Distribution and circumstances of injuries in squatter settlements of Karachi, Pakistan

Clean environment index: A new approach for litter assessment

Littered waste is one of the ubiquitous problems in urban environments. In this study, urban environmental pollution was evaluated for the first time using a new developed index. The findings indicated that cigarette butts with an average 58% are the largest share in the composition of littered waste. In addition, the numbers of littered wastes throughout the study area had a spatial variation. According to clean environment index (CEI), the entire study area was found to be in a moderate status. However, 40% of the study areas were classified in a dirty and extremely dirty status. Comparison of the studied urban land-uses showed that residential land use with CEI equal to 3.38 is interpreted in the clean status, while commercial land use with CEI equal to 15.05 can be classified in the dirty status. The application of CEI has a good capability to assess littered waste; this index can be employed to evaluate the pollution of urban sidewalks and other environments such as beaches.

Unintentional injuries among children aged 1-5 years: understanding the burden, risk factors and severity in urban slums of southern India

Background

Globally, 5.82 million deaths occurred among children under the age of five years in 2015 and injury specific mortality rate was 73 per 100,000 population. In India, injury specific mortality rate is around 2.1 per 1000 live births contributing to 4% of the total under 5 mortality rate. This study aims to estimate the burden and understand factors associated with unintentional injuries among children aged 1–5 years residing in urban slums of Vellore, southern India. We also attempted to assess the hazards posed by the living environment of these children and study their association with unintentional injury patterns.

Methods

This cross-sectional study was conducted in eight urban slums of Vellore, southern India and primary caregivers of children aged 1–5 years were interviewed with a questionnaire to obtain the details of injuries sustained in the past three months. Environmental hazard risk assessment was conducted at places frequented by these children and their scores calculated. Baseline prevalence and incidence rates of unintentional injuries were estimated. Multivariate logistic regression and poisson regression analysis were performed to examine factors associated with unintentional injuries and repeated injuries respectively. Association between environmental hazard risk and unintentional injuries was estimated.

Results

Prevalence of unintentional injuries was 39.1% (95% CI 35.4–42.9%) and incidence rate was 16.5 (95% CI 14.7–18.3) per 100 child months (N = 662). Bivariate analysis revealed that children of working mothers (OR 1.48; 1.01–2.18) and children from overcrowded families (OR 1.78; 1.22–2.60) had increased odds of sustaining unintentional injuries. Multivariate regression analysis revealed that children from overcrowded families had increased odds of sustaining unintentional injuries (AOR 1.66, 95% CI 1.14–2.41). Boys (IRR 1.33, 95% CI 1.07–1.66) and children from overcrowded families (IRR 1.50; 1.14–1.98) were at increased risk of having repeated injuries. There is an increase in incidence rate of injuries with an increased environmental hazard risk, although not statistically significant.

Conclusions

The burden of unintentional injuries was very high among study children when compared to studies in other urban slums in India. Environment plays an important role in the epidemiology of unintentional injuries; providing safe play environment and adequate supervision of children is important to reduce its burden.

Electronic supplementary material

The online version of this article (10.1186/s40621-018-0170-y) contains supplementary material, which is available to authorized users.

Uncovering the burden of intentional injuries among children and adolescents in the emergency department

Introduction

In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.

Methods

The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional injuries and compares patient demographics, nature of injury, and discharge outcome for two categories of intentional injuries: assault and self-inflicted injuries.

Results

Intentional injuries presenting to the emergency departments (EDs) accounted for 8.2% (2551/30,937) amongst all other causes for under 18 years. The boy to girl ratio was 1:0.35. Intentional injuries included assault (n = 1679, 65.8%) and self-inflicted injuries (n = 872, 34.2%). Soft tissue injuries were most commonly seen in assault injuries in boys and girls but fractures were more common in self-inflicted injuries in both genders.

Conclusion

Intentional injury is one of the reasons for seeking emergency treatment amongst children and a contributor to morbidity in EDs of Pakistan. Moreover, such injuries may be underestimated due to lack of reporting and investigative resources. Early identification may be the first step leading to prevention.

What is left behind when the lights go off? Comparing the abundance and composition of litter in urban areas with different intensity of nightlife use in Mar del Plata, Argentina

Nightlife activities represents an important source of urban litter; the latter often being left behind or abandoned in public places and streets. Mar del Plata is a very important city on the Atlantic coast of Argentina and is the main tourism destination in the South Atlantic region of South America. However, few studies on urban litter related to nightlife activities have been conducted in the area. Here we assessed (i) the abundance and composition of litter, and (ii) the spatial and temporal variations of its abundance, diversity, richness and evenness in urbanized areas with different intensity of nightlife activities from April 2008 to March 2009. An overall of 13,503 items were counted. Around 92% of the total litter was comprised by cigarette butts, papers and plastics. We found significant spatial differences in the abundance of litter between sampling sites, with the greatest amounts of litter at the Alem site followed by the Hipólito site (both with an intensive nightlife activity) compared with the Chauvin site (a quiet high-income neighborhood). The composition of litter of the Alem and the Hipólito sites was relatively similar and both sites differ with respect to the Chauvin site. Cigarette butts, papers, and plastics were the items that contributed most to the dissimilarity between sampling sites. The diversity of litter was the single community parameter that significantly differed from the other seasons. We discussed the potential effect of nightlife activities on the amounts and quality of urban litter in the city of Mar del Plata.

Epidemiology of injuries in metropolitan Tehran, Iran: a household survey

A household survey was conducted to determine the epidemiological characteristics of injuries among people living in Tehran, the mega capital of Iran. Using cluster random sampling in April 2007, survey was conducted seeking information about injuries occurred within families in past Persian year. All injury patterns and causes were classified according to ICD-10 and analysed using SPSS version 16. Out of 9173 household participants, 765 ones (8.3%) had injuries during the past Persian year, frequently open wounds and burns with a male to female ratio of 0.54 : 1. They occurred mostly due to 'exposure to the inanimate mechanical forces', followed by 'contact with heat or hot substances' and 'falls'. The common locations were home, and then streets. Approximately 15% of injuries required medical attention and the incidence rate was 175.5 per 10,000 person-year with male to female ratio of 2.37 : 1. They were frequently fractures and open wounds and mostly associated with falls and transport accidents that had been transpired on streets or at workplace. This study evidences the high rate of injuries in Tehran city and prevention priorities should be given to traffic and home injuries.

Spatial and temporal variations of urban litter in Mar del Plata, the major coastal city of Argentina

Urban littering is considered an important environmental and public issue globally. This problem is growing considerably within coastal communities of the southern region of South America. The goals of this study were to assess (1) the abundance and composition of urban litter; (2) the spatial and temporal variations of its abundance; and (3) the relationship between the abundance of litter and three anthropogenic variables (i.e. abundance of pedestrians, of parked vehicles, and of trash bins) in Mar del Plata, the most populated coastal city in Argentina. Eighty-eight transects, each covering 1425 m(2), were sampled along four sites from April 2008 to March 2009. Results showed 20,336 items (ca. 14 items per m(2)) of which cigarette butts (33%), papers (31%), and plastics (22%) were the most commonly littered items. Higher amounts of litter were found in an industrial area (city's harbor), while the abundance of litter appeared relatively even throughout the year. Redundancy analysis techniques indicated a high abundance of all three anthropogenic variables associated with the central business district area of the city and an area in close proximity to a major seaside resort, where cigarette butts and papers dominated. This is the first study that has examined spatial and temporal variations of urban litter in a high-density coastal city in Argentina. Our results showed that addressing the problems associated with urban litter must include intensive educational and advertising campaigns directed at pedestrians and owners of parked vehicles, but waste reduction, clean-up operations and law enforcement should be also considered.

Playground injuries in children

Background

Rapid urbanization and unplanned population development can be detrimental to the safety of citizens, with children being a particularly vulnerable social group. In this review, we assess childhood playground injuries and suggest safety mechanisms which could be incorporated into playground planning.

Methods

Inclusion criteria were “children” as the focus group, “playground” as the main field of study, and “unintentional injury” and “safety” as the concepts of study. The keywords used for the PubMed search were “playground”, “children”, and “injury”. Initially we 182 articles. After screening according to inclusion criteria, 86 articles were found, and after reading the abstracts and then the full text, 14 articles were finally included for analysis. The papers reviewed included four case-control studies, three case studies, three descriptive studies, two interventional studies, one retrospective study, one cross-sectional study, and one systematic review.

Results

Playground-related fractures were the most common accidents among children, underscoring the importance of safety promotion and injury prevention in playgrounds, lowrisk equipment and playing hours (week days associated with higher risk), implementation of standards, preventing falls and fall-related fractures, and addressing concerns of parents about unsafe neighborhoods. With the exception of one study, all of the reviewed papers had not implemented any practical safety plan. Safe engineering approaches were also ignored.

Conclusion

We recommend a systematic safety approach based on the “safety circle” which includes three main areas, ie, equipment, environment, and children.

Epidemiology of burn injuries in the East Mediterranean Region: a systematic review

BACKGROUND

Burn injuries remain one of the leading causes of injury morbidity and mortality in the World Health Organization's East Mediterranean Region. To provide an overview on the epidemiology of burn injuries in this region, a systematic review was undertaken.

METHODS

Medline, Embase and CINAHL were searched for publications on burns in this region published between 01/01/1997 and 16/4/2007. Data were extracted to a standard spreadsheet and synthesised using a narrative synthesis. No attempt has been made to quantitatively synthesise the data due to the large degree of clinical heterogeneity between study populations.

RESULTS

Seventy one studies were included in the review, from 12 countries. Burn injuries were found to be one of the leading causes of injury morbidity and mortality. The reported incidence of burns ranged from 112 to 518 per 100,000 per year. Burn victims were more frequently young and approximately one third of the victims were children aged 0-5 years. Hospital mortality ranged from 5 to 37%, but was commonly above 20%. Intentional self-harm burns particularly involving women were common in some countries of the region and were associated with a very high mortality of up to 79%.

CONCLUSION

Burn injuries remain an important public health issue in the East Mediterranean Region therefore further research is required to investigate the problem and assess the effectiveness of intervention programmes.

Child injury in a changing world

The importance of child injuries has now been recognised as a significant public health problem internationally. The World Health Organisation (WHO) and United Nations Children's Fund (UNICEF) have recently published the first world report on child injury prevention. As infectious diseases decline, the relative importance of injury has increased, but the pace of change of global processes means that absolute increases in injury may occur over the next 20-30 years. This paper examines child injury in a changing world by outlining the ways in which the forces of globalisation, urbanisation, motorisation and environmental change could have an impact on injury epidemiology and policy. We consider how those in public health and those in the injury field should respond to the changing world of injury. Child injury prevention needs to be incorporated into planning for the rapidly changing urban environments of low-income countries and strategies devised for the large numbers of people displaced by environmental change.

Incidence and pattern of unintentional injuries and resulting disability among children under 5 years of age: results of the National Health Survey of Pakistan

National estimates of injuries for children under 5 years based on population representative surveys are not readily available globally and have not been reported for developing countries. This study estimated the annual incidence, pattern and distribution of unintentional injuries according to age, gender, socio-economic status, urban/rural residence and disability caused among children aged under 5 years in Pakistan. The National Health Survey of Pakistan (NHSP 1990-94) is a nationally representative survey of households to assess the health profile of the country. A two-stage stratified design was used to select 3223 children under 5 years of age for interview and examination. Data were used for boys and girls in urban and rural areas over the preceding year. A community development index was developed to assess the relationship between socio-economic status and injuries. Weighted estimates were computed adjusting for complex survey design using surveyfreq and surveylogistic option of SAS 9.1 software. Post hoc power calculations were made for each variable keeping the design effect at 3.0. The overall annual incidence of unintentional injuries was 47.8 [95% CI 36.6, 59.0] per 1000 per year; 50.2 [95% CI 37.0, 63.4] and 45.2 [95% CI 29.4, 61.0] per 1000 per year among boys and girls under 5 years of age respectively. An estimated 1.1 million unintentional injuries occur in Pakistan annually among these children. Injury rates increase with age among the under-5s. Urban and rural injuries were 56.1 [95% CI 33.5, 78.7] and 44.1 [95% CI 31.1, 57.1] per 1000 per year respectively. The children living in least developed communities had almost 3 times higher risks of injuries than most developed communities. The annual incidence of types of injuries were: falls 28.7 [95% CI 19.5, 37.9], cuts/bruises 9.7 [95% CI 5.3, 14.1] and burns 6.6 [95% CI 3.0, 10.2] per 1000 per year. Falls were the most common type of injury (60%) followed by cuts/bruises (21%) and burns (14%). The majority of injuries occur at home (85%), with just 10% due to road traffic. Road traffic injuries and injuries to the female child were more likely to result in disability. There is a high burden of unintentional injuries and disability among children under 5 in Pakistan. These results are useful for planning further research and for prioritising prevention programmes nationally and in other developing countries with similar situation.

Injury prevention and the attainment of child and adolescent health

Urgent attention is required to tackle the problem of child and adolescent injury across the world. There have been considerable shifts in the epidemiological patterns of child deaths; while great progress has been made in preventing infectious diseases, the exposure of children and adolescents to the risks of injury appear to be increasing and will continue to do so in the future. The issue of injuries is too often absent from child and adolescent health agendas. In December 2008, WHO and the United Nations Children's Fund published the World report on child injury prevention, calling global attention to the problem of child injuries. This article expands on the report's arguments that child injuries must be integrated into child health initiatives and proposes initial steps for achieving this integration.

Children's perceptions and behavior with respect to glass littering in developing countries: a case study in Palestine's Nablus district

The aims of this study were to assess the current situation regarding glass litter on the streets and children's attitudes, and behavior concerning glass litter. Out of 240 interviewed children, 41.7% admitted glass littering. This was reflected in the high incidence of injuries caused by street glass among children; 140 (58.3%) of the children interviewed had been injured by broken glass at least once while walking outdoors and 95 of the children had received professional medical care for the lacerations. As reported by the children who admitted to glass littering, the most effective elements (29.6%) in preventing them from littering the streets with glass were moral and religious convictions, and the next most effective practice (20.4%) was improved street cleanliness. Preventive measures such as encouraging moral and religious convictions among children, more effective street cleaning by local authorities, improved footwear, education, and glass recycling incentives, as well as engaging the community in street cleaning campaigns, are all needed to address this public health hazard. More recreational facilities should be provided. Public awareness initiatives led by environmentalists, social workers, primary health care providers or home healthcare providers may also help educate children to wear shoes, prevent glass injuries and increase glass litter awareness.

Incidence, patterns and severity of reported unintentional injuries in Pakistan for persons five years and older: results of the National Health Survey of Pakistan 1990-94

BACKGROUND

National level estimates of injuries are not readily available for developing countries. This study estimated the annual incidence, patterns and severity of unintentional injuries among persons over five years of age in Pakistan.

METHODS

National Health Survey of Pakistan (NHSP 1990-94) is a nationally representative survey of the household. Through a two-stage stratified design, 18, 315 persons over 5 years of age were interviewed to estimate the overall annual incidence, patterns and severity of unintentional injuries for males and females in urban and rural areas over the preceding one year. Weighted estimates were computed adjusting for complex survey design using surveyfreq and surveylogistic option of SAS 9.1 software.

RESULTS

The overall annual incidence of all unintentional injuries was 45.9 (CI: 39.3-52.5) per 1000 per year; 59.2 (CI: 49.2-69.2) and 33.2 (CI: 27.0-39.4) per 1000 per year among males and females over five years of age, respectively. An estimated 6.16 million unintentional injuries occur in Pakistan annually among persons over five years of age. Urban and rural injuries were 55.9 (95% CI: 48.1-63.7) and 41.2 (95% CI: 32.2-50.0) per 1000 per year, respectively. The annual incidence of injuries due to falls were 22.2 (95% CI: 18.0-26.4), poisoning 3.3 (95%CI: 0.5-6.1) and burn was 1.5 (95%CI: 0.9-2.1) per 1000 per year. The majority of injuries occurred at home 19.2 (95%CI: 16.0-22.4) or on the roads 17.0 (95%CI: 13.8-20.2). Road traffic/street, school and urban injuries were more likely to result in handicap.

CONCLUSION

There is high burden of unintentional injuries among persons over five years of age in Pakistan. These results are useful to plan further studies and prioritizing prevention programs on injuries nationally and other developing countries with similar situation.