Samuel N. Forjuoh

Epidemiology of transport-related injuries in Ghana.

To better elucidate the incidence, characteristics, and consequences of transport-related injuries in a less developed country in Africa, we undertook an epidemiologic survey in Ghana. A total of 21,105 persons were surveyed, in both an urban area (Kumasi, n = 11,663) and a rural area (Brong-Ahafo, n = 9442). In the preceding year, a total of 656 injuries were reported in the urban area and 928 injuries reported in the rural area. Transport-related mechanisms accounted for 16% of all injuries in the urban and 10% of all injuries in the rural area. The annual incidence of transport-related injuries was almost identical in the two settings, 997/100,000 persons in the urban area and 941/100,000 in the rural area. In both settings, transport-related injuries were more severe than other types of injuries in terms of mortality, length of disability, and economic consequences. In the urban area, the most common transport-related mechanisms were either to passengers involved in crashes of mini-buses or taxis (29%) or to pedestrians struck by these vehicles (21%). In the rural area, the most common transport-related mechanisms were bicycle crashes. The second most common rural mechanisms were motor vehicle crashes, which were the most severe and which involved commercial (83%) rather than private vehicles. Prevention strategies need to be different from those in developed countries and should target commercial drivers more than private road users.

A review of successful transport and home injury interventions to guide developing countries

Injury is recognized as an increasing public health problem in developing countries. Extensive research on injury control has been conducted in the U.S. and other industrialized countries in the past several decades, but research is still in its infancy in developing countries. In this paper, successful interventions for transport and home injuries are reviewed in the context of the developing country setting. The aim is to evaluate injury interventions developed in the industrialized countries and identify those likely to be usable in developing countries. The evaluation criteria used include the efficacy of the interventions, as well as their affordability, feasibility and sustainability. The review demonstrates that while several interventions are available in the field of injury prevention for developing countries to import, caution should be taken in doing this. The use of automobile safety seat belts, bicyclist and motorcyclist helmets, speed limits, laws banning the sale of alcohol at lorry parks, pedestrian crossing signs, adequate roadway lighting, separation of pedestrians from vehicles, conspicuity-enhancement measures, simple safety equipment, and poison prevention packaging should be seriously considered by developing countries to reduce the morbidity and mortality from transport and home injuries. Since injury prevention may often require a blend of several interventions due to the multifactorial nature of the causes of injury, interventions that appear to be most effective are those with multidimensional strategies including education, legislation and environmental modification. This review should serve as a useful guide to injury control efforts in developing countries which must grapple with limited resources and low levels of education.

Child death reviews: a gold mine for injury prevention and control

Objectives—The purpose of this study was to demonstrate how child death review teams can be used to prevent future deaths through retrospective, multiagency case analysis and recommendations for educational programs and policy change. Methods—A listing of all deaths to persons ages 21 years and younger in Philadelphia that occurred in 1995 was compiled by the Philadelphia Interdisciplinary Youth Fatality Review Team (PIYFRT), a multiagency, multidisciplinary, community based group created in 1993 with the mission to prevent future deaths through review, analysis, and initiation of corrective actions. Data were collected on demographic variables, as well as the circumstantial variables on injuries such as weapon type, alcohol and drug use, and contact with the criminal justice system, among others. Each case was reviewed thoroughly to determine whether or not the death was preventable. Selected injury related death cases were analyzed further by demographic and circumstantial variables. Results—In 1995, 607 children ages 21 years and younger died in Philadelphia from natural causes (61.6%), unintentional injuries (16.3%), homicide (18.6%), suicide (2.3%), and undetermined causes (1.2%). More than a third (37.2%) of all deaths were considered preventable. Of the injury deaths (n=224), 95% were judged to be preventable. Preventable fire/burn injury deaths (n=29) were associated with lack of a smoke detector, non-supervision of children, and faulty home appliances. Violent deaths were associated with substance abuse, gang involvement, chronic truancy, academic failure, and access to weapons. Conclusions—Relevant policies for these preventable or intervenable deaths are discussed such as use of non-battery powered smoke detectors.

Risk factors for childhood burns: a case-control study of Ghanaian children.

STUDY OBJECTIVE--To study risk factors for childhood burns in order to identify possible preventive strategies. DESIGN--Case-control design with pair matching of controls to cases in relation to age, sex, and area of residence. The cases and controls were identified by a community based, multisite survey. The effects of host and socioenvironmental variables reported by mothers were investigated in a multivariate analysis using conditional logistic regression. SETTING--A developing country setting the Ashanti Region in Ghana. PARTICIPANTS--These comprised 610 cases aged 0-5 years who had been burned (as evidenced by a visible scar) and 610 controls with no burn history. MAIN RESULTS--The presence of a pre-existing impairment in a child was the strongest risk factor in this population (OR = 6.71; 95% CI 2.78, 16.16). Other significant risk factor included: sibling death from a burn (OR = 4.41; 95% CI 1.16, 16.68); history of burn in a sibling (OR = 1.79; 95% CI 1.24, 2.58); and storage of a flammable substance in the home (OR = 1.51; 95% CI 1.03; 2.21). Maternal education had a protective effect against childhood burns, although this effect was not strong (OR = 0.76; 95% CI 0.55, 1.05). CONCLUSIONS--Community programmes to ensure adequate child supervision and general child wellbeing, particularly for those with impairments, as well as parental education about burns are recommended, to reduce childhood burns in this region of Ghana. The public should bed advised against storing flammable substances in the home.

Injuries in developing countries: policy response needed now

Anthony B. Zwil, Sam Forjuoh2, Shiva Murugusampillay3, Wilson Odero1y4 and Charlotte Wattsly ‘Health Policy Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK; 2Department of Emergency Medicine, Center for Injury Research and Control, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; 3Department of p E zdemiology and Disease Control, Ministry of Health and Child WeFare, Harare, Zimbabwe; 4Department of Community Health, Moi University, Moi, Kenya; sMusasa Project, Harare, Zimbabwe

Injury control in Africa: getting governments to do more

Despite increasing recognition of injury as a major public health problem worldwide, it has received limited attention and resources. This lack of attention is most notable in low‐income countries. As part of efforts to develop coordinated injury control activities in Africa, a round table session was held at the Third International Conference on Injury Prevention and Control in Melbourne, Australia. The aims of the forum were to provide injury control researchers from Africa the opportunity to come together and reflect on issues of injury control in Africa, to deliberate on strategies of getting African governments to show more interest in injury control, and to solicit more assistance from the international donor community. Participants from Ghana, Kenya, South Africa and Zimbabwe presented the magnitude of the injury burden in their respective countries, reflected on current research efforts and highlighted the preventive efforts being undertaken. The forum made many recommendations including several regarding specific actions required of African governments, individual researchers and donor agencies.

Injuries and Health Care Use in Women with Partners in Batterer Intervention Programs

Objective:To characterize injury frequency, injury patterns, and health care seeking behavior in women with intimate partners enrolled in batterer intervention programs. Methods: A standardized telephone interview was conducted on a sample of women with male partners enrolled in batterer intervention programs in four U.S. cities. Information on prior injuries and the utilization of health care services was sought. Results: Four hundred and eighty eight of the 648 women (75.3%) reported a history of prior injury as a result of abuse. Contusions were the most common injury. Of the women reporting contusions, 233 (51.4%) reported contusions as their only injuries. Another 220 women (48.6%) reported other injuries in addition to contusions. In the majority of cases (63.2%) the contusions were to multiple body parts. When the contusion involved only one anatomical region, it was mostly to the face. A total of 192 of the 488 injured women (39.3%) reported ever seeking medical care for injuries caused by their intimate partner. Twenty-three women (4.7% of the injured cohort or 3.5% of the total cohort) reported having ever been hospitalized for injuries sustained from abuse.

Injury control in developing nations: what can we learn from industrialized countries?

In spite of the enormous differences between industralized countries and developing countries regarding their economics, politics, education, and health priorities, as well as their culture, developing countries can learn health care management from the experiences of industrialized countries. Injury control is no exception. After all, why spend time reinventing the wheel? Injury prevention is the study, identification, and implementation of strategies to prevent or reduce the transfer of energy to the human body or to ensure the supply of such essentials as heat or oxygen to the body. The various forms of energy that may injure the human body include mechanical energy, as in a motor vehicle collision or during a fall, thermal energy, as in a scald burn, electrical energy, as in an electrocution, or chemical energy, as in some forms of poisoning. The human body may also be denied heat during hypothermia, and oxygen during drowning or near drowning. The same public health approach used to successfully eliminate smallpox in both industrialized countries and developing countries has already been applied to injury control in the industrialized world with some success. Much ofwhat we currently know about injury control has been made possible by the pioneering works of several individuals, including Hugh de Haven, Edward Press, John Gordon, James Gibson, and William Haddon Jrall ofwhom worked in industrialized countries,`5 Hugh de Haven paved the way for our understanding of the importance of injury thresholds in the biomechanical energy exchanges,l while Press was the first to propose the epidemiologic approach to injury control.2 Together Gordon and Gibson defined the agent of injury,34 and Haddon is credited with the development of the structured framework for modern injury prevention.56 All these scientific contributions have led to the current understanding of the model of injury causation and the methods for intervention in industrialized countries. Although no injury type has yet been eradicated, the incidence of many has been reduced drastically. For example, a 50 0 reduction was observed for childhood falls from windows after an intervention program in New York City.7 With the present trend, near elimination ofmany injury types is attainable in the industrialized world. Developing countries are now hanging between the stages of epidemiologic polarization and protracted epidemiologic transition. This means that they have the onerous task of tackling the problem of injuries on top of the longstanding problems of infections, malnutrition, and other serious emerging health problems like HIV/AIDS, diabetes, and hypertension. Thus, in spite of the recent recognition of the importance of injury control by several developing countries, other competing health problems do not permit many developing countries to have the time, take the time, and spend the time and resources to adequately deal with this other major public health problem. The problem is further compounded by the fact that injuries are still viewed in many developing countries as random, haphazard events, or even as acts of God. However, in any way one looks at it, the injury problems from unintentional causes seen in many developing countries are an exact mirror image of those seen in industrialized countries. The exchanges of energy that cause injuries be they mechanical, thermal, electrical, or chemical are the same in industrialized countries as in developing countries. Injuries from motor vehicle collision, falls, burns, and poisonings comprise the bulk of unintentional injuries in developing countries8 just as in industrialized countries.9 Intentional injuries, however, vary slightly due to the prevalence of specific consumer products that are utilized as vectors of the injury causation. For example, firearm related injuries are much more prevalent in the United States partly due to the fact that half of all homes contain a firearm. 10 The science of injury control has been expanded to encompass the totality of health including prevention, promotion, timely treatment, and rehabilitation. For example, injury prevention and promotion campaigns include education of the public about behaviors on how to avoid certain injuries. Public encouragement on the use of safety belts in automobiles and installation and proper placement of smoke detectors on all habitable floors of residential dwellings are but two examples of the myriad of injury prevention drives. The combination of poor resources, lack of personnel, and high illiteracy rates in developing countries dictates that they learn injury control from industralized countries. This learning process should involve the epidemiology, mechanisms, and the patterns of injury in different segments of the population. For instance, the epidemiology of childhood injuries has been found to be characterized by a different set of factors due to the fact that the Department of Emergency Medicine, Center for Injury Research and Control, University of Pittsburgh, 230 McKee Place, Suite 400, Pittsburgh, PA 15213, USA

Correlates of injury to women with partners enrolled in batterer treatment programs.

OBJECTIVESnThis study examined correlates of injury in a cohort of women who were partners of men enrolled in batterer treatment programs.nnnMETHODSnCross-sectional data of 670 pairs of battered women and their partners were analyzed. Prevalence rates of womens self-reports of injury due to their partners abusive behavior were computed and compared by couples demographic and behavioral characteristics.nnnRESULTSnMens use of severe tactics of abuse was the characteristic most significantly associated with injury (odds ratio = 15.47; 95% confidence interval = 9.02, 26.55).nnnCONCLUSIONSnOur findings underscore the need to obtain information on the specific tactics used by couples to settle their disputes during universal screening by practitioners.

The mechanisms, intensity of treatment, and outcomes of hospitalized burns : Issues for prevention

The mechanisms, intensity of treatment, and outcomes of fire and burn injuries that result in hospitalizations were investigated to assist in ongoing prevention efforts. All hospital discharge records with a fire or burn diagnosis were extracted from the 1994 Pennsylvania statewide hospital discharge data. Cases were categorized into 4 specific burn mechanisms: conflagrations, controlled fires, clothing ignition, and hot substances and scalds. A total of 3173 cases were reported for a rate of 26.3 per 100,000 people. Hot substances and scalds were the most common mechanism (58%) of fire and burn hospitalizations. While most injuries resulting from clothing ignition, conflagrations, and hot substances and scalds were reported as unintentional, 25% of the cases resulting from controlled fires were reported as self-inflicted. The mean hospital charge per hospitalization day (which reflected the intensity of burn treatment) was 2783 but varied significantly by mechanism (P < .001):