Priyanka Agrawal

Epidemiology of Burns in Rural Bangladesh: An Update

Each year, approximately 265,000 deaths occur due to burns on a global scale. In Bangladesh, around 173,000 children under 18 sustain a burn injury. Since most epidemiological studies on burn injuries in low and middle-income countries are based on small-scale surveys or hospital records, this study aims to derive burn mortality and morbidity measures and risk factors at a population level in Bangladesh. A household survey was conducted in seven rural sub-districts of Bangladesh in 2013 to assess injury outcomes. Burn injuries were one of the external causes of injury. Epidemiological characteristics and risk factors were described using descriptive as well as univariate and multivariate logistic regression analyses. The overall mortality and morbidity rates were 2 deaths and 528 injuries per 100,000 populations. Females had a higher burn rate. More than 50% of injuries were seen in adults 25 to 64 years of age. Most injuries occurred in the kitchen while preparing food. 88% of all burns occurred due to flame. Children 1 to 4 years of age were four times more likely to sustain burn injuries as compared to infants. Age-targeted interventions, awareness of first aid protocols, and improvement of acute care management would be potential leads to curb death and disability due to burn injuries.

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.

Epidemiology of Drowning in Bangladesh: An Update

Over one-quarter of deaths among 1–4 year-olds in Bangladesh were due to drowning in 2003, and the proportion increased to 42% in 2011. This study describes the current burden and risk factors for drowning across all demographics in rural Bangladesh. A household survey was carried out in 51 union parishads of rural Bangladesh between June and November 2013, covering 1.17 million individuals. Information on fatal and nonfatal drowning events was collected by face-to-face interviews using a structured questionnaire. Fatal and non-fatal drowning rates were 15.8/100,000/year and 318.4/100,000/6 months, respectively, for all age groups. The highest rates of fatal (121.5/100,000/year) and non-fatal (3057.7/100,000/6 months) drowning were observed among children 1 to 4 years of age. These children had higher rates of fatal (13 times) and non-fatal drowning (16 times) compared with infants. Males had slightly higher rates of both fatal and non-fatal drowning. Individuals with no education had 3 times higher rates of non-fatal drowning compared with those with high school or higher education. Non-fatal drowning rates increased significantly with decrease in socio-economic status (SES) quintiles, from the highest to the lowest. Drowning is a major public health issue in Bangladesh, and is now a major threat to child survival.

Impact of first aid on treatment outcomes for non-fatal injuries in rural Bangladesh: Findings from an injury and demographic census

Non-fatal injuries have a significant impact on disability, productivity, and economic cost, and first-aid can play an important role in improving non-fatal injury outcomes. Data collected from a census conducted as part of a drowning prevention project in Bangladesh was used to quantify the impact of first-aid provided by trained and untrained providers on non-fatal injuries. The census covered approximately 1.2 million people from 7 sub-districts of Bangladesh. Around 10% individuals reported an injury event in the six-month recall period. The most common injuries were falls (39%) and cuts injuries (23.4%). Overall, 81.7% of those with non-fatal injuries received first aid from a provider of whom 79.9% were non-medically trained. Individuals who received first-aid from a medically trained provider had more severe injuries and were 1.28 times more likely to show improvement or recover compared to those who received first-aid from an untrained provider. In Bangladesh, first-aid for non-fatal injuries are primarily provided by untrained providers. Given the large number of untrained providers and the known benefits of first aid to overcome morbidities associated with non-fatal injuries, public health interventions should be designed and implemented to train and improve skills of untrained providers.

Caregiver Supervision Practices and Risk of Childhood Unintentional Injury Mortality in Bangladesh

Unintentional injury-related mortality rate, including drowning among children under five, is disproportionately higher in low- and middle-income countries. The evidence links lapse of supervision with childhood unintentional injury deaths. We determined the relationship between caregiver supervision and unintentional injury mortality among children under five in rural Bangladesh. We conducted a nested, matched, case-control study within the cohort of a large-scale drowning prevention project in Bangladesh, “SOLID—Saving of Children’s Lives from Drowning”. From the baseline survey of the project, 126 cases (children under five with unintentional injury deaths) and 378 controls (alive children under five) were selected at case-control ratio of 1:3 and individually matched on neighborhood. The association between adult caregiver supervision and fatal injuries among children under five was determined in a multivariable conditional logistic regression analysis, and reported as adjusted matched odds ratio (MOR) with 95% confidence intervals (CIs). Children under five experiencing death due to unintentional injuries, including drowning, had 3.3 times increased odds of being unsupervised as compared with alive children (MOR = 3.3, 95% CI: 1.6–7.0), while adjusting for children’s sex, age, socioeconomic index, and adult caregivers’ age, education, occupation, and marital status. These findings are concerning and call for concerted, multi-sectoral efforts to design community-level prevention strategies. Public awareness and promotion of appropriate adult supervision strategies are needed.

Burden of Injuries in Bangladesh: A Population-Based Assessment

Injuries claim over 5 million lives, with more than 90% of those occurring in low- and middle-income countries (LMICS) [...].

PW 0845 Hospital burden of pediatric injuries in oman

Injuries are among the top causes of hospital-based mortality in individuals 1 to 44 years of age in Oman. However, little is known about the distribution and risk of injuries among children under 15 years of age. This paper uses data collected from a trauma registry established in two hospitals in Oman to describe the epidemiology and risk factors for injuries among children 0–15 years of age. The data from pilot trauma registry of two regional hospitals (Nizwa and Khoula) of Oman, was included. All patients between 0–15 years with a diagnosis of injury/trauma admitted to the hospital, and those who had trauma team activation in the Emergency Department (ED) were included in the analysis. Descriptive and multivariate regression analyses were conducted to generate socio-demographic profiles and to study risk factors for need of surgical management of injuries. Out of 795, 59.5% children were under-5 years of age; 67% were males. Around 50% of the injuries were due to falls, followed by exposure to inanimate mechanical forces and transport injuries. Burn injuries were seen more commonly in females. Three-fourth of all injuries occurred in private residences. Almost 92% of the injuries were minor in severity (Injury severity score <9). Patients suffering from head injuries (OR=21.6: 95% CI 13.98 to 33.35), or being involved in a burn injury (5.73; 95% CI 2.68 to 12.25) were at higher risk of undergoing surgical treatment. More than 30% of all injury admissions to EDs in Oman were children under 15 years of age. High Incidence of falls, home injuries and burns highlight the need for age-targeted interventions, programs and policies changes to reduce injury events in this population. Although infrequent, transport injuries and head injuries put the children in need of surgical management and prolong hospital care.

PA 08-2-1720 Caregiver supervision practices and risk of childhood unintentional injury mortality in bangladesh

Background Childhood mortality from unintentional injuries is disproportionately high in low-and-middle-income-countries (LMICs). Inadequate supervision is often described as contributory to these childhood unintentional injury deaths. Objective This paper highlights the relationship between caregiver supervision and unintentional injury mortality among children under five in rural Bangladesh. Method A nested, matched, case-control study was conducted within a large-scale drowning prevention cohort study in Bangladesh. From the baseline survey conducted as part of the study in 2013, 126 cases (under-five children that died from unintentional injuries) and 378 controls (alive, but similarly aged children) were selected at a case-control ratio of 1:3, and individually matched on neighborhood factors. The association between adult caregiver supervision and fatal injuries among under-five children was determined in a multivariable conditional logistic regression analysis, and reported as adjusted matched odds ratio (MOR) with 95% confidence intervals (CIs). Results Overall, 18.4% of the children aged 0–5 years had some form of supervision by an adult caregiver during the peak period for childhood injury events in Bangladesh, 9 am – 1 pm. Less than 5% of the caregivers had an education above secondary level and 28.6% were involved in agriculture or farming. Under-five children who died from unintentional injury deaths, mostly drowning, had three times higher odds of being unsupervised as compared to alive children (MOR=3.3, 95% CI: 1.6–7.0), while adjusting for child’s gender, age, socioeconomic index, and adult caregiver’s age, education, occupation, and marital status. Conclusion Appropriate adult supervision is essential for prevention of childhood unintentional injuries in Bangladesh and other similar LMICs. Multi-sectoral efforts to facilitate the design and implementation childhood supervision strategies e.g. community-based daycare are needed.

A systematic approach to injury policy assessment: introducing the assessment of child injury prevention policies (A-CHIPP)

Introduction This study presents a systematic approach—assessment of child injury prevention policies (A-CHIPP)—to assess and track policies on effective child injury interventions at the national level. Results from an initial pilot test of the approach in selected countries are presented. Method A literature review was conducted to identify conceptual models for injury policy assessment, and domains and indicators were proposed for assessing national injury policies for children aged 1–9 years. The indicators focused on current evidence-supported interventions targeting the leading external causes of child injury mortality globally, and were organised into a self-administered A-CHIPP questionnaire comprising 22 questions. The questionnaire was modified based on reviews by experts in child injury prevention. For an initial test of the approach, 13 countries from all six WHO regions were selected to examine the accuracy, usefulness and ease of understanding of the A-CHIPP questionnaire. Results Data on the A-CHIPP questionnaire were received from nine countries. Drowning and road traffic injuries were reported as the leading causes of child injury deaths in seven of these countries. Most of the countries lacked national policies on interventions that address child injuries; supportive factors such as finance and leadership for injury prevention were also lacking. All countries rated the questionnaire highly on its relevance for assessment of injury prevention policies. Conclusion The A-CHIPP questionnaire is useful for national assessment of child injury policies, and such an assessment could draw attention of stakeholders to policy gaps and progress in child injury prevention in all countries.

166 Epidemiology of burns in rural Bangladesh: an update

Background Burns account for approximately 265,000 deaths each year with predominance in low and middle-income countries. Since most existing estimates of burn mortality and morbidity in Bangladesh have been derived from hospital records or small-scale surveys, the aim of this study was to get prevalence measures for burns and risk factors at a population level in rural Bangladesh. Methods Census household data collected from seven rural sub-districts in Bangladesh was used to assess injury outcomes, including burns, in 2013–2014. Descriptive statistics, and univariate and multivariate analyses were conducted to determine the epidemiological characteristics and risk factors for burn injuries. Results The overall burn mortality and morbidity rates were 2.14 deaths and 528 burn injuries per 100,000 populations. Females had a 63% (95% confidence intervals, CI: 15%–75%) higher chance of burn injuries than men across all age groups, with majority of injuries occurring inside the home. Approximately 50% of burn injuries occurred in the 25–64 year old age group. Deaths occurred mainly by flame burns (88%) where as non-fatal injuries were largely due to contact with hot liquids (56.53%), like cooking oil (21.4%). Deaths were also observed mostly in the winter season. Furthermore, children 1–4 years of age were 4.36 (95% CI: 3.37–5.63) times likelier to suffer from burn injuries than infants keeping all other factors constant. Higher level of education was seen to be associated with lower risk of burn injuries. Conclusions Burns in rural Bangladesh are mainly seen across two extremes of ages in men and women, the propensity being higher in females. Crammed housing spaces, young age and poor educational background were found to be risk factors for burn injuries.