Nagesh N. Borse

CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 Year Olds in the United States, 2000-2006

Unintentional injuries are the leading cause of morbidity and mortality among children in the United States. This report uses data from the National Vital Statistics System and the National Electronic Injury Surveillance System - All Injury Program to provide an overview of unintentional injuries related to drowning, falls, fires or burns, transportation-related injuries, poisoning, and suffocation, among others during the period 2000 - 2006. Results are presented by age group and sex, as well as the geographic distribution of injury death rates by state.

Data Sources for Improving Estimates of the Global Burden of Injuries: Call for Contributors

Kavi Bhalla and colleagues invite individuals and organizations to provide local injury data sources to help inform estimates of the global burden of injuries.

A review of unintentional injuries in adolescents.

Unintentional injuries are the largest source of premature morbidity and mortality and the leading cause of death among adolescents 10-19 years of age. Fatal injury rates of males are twice those of females, and racial disparities in injury are pronounced. Transportation is the largest source of these injuries, principally as drivers and passengers, but also as cyclists and pedestrians. Other major causes involve drowning, poisonings, fires, sports and recreation, and work-related injuries. Implementing known and effective prevention strategies such as using seat belts and bicycle and motorcycle helmets, installing residential smoke alarms, reducing misuse of alcohol, strengthening graduated driver licensing laws, promoting policy change, using safety equipment in sports and leisure, and protecting adolescents at work will all contribute to reducing injuries. The frequency, severity, potential for death and disability, and costs of these injuries, together with the high success potential of prevention strategies, make injury prevention a key public health goal to improve adolescent health in the future.

Unintentional childhood injuries in the United States: key findings from the CDC childhood injury report.

On December 10, 2008, theWorld Health Organization (WHO), in collaborationwith United Nations Childrens Fund (UNICEF), launched theWorld ReportonChild InjuryPrevention (WHO/UNICEF, 2008) todrawattention to thepreventable loss of 830,000 childrenandadolescents to anunintentional injury annually throughout theworld. To coincidewith the global report, the Centers for Disease Control and Prevention (CDC) also analyzed deaths and non-fatal injuries to children and adolescents and inDecember 2008, released theCDCChildhood Injury Report: Patterns of Unintentional Injuries among 019 year olds in the United States, 2000-2006 (Borse et al., 2008). This article summarizes some of the key findings of this report. Impact of Industry: The CDC childhood injury report can inform thework of practitioners, policy-makers, elected officials, and researchers to better understand the problem and take the necessary steps to reduce the devastating burden childhood injuries place on this nation. The CDC Childhood Injury Report provides an overview of patterns of childhood unintentional injuries in the United States, related to drowning, falls, fires or burns, transportation (e.g., motor-vehicle crashes), poisoning, and suffocation, among other injuries such as overexertion, and being struck by or against an object (Borse et al., 2008). The burden of deaths and nonfatal injuries due to each cause is shown in this report by age group and sex, as well as the geographic distributionof injurydeath rates by state. Thedataused in this reportwere obtained fromtwosources. Injury deathdata from 2000 – 2005 were derived from the National Center for Health Statistics (NCHS), National Vital Statistics System (CDC, 2008). Non-fatal injury data from 2001-2006 were derived from the National Electronic Injury Surveillance System All Injury Program (U.S. Consumer Product Safety Commission, 2000). We summarize this report in three sub-headings: Leading causes of Deaths and Nonfatal Injuries, Injury Deaths, and Nonfatal Injuries. The methodology used for analysis is available at www.cdc.gov/SafeChild/ChildhoodInjuryReport.

The Effect of Age on Transmission of 2009 Pandemic Influenza A (h1n1) in a Camp and Associated Households

Background: A major portion of influenza disease burden during the 2009 pandemic was observed among young people. Methods: We examined the effect of age on the transmission of influenza-like illness associated with the 2009 pandemic influenza A (H1N1) virus (pH1N1) for an April–May 2009 outbreak among youth-camp participants and household contacts in Washington State. Results: An influenza-like illness attack rate of 51% was found among 96 camp participants. We observed a cabin secondary attack rate of 42% (95% confidence interval = 21%–66%) and a camp local reproductive number of 2.7 (1.7–4.1) for influenza-like illness among children (less than 18 years old). Among the 136 contacts in the 41 households with an influenza-like illness index case who attended the camp, the influenza-like illness secondary attack rate was 11% for children (5%–21%) and 4% for adults (2%–8%). The odds ratio for influenza-like illness among children versus adults was 3.1 (1.3–7.3). Conclusions: The strong age effect, combined with the low number of susceptible children per household (1.2), plausibly explains the lower-than-expected household secondary attack rate for influenza-like illness, illustrating the importance of other venues where children congregate for sustaining community transmission. Quantifying the effects of age on pH1N1 transmission is important for informing effective intervention strategies.

Years of potential life lost from unintentional child and adolescent injuries — United States, 2000–2009

INTRODUCTION Quantifying years of potential life lost (YPLL) highlights childhood causes of mortality and provides a simple method to identify important causes of premature death. METHODS CDC analyzed data from the National Vital Statistics System multiple cause of death files for 2000-2009. RESULTS An average of 890YPLL were lost each year due to unintentional injuries for every 100,000 persons aged 0-19 years. YPLL rates differed by sex, age group, race/ethnicity, injury mechanism and state. CONCLUSIONS This report provides new information which can be used to prioritize interventions and identify subgroups of the population most at risk.

National burden of road traffic injuries in Argentina

More than 1.2 million people die and as many as 50 million people are injured or disabled due to road traffic injuries (RTIs) every year worldwide. The lack of reliable data hinders efforts to describe the characteristics of the issue and prioritise prevention activities. The objective was to provide a snapshot of fatal and non-fatal RTI in Argentina. We used the methodology proposed by the Global Burden of Disease Injury Expert group. External causes of deaths with unknown codes were proportionately redistributed over the known categories. In 2007 in Argentina, we estimated 5915 RTI deaths, compared with 3983 RTI deaths reported previously by the Ministry of Health, accounting for 1931 additional cases. The highest number of deaths occurred in young men (15–29 years old), although the highest RTI death rates were in the age group of 55 years and older. Four-wheeled vehicle occupants were the most common road user type killed (59.1%); vulnerable road users represented one third (29.5%) of deaths and 64% of non-fatal RTI. The national and regional estimates of RTI in Argentina should help policy makers and public-health researchers to understand the importance of RTI prevention and design specific interventions to further reduce these preventable deaths and injuries.

The burden of childhood injuries and evidence based strategies developed using the injury surveillance system in Pasto, Colombia

Objective This article characterises the burden of childhood injuries and provides examples of evidence–based injury prevention strategies developed using a citywide injury surveillance system in Pasto, Colombia. Methods Fatal (2003-2007) and non-fatal (2006-2007) childhood injury data were analysed by age, sex, cause, intent, place of occurrence, and disposition. Results Boys accounted for 71.5% of fatal and 64.9% of non-fatal injuries. The overall fatality rate for all injuries was 170.8 per 100,000 and the non-fatal injury rate was 4,053 per 100,000. Unintentional injuries were the leading causes of fatal injuries for all age groups, except for those 15-19 years whose top four leading causes were violence-related. Among non-fatal injuries, falls was the leading mechanism in the group 0-14 years. Interpersonal violence with a sharp object was the most important cause for boys aged 15-19 years. Home was the most frequent place of occurrence for both fatal and non-fatal injuries for young children 0-4 years old. Home, school and public places became an important place for injuries for boys in the age group 5-15 years. The highest case-fatality rate was for self-inflicted injuries (8.9%). Conclusions Although some interventions have been implemented in Pasto to reduce injuries, it is necessary to further explore risk factors to better focus prevention strategies and their evaluation. We discuss three evidence-based strategies developed to prevent firework-related injuries during festival, self-inflicted injuries, and road traffic-related injuries, designed and implemented based on the injury surveillance data.

Did PEPFAR investments result in health system strengthening? A retrospective longitudinal study measuring non-HIV health service utilization at the district level

Objectives PEPFAR’s initial rapid scale-up approach was largely a vertical effort focused fairly exclusively on AIDS. The purpose of our research was to identify spill-over health system effects, if any, of investments intended to stem the HIV epidemic over a 6-year period with evidence from Uganda. The test of whether there were health system expansions (aside from direct HIV programming) was evidence of increases in utilization of non-HIV services—such as outpatient visits, in-facility births or immunizations—that could be associated with varying levels of PEPFAR investments at the district level. Methods Uganda’s Health Management Information System article-based records were available from mid-2005 onwards. We visited all 112 District Health offices to collect routine monthly reports (which contain data aggregated from monthly facility reports) and annual reports (which contain data aggregated from annual facility reports). Counts of individuals on anti-retroviral therapy (ART) at year-end served as our primary predictor variable. We grouped district-months into tertiles of high, medium or low PEPFAR investment based on their total reported number of patients on ART at the end of the year. We generated incidence-rate ratios, interpreted as the relative rate of the outcome measure in relation to the lowest investment PEPFAR tertile, holding constant control variables in the model. Results We found PEPFAR investment overall was associated with small declines in service volumes in several key areas of non-HIV care (outpatient care for young children, TB tests and in-facility deliveries), after adjusting for sanitation, elementary education and HIV prevalence. For example, districts with medium and high ART investment had 11% fewer outpatient visits for children aged 4 and younger compared with low investment districts, incidence rate ratio (IRR) of 0.89 for high investment compared with low (95% CI, 0.85–0.94) and IRR of 0.93 for medium compared with low (0.90–0.96). Similarly, 22% fewer TB sputum tests were performed in high investment districts compared with low investment, [IRR 0.78 (0.72–0.85)] and 13% fewer in medium compared with low, [IRR 0.88 (0.83–0.94)]. Districts with medium and high ART investment had 5% fewer in-facility deliveries compared with low investment districts [IRR 0.95 for high compared with low, (91–1.00) and 0.96 for medium compared with low (0.93–0.99)]. Although not statistically significant, the rate of maternal deaths in high investment district-months was 13% lower than observed in low investment districts. Conclusions This study sought to understand whether PEPFAR, as a vertical programme, may have had a spill-over effect on the health system generally, as measured by utilization. Our conclusion is that it did not, at least not in Uganda.

Did PEPFAR funding affect non-HIV health indicators? Longitudinal study of facility-based baby deliveries in Uganda, 2005–10

Abstract Background While PEPFAR investments were associated with HIV-related survival, it has been less clear what the effects of this investment in HIV care have been for health-care use generally, especially in maternal care. Understanding of these effects could have implications for how to organise future global health initiatives for major health problems. Maternal mortality in Uganda remains high (310 per 100 000 livebirths in 2010) and could be reduced by increasing deliveries at health facilities. Methods We visited all of Ugandas 56 districts to collect maternity care data from Health Management Information System records, between the years 2005 and 2010, including monthly reports from all public and most private facilities. Our unit of analysis was district-month. We fitted a negative binomial mixed effects model, with number of infants delivered in health facilities per district-month as outcome, and three categories (tertiles) of population-adjusted annual number of PEPFAR-supported patients on antiretroviral therapy (ART) as input. We adjusted for regional HIV prevalence and proportion of elementary school-aged children attending school. To adjust for secular and seasonal effects, we included control variables for year and month. Random effects for district and an offset for district population were included in the model. Findings People on ART per district-month per 1000 population grew from 1079 in 2005, to 6485 in 2010. Facility deliveries averaged 709 per district-month, growing from 561 in 2005 to 830 in 2010. The average rate of health facility deliveries increased by 4% (incidence rate ratio [IRR] 1·04, 95% CI 1·008–1·068, p=0·012) in districts with medium-level PEPFAR investment in ART care, compared with lowest PEPFAR investment districts. In higher-level investment districts, deliveries increased by 8% (IRR 1·08, 95% CI 1·037–1·126, p=0·0001), relative to low-investment districts. Interpretation PEPFAR investments in ART scale-up in Uganda appear to be associated with small increases in health facility deliveries. Funding This research was funded by the US Centers for Disease Control, Division of Public Health Systems and Workforce Development through a cooperative agreement with the University of Washington and through subcontracts with Makerere University and the Uganda Ministry of Health.