Fall-related injuries in a low-income setting: Results from a pilot injury surveillance system in Rawalpindi, Pakistan

Estimation of the burden of out-of-hospital traumatic cardiac arrest in Karachi, Pakistan, using a cross-sectional capture-recapture analysis

Background

The burden of trauma-related-out-of-hospital cardiac arrest (OHCA) in developing countries like Pakistan remains largely unexplored due to a lack of organized pre-hospital systems. In order to estimate the burden, we used a two-sample capture-recapture method which has been used in several domains to estimate difficult-to-count populations.

Methods

We obtained 3-month data from two sources: Records of two major EMS (emergency medical services) systems and five major hospitals providing coverage to the city’s population. All adults with traumatic OHCA were included. Information on variables such as name, age, gender, date and time of arrest, cause of arrest, and destination hospital were obtained for these cases and data were compared to obtain a matched sample. Utilizing an equation and different levels of restrictive criteria, estimates were obtained for burden.

Results

The EMS records reported 788 and hospital records reported 344 cases of traumatic OHCA. The capture-recapture analysis estimated the annual traumatic OHCA incidence as 45.7/100,000 (95% CI: 44.2 to 47.3). Estimation of the burden from individual hospital or EMS records underestimated and calculated only 14.6% and 33.9% of the total burden, respectively. Most of the traumatic arrest victims had gunshot wound (GSW) (65.2%) followed by road traffic injuries (RTI) (20.8%).

Conclusion

The actual burden of traumatic OHCA in Pakistan is larger than the burden reported by either the hospitals or EMS services alone. Most of the cases occurred due to GSW and RTI. A multipronged approach is required to manage the problem; from prevention to developing organized trauma care systems and training lay responders in pre-hospital trauma care is vital.

Incidence, Risk and Protective Factors for Unintentional, Nonfatal, Fall-Related Injuries at Home: A Community-Based Household Survey from Ujjain, India

Background

Childhood injury is an increasing public health burden and considered a major cause of childhood morbidity and mortality worldwide. In this study, we identified the distribution and risk factors for fall-related child injuries at home in Ujjain, India.

Methods

A community-based, cross-sectional study was conducted in 2017 in Ujjain, India, which included 6308 children up to 18 years of age living in 2518 households. Data were collected using a pretested, semi-structured, proforma from the parents of the included children.

Results

The overall incidence of home injury was 7.78% (95% confidence interval [CI]: 7.12–8.84) in the last 1 year, ie, 2015–16. The incidence was significantly higher at 5–10 years of age (odds ratio [OR]: 2.91, 95% CI: 1.75–4.85; P < 0.001), followed by 1–5 years (OR: 2.66, 95% CI: 1.59–4.45; P < 0.001). The incidence of injuries was higher in boys than in girls (adjusted odds ratio [aOR]: 1.73, 95% CI: 1.43–2.10; P < 0.001). Other risk factors associated with unintentional fall injuries at home were residence (rural vs urban; aOR: 1.25, 95% CI: 1.03–1.51; P = 0.018), number of family members (≤4 vs 5–10 and ≤4 vs >10; aOR: 0.69, 95% CI: 0.56–0.86; P < 0.001 and aOR: 0.67, CI: 0.48–0.94; P < 0.023, respectively), cooking area (combined vs separate; aOR: 0.82, 95% CI: 0.68–1.00; P = 0.057), and whether mother is alive vs not alive (aOR: 2.09, 95% CI: 1.10–3.94; P = 0.023).

Conclusion

The incidence of fall injuries among children at home in Ujjain, India, was similar to other resource constraint settings. The incidence was higher in rural areas, in the age group of 5–10 years, and in families in which the mother was not alive. By contrast, large and combined families had a lower incidence of falls.