries is also important to build up a picture of the extent of the national, regional and global problem. To address the need for improved injury surveillance, in 2001 the World Health Organization (WHO),

Global collaboration on road traffic injury prevention

Worldwide, nearly 1.2 million people are killed in road traffic crashes every year and 20 million to 50 million more are injured or disabled. These injuries account for 2.1% of global mortality and 2.6% of all disability-adjusted life years (DALYs) lost. Low- and middle-income countries account for about 85% of the deaths and 90% of the DALYs lost annually. Without appropriate action, by 2020, road traffic injuries are predicted to be the third leading contributor to the global burden of disease. The economic cost of road traffic crashes is enormous. Globally it is estimated that US

Injury prevention and the attainment of child and adolescent health

518 billion is spent on road traffic crashes with low- and middle-income countries accounting for US

Road traffic injuries are a global public health problem

65 billion – more than these countries receive in development assistance. But these costs are just the tip of the iceberg. For everyone killed, injured or disabled by a road traffic crash there are countless others deeply affected. Many families are driven into poverty by the expenses of prolonged medical care, loss of a family breadwinner or the added burden of caring for the disabled. There is an urgent need for global collaboration on road traffic injury prevention. Since 2000, WHO has stepped up its response to the road safety crisis by firstly developing a 5-year strategy for road traffic injury prevention and following this by dedicating World Health Day 2004 to road safety and launching the WHO/World Bank World Report on Road Traffic Injury Prevention at the global World Health Day event in Paris, France. This short article highlights the main messages from the World Report and the six recommendations for action on road safety at a national and international level. It goes on to briefly discuss other international achievements since World Health Day and calls for countries to take up the challenge of implementing the recommendations of the World Report.

Clinical assessment compared with breathalyser readings in the emergency room: concordance of ICD-10 Y90 and Y91 codes

Urgent attention is required to tackle the problem of child and adolescent injury across the world. There have been considerable shifts in the epidemiological patterns of child deaths; while great progress has been made in preventing infectious diseases, the exposure of children and adolescents to the risks of injury appear to be increasing and will continue to do so in the future. The issue of injuries is too often absent from child and adolescent health agendas. In December 2008, WHO and the United Nations Childrens Fund published the World report on child injury prevention, calling global attention to the problem of child injuries. This article expands on the reports arguments that child injuries must be integrated into child health initiatives and proposes initial steps for achieving this integration.

Introduction: the global challenge of road traffic injuries: can we achieve equity in safety?

EDITOR—Road traffic crashes and their sequelae are a scourge in all societies, both developed and developing. Each year over a million people are killed in road traffic collisions worldwide and some 10 million people are injured or disabled by these events,1 predominantly in low and middle income countries.2 Despite what is known about road traffic crashes and their health consequences, policymakers worldwide show little awareness of their contribution to the burden of disease; consequently they are neglected …

Addressing the Implementation Gap in Global Road Safety: Exploring Features of an Effective Response and Introducing a 10-Country Program

Objectives: The purpose of this study was to analyse the validity of clinical assessment of alcohol intoxication (ICD-10 Y91) compared with estimated blood alcohol concentration (BAC) using a breath analyser (ICD-10 Y90) among patients in the emergency room (ER). Methods: Representative samples of ER patients reporting within six hours of injury (n = 4798) from 12 countries comprising the WHO Collaborative Study on Alcohol and Injuries were breath analysed and assessed blindly for alcohol intoxication at the time of ER admission. Data were analysed using Kendall’s Tau-B to measure concordance of clinical assessment and BAC, and meta analysis to determine heterogeneity of effect size. Results: Raw agreement between the two measures was 86% (Tau-B 0.68), but was lower among those reporting drinking in the six hours prior to injury (raw agreement 39%; Tau-B 0.32). No difference was found by gender or for timing of clinical assessment in relation to breath analysis. Patients positive for tolerance or dependence were more likely to be assessed as intoxicated at low levels of BAC. Estimates were homogeneous across countries only for females and for those negative for alcohol dependence. Conclusions: Clinical assessment is moderately concordant with level of BAC, but in those patients who have actually been drinking within the last six hours the concordance was much less, possibly because, in part, of a tendency on the part of clinicians to assign some level of intoxication to anyone who appeared to have been drinking.

World Health Organization dedicates World Health Day to road safety.

This paper provides an overview of this special issue of Injury Control and Safety Promotion, which is devoted to road traffic injuries and health equity. The issue includes nine country reports that provide baseline data on the burden of road traffic injuries. The reports also analyze current road safety activities, key stakeholders and major constraints to road safety. The country reports all emphasize that a critical first step toward improving road safety conditions is accurate data collection. A number of other common challenges are reported, including the lack of properly organized public transportation systems; highways that cross populated areas and markets; inadequate provisions for pedestrians; and ineffective national road safety councils. The reports were part of an international conference to review the current impact of road traffic injuries in low- and middle-income Asian, African and Latin American countries, assess interventions to reduce the burden of these injuries, and begin to develop multi-country intervention plans for reducing this toll through programs, policies, research and action. As a result of the discussions at the conference, a call to action was developed as a shared statement of purpose and commitment to work together to reduce road traffic injuries.