Puspa Raj Pant

Public Health, Prevention and Health Promotion in Post-Earthquake Nepal

Situated on the meeting point of the Indian sub-continent and mainland Asia, Nepal is very much an earthquake-prone country. Eight centuries ago the first recorded earthquake killed one-third of people living in Kathmandu Valley in 1255 and the country has suffered major earthquakes regularly since. The recent two major earthquakes in April and May 2015 resulted in nearly 9,000 deaths and a further 23,300 injuries and these figure continue to rise [2]. This year nearly 594,000 homes were destroyed and another 280,000 damaged , 75% of which were private dwellings [1,3]. Consequently, over 8 million people, including 1.1 million children have been affected by this disaster [3], with14 district of central and western Nepal hit the hardest. In addition, there was widespread physical damage estimated to reach billions of dollars. Repairs are needed to infrastructure (e.g. roads and health posts) and services including public utilities (e.g. water, sewerage, and electricity). Recent damages have often been greatest in the more remote districts hindering relief and repair work locally. Millions of people are now homeless and living in the open, or in overcrowded shelters assembled for internally displaced people (IDP). A number of landslides triggered by rainfall on fragile landscapes have blocked the highways and disrupted transport, with some communities subjected to relocation. The immediate impact of a disaster often requires emergency relief such as shelter, water supply, road networks, and services. However, in Public Health we are trained to think longer-term. The collapse of building providing health services during disasters and that of healthcare systems afterwards can have a prolonged impact on the health and well-being of affected communities. Language: en

Community perceptions of unintentional child injuries in Makwanpur district of Nepal: a qualitative study

BackgroundIn Nepal, childhood unintentional injury is an emerging public health problem but it has not been prioritised on national health agenda. There is lack of literature on community perceptions about child injuries. This study has explored community perceptions about child injuries and how injuries can be prevented.MethodsFocus group discussions were conducted with mothers, school students and community health volunteers from urban and rural parts of Makwanpur district in Nepal. FGDs were conducted in Nepali languages. These were recorded, transcribed and translated into English. A theoretical framework was identified and thematic analysis conducted.ResultsThree focus group discussions, with a total of 27 participants, took place. Participants were able to identify examples of child injuries which took place in their community but these generally related to fatal and severe injuries. Participants identified risk factors such as the child’s age, gender, behaviours and whether they had been supervised. Consequences of injuries such as physical and psychological effects, impact on household budgets and disturbance in household plans were identified. Suggestions were made about culturally appropriate prevention measures, and included; suitable supervision arrangements, separation of hazards and teaching about safety to the parents and children.ConclusionCommunity members in Nepal can provide useful information about childhood injuries and their prevention but this knowledge is not transferred into action. Understanding community perceptions about injuries and their prevention can contribute to the development of preventive interventions in low income settings.

Epidemiology of unintentional child injuries in the Makwanpur District of Nepal: a household survey

Secondary sources of information indicate that the proportion of child deaths due to injuries is increasing in Nepal. This study aimed to describe the epidemiology of unintentional injuries in children, explore risk factors and estimate the burden faced by families and the community in the Makwanpur district. We conducted a household survey in Makwanpur, covering 3441 households. Injuries that occurred during the 12 months before the survey and required treatment or caused the child to be unable to take part in usual activities for three or more days were included. We identified 193 cases of non-fatal unintentional child injuries from 181 households and estimated an annual rate of non-fatal injuries of 24.6/1000 children; rates for boys were double (32.7/1000) that for girls (16.8/1000). The rates were higher among the children of age groups 1–4 years and 5–9 years. Falls were the most common cause of non-fatal child injuries followed by burns in preschool children and road traffic injuries were the most likely cause in adolescence. Mean period of disability following injury was 25 days. The rates and the mechanisms of injury vary by age and gender. Falls and burns are currently the most common mechanisms of injury amongst young children around rural homes.

Epidemiology of unintentional child injuries in the South-East Asia Region: a systematic review

All the 11 members of the South-East Asia Region (SEAR) of the World Health Organization are categorised as low- and middle-income countries. This region has over a quarter of the worlds total population but comprises about one-third of the worlds unintentional injury-related deaths. There is a paucity of good-quality mortality and morbidity data from most of these countries. This is the first systematic review of community-based surveys on child injuries that summarises evidence from child injury studies from the SEAR countries. The included papers reported varying estimates of overall non-fatal unintentional injury rates across the countries, from 15/1000 children in Thailand to as high as 342/1000 children in India. The fatal injury rates were also found to be varying. This review revealed a need for strengthening child injury research using standard methodologies across the region and for promoting the dissemination of the results.

Stipulating citizen's fundamental right to healthcare: Inference from the Constitution of Federal Republic of Nepal 2015

Nepal has a great opportunity to learn from, and collaborate with, non-governmental development partners and private sectors, and from other governments and organizations around the world, but we must move promptly.

Mental health in BME groups with diabetes: an overlooked issue?

A recent commentary in The Lancet emphasised the effect of mental health on diabetes. We would particularly like to highlight the mental health issues of black and minority ethnic (BME) populations with diabetes in the UK, owing to the considerably higher prevalence of diabetes and mental illness among BME populations compared with the national average.

PW 1641 Establishing an injury research centre in nepal; challenges and opportunities

In November 2016 the UK National Institute for Health Research launched a Global Health Research Programme to promote collaboration between UK Universities and countries eligible for receipt of UK Government Overseas Development Aid. The University of the West of England, Bristol, in collaboration with Kathmandu Medical College Nepal, and other organisations including MIRA (Mother and Infant Research Activities) secured three years funding to establish a Nepal Injury Research Centre, commencing July 2017. The aim of the Centre is to build a sustainable research network and infrastructure with the capacity and capability for injury research. We will use a public health approach to provide the evidence for behavioural, environmental and legislative change for the prevention of all types of injury and first response, piloting activities in Makwanpur district of Nepal. The opportunities afforded by this award are significant; to recruit and develop a research workforce capable of future independence, to build a relationship with strategic decision makers that will align the research with national priorities and provide a forum through which evidence can influence policy and legislation. The challenges are significant too; to identify and address evidence gaps within the limited duration of the award, to balance national priorities with other injury issues not currently recognised, to establish a mechanism to monitor injuries that can be used to measure change, and all within a context of marked social and political development. The presentation will describe the strategies we are using to meet the challenges, including working with, and learning from, established units such as the Centre for Injury Prevention Research Bangladesh, and advocating for a National Injury Advisory Committee in Nepal. This model of funding and the strategies taken in Nepal have the potential to influence the development of injury research capability and capacity in other low and middle income countries.

PW 1628 Status of injury prevention research in nepal; a systematic review

Background In 2017 work commenced to establish a Nepal Injury Research Centre. To inform our activities it was necessary to review the evidence arising from existing injury research. Objectives To identify published literature reporting incidence or outcome of injuries sustained in Nepal and explore the quantity of research, types of injuries studied, quality and methodologies used, and the epidemiology reported. Methods A systematic review of observational and experimental studies reporting injury rates or outcomes affecting populations resident in Nepal. Five electronic databases were searched, no language or date restrictions were applied. Case series of less than 10 persons were excluded. Data were extracted on design, methods and results and synthesised narratively. Findings 175 studies were reported in 186 publications, identified from 3263 potentially eligible citations. Most were observational studies, often low in the hierarchy of evidence, with only 2/186 (1.1%) experimental studies. The types of injuries studied did not reflect the burden of injuries as perceived by stakeholders; only 21/186 (11.7%) publications focused on road traffic injuries despite this being a government priority. Most publications, 142/186 (76.3%), were case series, predominantly analyses of admissions to hospitals and likely to underestimate the true burden of injuries. Nationally representative community-based surveys were few but suggested an incidence of fatal injuries of ˜30/100000/yr, and of non-fatal injuries between 24.6–35.5/1000/yr. Conclusions Acknowledging the risk of bias arising from observational data, these studies suggest that for every fatal injury there may be more than 100 non-fatal injuries in Nepal. Further research is needed to understand and prevent injuries causing the greatest burden, such as road traffic injuries. Developing capability in research methods should be a priority. Policy implications The existing evidence is likely to underestimate the true burden of injuries in Nepal and does not enable the development of evidence-based policies and legislation.

Implication of Air pollution on health effects in Nepal: Lessons from global research

The Nepal Health Research Council and recent National Health Policy of Nepal (2014) have included ‘air pollution’ as a priority research/public health agenda that is guaranteed by the Constitution. There is an urgent need to organise the future policies and actions to ensure the commitments to reduce air pollution.

181 Developing educational package on child injury prevention mobilising womens’ groups in rural nepal

Background Non-fatal injuries are many times more common than fatal injuries and may lead to lifelong consequences in children. Lack of child injury surveillance system hinders evidence generation in a low-income setting. Children in rural Nepal are exposed to widespread injury risks and families may have little awareness of how they can be prevented. Community mobilisation may be an effective approach. This study aimed to develop an educational package on child injury prevention and assess the feasibility of delivering it with the involvement of women’s groups. Methods An educational package was developed for Female Community Health Volunteers (FCHVs) that included both primary and secondary prevention materials for unintentional child injuries and was adapted from those developed by CIPRB (Bangladesh). Ten women’s groups across 9 wards in one village development committee (VDC) area were actively engaged in 6 monthly meetings. The sessions were led by FCHV and lasted for 1–2 hours where rigorous discussions were held using the educational materials provided. Structured checklists were used to obtain feedback and to assess the delivery and reach of the programme. Results First-aid training, meeting faciliation guide, parents’ booklet and educational wall posters were the major outputs of this project. Nine FCHVs received first-aid training and kits. FCHVs convened 10 women’s groups to run over 6 months with 25 to 30 mothers attending each session. Each group presented their views on child injury risks and proposed prevention activities at local public meetings. Community members appreciated the project and developed their own interventions to tackle local injury hazards. Conclusions It is feasible to develop and implement a community mobilisation intervention where women’s groups work with FCHVs to prevent injuries in children. The intervention was well received by the women’s groups and by community members.