Shirin Wadhwaniya

Saving of Children’s Lives from Drowning Project in Bangladesh

Although childhood deaths from communicable diseases have declined during the last decade, the proportion of deaths resulting from injuries has increased steadily during the same period across the world. Drowning is the second leading cause of injury-related deaths among children worldwide. It accounted for approximately 359,000 deaths in 2011, of which 18% occurred in children between the ages of 1 and 4 years. Thirty-seven percent of the drowning deaths in this age range occur in South Asia region alone,3 comprising six countries, including Afghanistan, Bangladesh, Bhutan, India, Nepal, and Pakistan. Language: en

Pre-Travel Consultation Without Injury Prevention Is Incomplete

International travel is fast growing. In 2011, 982 million international tourists traveled around the world to visit friends and relatives, for business, leisure, or other purposes.1 While Europe (51%) continues to be a popular tourist destination attracting about half a billion people, Asia and the Pacific (22%) are also gaining popularity.1 In 2011, 217 million people traveled to Asia‐Pacific and 50 million people traveled to the African region and these are projected to become leading travel destinations in the near future.1 This means that more than ever before, more people will be traveling to low and middle income countries (LMICs) of the world. Over the years, as travel patterns and destinations are changing, travel medicine is attempting to keep pace to reduce risk of diseases and adverse health events and to make travel a healthy and enjoyable experience. With increasing availability of immunizations and prophylactic treatments, a change in morbidity and mortality patterns has been observed among global travelers. Infectious diseases now account for a very small proportion of reported deaths (<2%) among travelers.2 Travelers however are now 10 times more likely to die from injuries than from infectious diseases, which presents a relatively new challenge for travel medicine.2 Several studies have examined the causes of mortality among travelers and in these studies injuries were found to be a leading cause of preventable deaths; and the most common cause of injury deaths was road traffic injuries (RTIs).3–7 RTI was also the major reason to transfer US citizens out of a country after non‐fatal injuries.2 Other causes of injury deaths among travelers include homicide, drowning, and suicide.2,4–7 In 2010, RTIs ranked as the 8th leading cause of death in the world, and in the last decade moved up … Corresponding author: Prof. Adnan A. Hyder, MD, MPH, PhD, Johns Hopkins International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Suite E‐8132, Baltimore, MD 21205, USA. E‐mail: ahyder{at}jhsph.edu

Qualitative study to explore stakeholder perceptions related to road safety in Hyderabad, India

The Bloomberg Philanthropies Global Road Safety Programme in India focuses on reduction of drink driving and increase in helmet usage in the city of Hyderabad. During the early stages of implementation, perceptions of stakeholders on road safety were explored as part of the monitoring and evaluation process for a better understanding of areas for improving road safety in Hyderabad. Fifteen in-depth interviews with government officials, subject experts, and road traffic injury victims, and four focus group discussions with trauma surgeons, medical interns, nurses, and taxi drivers were conducted, analysed manually, and presented as themes. Respondents found Hyderabad unsafe for road-users. Factors such as inadequate traffic laws, gaps in enforcement, lack of awareness, lack of political will, poor road engineering, and high-risk road users were identified as threats to road safety. The responsibility for road safety was assigned to both individual road-users and the government, with the former bearing the responsibility for safe traffic behaviour, and the latter for infrastructure provision and enforcement of regulations. The establishment of a lead agency to co-ordinate awareness generation, better road engineering, and stricter enforcement of traffic laws with economic and non-economic penalties for suboptimal traffic behaviour, could facilitate improved road safety in Hyderabad.

Characteristics associated with alcohol consumption among emergency department patients presenting with road traffic injuries in Hyderabad, India

INTRODUCTION Each year in India, road traffic crashes lead to more than 200,000 deaths and the country has seen an unprecedented rate of roadway fatalities in recent years. At the same time, alcohol consumption per capita among Indians is rising. Despite these increasing trends of road traffic injuries (RTIs) and alcohol use, alcohol is not routinely assessed as a risk factor for RTIs. This study aims to examine the involvement of alcohol among emergency department patients presenting with RTIs in the Indian city of Hyderabad. PATIENTS AND METHODS As part of a prospective study, data were collected from 3366 patients (88.0% male) presenting with RTIs at an emergency department in Hyderabad, India, from September 2013 to February 2014. Logistic regression models were used to assess individual-level and road traffic crash characteristics associated with suspected or reported alcohol consumption six hours prior to the RTI. RESULTS Alcohol was suspected or reported among 17.9% of the patients with RTIs. Adjusting for confounders, males experienced 9.8 times greater odds of alcohol-related RTIs than females. Compared to 15-24 year-olds, the odds of alcohol consumption was 1.4 times greater among 25-34 year-olds and 1.7 times greater among 35-44 year-olds, adjusting for confounding factors. Patients who were passengers in vehicles other than motorized two-wheelers had 90% reduced odds of an alcohol-related RTI than motorized two-wheeler drivers. Drivers of non-two-wheelers, passengers on two-wheelers, and pedestrians did not have significantly different odds of an alcohol-related RTI compared to two-wheeler drivers. Nighttime crashes were associated with nearly a threefold increase in the odds of alcohol consumption. CONCLUSIONS Given that alcohol was suspected or reported in more than one in six injured ED patients with RTIs, it is clear that alcohol is a serious risk factor for RTIs; this evidence can guide prevention efforts. These findings suggest that evidence-based interventions to reduce drink-driving, such as random breath testing (where law enforcement officials stop drivers on the road to test them for alcohol use), could be more widespread in India. Future studies should assess the effectiveness of greater implementation and enforcement of policies to decrease alcohols availability to reduce RTIs.

The validity of self-reported helmet use among motorcyclists in India

Background: Motorcyclists are the most vulnerable vehicle users in India. No published study has assessed the validity of self-reported estimates of helmet use in India. The objectives of this study were to assess helmet use by comparing observed and self-reported use and to identify factors influencing use among motorcyclists in Hyderabad, India. Methods: Population-based observations were recorded for 68 229 motorcyclists and 21 777 pillion riders (co-passengers). Concurrent roadside observations and interviews were conducted with 606 motorcyclists, who were asked whether they “always wear a helmet”. Multivariate logistic regression analyses were conducted to determine factors influencing helmet use. Results: In the population-based study, 22.6% (n = 15,426) of motorcyclists and 1.1% (n = 240) of pillion riders (co-passengers) were observed wearing helmets. In roadside interviews, 64.7% (n = 392) of the respondents reported always wearing a helmet, 2.2 times higher than the observed helmet use (29.4%, n = 178) in the same group. Compared with riders aged ≥40 years, riders in the age groups 30–39 years and 18–29 years had respectively 40% (95% confidence interval [CI]: 0.4 to 1.0, P < 0.05) and 70% (95% CI: 0.2 to 0.5, P < 0.001) lower odds of wearing a helmet after controlling for other covariates. Riders with postgraduate or higher education had higher odds of wearing a helmet (adjusted odds ratio [OR]: 4.1, 95% CI: 2.5 to 6.9, P < 0.001) than those with fewer than 12 grades of schooling. After adjusting for other covariates, younger riders also had 40% (95% CI: 0.3 to 0.9, P< 0.05) lower odds of self-reporting helmet use, while those with postgraduate or higher education had 2.1 times higher odds (95% CI: 1.3 to 3.3, P < 0.01) of reporting that they always wear a helmet. Police had stopped only 2.3% of respondents to check helmet use in the three months prior to the interview. Conclusion: Observed helmet use is low in Hyderabad, yet a larger proportion of motorcyclists claim to always wear a helmet, which suggests that observational studies can provide more valid estimates of helmet use. Interview findings suggest that a combination of increased enforcement, targeted social marketing and increased supply of standard helmets could be a strategy to increase helmet use in Hyderabad.

E-mentoring for violence and injury prevention: Early lessons from a global programme

To address the growing burden of violence and injuries, especially in low- and middle-income countries, in 2007 the World Health Organization launched MENTOR-VIP, a global violence and injury prevention (VIP)-mentoring programme. The programme aims to develop human resource capacity through 12-month mentoring arrangements between individual VIP experts (mentors) and less-experienced injury practitioners (mentees). In this paper, we review the first five years of the programme (2007–2011) using a systems analysis and SWOT (Strengths, Weaknesses, Opportunities and Threats) frameworks, discuss programme findings and make recommendations. A well-defined programme with clear instructions, successful matching of mentorship pairs with similar interests and language, a formal accord agreement, institutional support and effective communication were identified as programme strengths. Overambitious projects, lack of funds and difficulties with communications were identified as programme weaknesses. Mentorship projects that require institutional permissions or resources could be potential threats to the success of mentorship. The study resulted in the four following recommendations to strengthen the programme: (1) institute additional steps in selection and matching mentor-mentee pair; (2) train mentors on e-mentoring; (3) conduct special orientation for mentees to the programme; and (4) maintain effective and open communication throughout the programme.

Pattern of fall injuries in Pakistan: the Pakistan National Emergency Department Surveillance (Pak-NEDS) study.

BackgroundWe aimed to analyse the frequency and patterns of fall-related injuries presenting to the emergency departments (EDs) across Pakistan.MethodsPakistan National Emergency Departments surveillance system collected data from November 2010 to March 2011 on a 24/7 basis using a standardized tool in seven major EDs (five public and two private hospitals) in six major cities of Pakistan. For all patients presenting with fall-related injuries, we analysed data by intent with focus on unintentional falls. Simple frequencies were run for basic patient demographics, mechanism of falls, outcomes of fall injuries, mode of arrival to ED, investigations, and procedures with outcomes.ResultsThere were 3335 fall-related injuries. In cases where intent was available, two-thirds (n = 1186, 65.3%) of fall injuries were unintentional. Among unintentional fall patients presenting to EDs, the majority (76.9%) were males and between 15-44 years of age (69%). The majority of the unintentional falls (n = 671, 56.6%) were due to slipping, followed by fall from height (n = 338, 28.5%). About two-thirds (n = 675, 66.6%) of fall injuries involved extremities, followed by head/neck (n = 257, 25.4%) and face (n = 99, 9.8%). Most of the patients were discharged from the hospital (n = 1059, 89.3%). There were 17 (1.3%) deaths among unintentional fall cases.ConclusionFalls are an important cause of injury-related visits to EDs in Pakistan. Most of the fall injury patients were men and in a productive age group. Fall injuries pose a burden on the healthcare system, especially emergency services, and future studies should therefore focus on safety measures at home and in workplaces to reduce this burden.

The Burden of Suicide in Rural Bangladesh: Magnitude and Risk Factors

The aim of the paper is to quantify the burden and risk factors of fatal and non-fatal suicidal behaviors in rural Bangladesh. A census was carried out in seven sub-districts encompassing 1.16 million people. Face-to-face interviews were conducted at the household level. Descriptive analyses were done to quantify the burden and Poisson regression was run to determine on risk factors. The estimated rates of fatal and non-fatal suicide were 3.29 and 9.86 per 100,000 person years (PY) observed, respectively. The risk of suicide was significantly higher by 6.31 times among 15–17 and 4.04 times among 18–24 olds compared to 25–64 years old. Married adolescents were 22 times more likely to commit suicide compared to never-married people. Compared to Chandpur/Comilla district, the risk of suicide was significantly higher in Narshingdi. Students had significantly lower risk of non-fatal suicidal behavior compared to skilled laborers. The risk of non-fatal suicidal behavior was lower in Sherpur compared to Chandpur/Comilla. Among adolescents, unskilled laborers were 16 times more likely to attempt suicide than students. The common methods for fatal and non-fatal suicidal behaviors were hanging and poisoning. Suicide is a major public health problem in Bangladesh that needs to be addressed with targeted interventions.

Understanding Cross-Cultural Requirements in mHealth Design: Findings of a Usability Study of Indian Health Professionals

Mobile health (m-health) applications are an increasingly important, cost-effective solution for recording, managing, and disseminating medical information. However, m-health applications designed without feedback from the intended user community may create significant usability challenges. A critical factor in the success of m-health applications rests on the design of user-friendly, cross-cultural interfaces to enable the usability, accessibility, perception, and acceptance of m-health applications. This is particularly true in international markets, where stakeholders may be from a variety of cultural and linguistic backgrounds. To assuage this point, this chapter presents the results of an initial usability study conducted over 6 months of eight Indian public health professionals’ user preferences in their interactions with an m-health application developed in the United States. Specifically, we use a qualitative analysis approach as a requirements analysis tool to identify cross-cultural factors that might influence usability, accessibility, and interaction challenges and affect m-health acceptance. Results indicate that technology familiarity, navigation, language, feedback mechanisms, cognitive overload, and background preferences are the key factors affecting performance and, ultimately, user acceptance.

Epidemiology of road traffic injury patients presenting to a tertiary hospital in Hyderabad, India

Background. Road traffic injuries kill more people in India than in any other country in the world, and these numbers are rising with increasing population density and motorization. Official statistics regarding road traffic injuries are likely subject to underreporting. This study presents results of a surveillance program based at a public tertiary hospital in Hyderabad, India. Methods. All consenting patients who presented to the casualty ward after a road traffic injury over a 9‐month period were enrolled. Interviews were performed and data abstracted from clinical records by trained research assistants. Data included demographics, injury characteristics, risk factors, safety behaviors, and outcomes. Results. A total of 5,298 patients were enrolled; their mean age was 32.4 years (standard deviation 13.8) and 87.3% were men; 58.2% of patients were injured while riding a motorcycle or scooter, 22.5% were pedestrians, and 9.2% used motorized rickshaws. The most frequent collision type was skid or rollover (40.9%). Male victims were younger than female victims and were overrepresented among motorized 2‐wheeler users. Patients were most frequently injured from 1600 to 2400. A total of 27.3% of patients were admitted. Hospital mortality was 5.3%, and 48.2% of deaths were among motorized 2‐wheeler users. Conclusion. This is one of the few prospective, hospital‐based studies of road traffic injury epidemiology in India. The patient population in this study was similar to prior hospital‐based studies. When compared to government surveillance systems, this study showed motorized 2‐wheeler users to be more frequently represented among the overall population and among fatalities. Further research should be done to develop interventions to decrease mortality associated with 2‐wheeled vehicles in India.