The epidemiology of moderate and severe injuries in a Nicaraguan community: a household-based survey

What Is the Need for and Access to Trauma Surgery in Low- and Middle-Income Countries? A Scoping Review

INTRODUCTION

Trauma is a major source of morbidity and mortality globally, but low- and middle-income countries (LMICs) are disproportionately affected by higher volumes of trauma and worse health outcomes. Despite this, there are limited data describing how many individuals in these regions need trauma surgery, and how many are able to access it.

METHODS

We performed a scoping review to examine the current available evidence on the need for, and access to, trauma surgery in LMICs in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We included studies published after 2000, across all languages, that reported data on LMICs, as defined by the Organization for Economic Cooperation and Development.

RESULTS

We identified 32 articles describing the need for trauma surgery and 24 articles describing the access to trauma surgery, representing 27 LMICs overall. The median rate of trauma need was 7361 individuals per 100,000 per year (IQR 6313-9461), whereas the median rate of trauma surgery was 64.8 procedures per 100,000 per year.

CONCLUSION

Our study suggests that the need for trauma surgery is far greater than the access provided in LMICs. Indeed, the median rate of trauma surgery currently performed in the represented LMICs was 20 times less than the Lancet Commission on Global Surgery's benchmark. This scoping review illustrates the pressing requirement to generate high-quality prospective data to describe trauma care in LMICs.

Causes of nonfatal occupational injury in the private sector in Tunisia

The absence of studies that investigate the causes and risk factors of nonfatal occupational injury in Tunisia inhibits the development of effective preventive strategies. The objective of this study was to identify the causes and risk factors of nonfatal occupational injury in the private sector in Tunisia. We used retrospective data derived from the occupational injury reporting forms submitted to the Caisse Nationale d’Assurance Maladie. A sample of 42,293 workers in the private sector for 2014 contains information on sociodemographic variables. Multivariable Poisson regression was used to investigate the association of cause-specific injury with demographic variables. The leading causes of nonfatal occupational injury were “falls” (employee fall and falling objects; 36%) and “struck by objects” (23%). Male employees were at higher risk of “exposure to extreme temperatures” (PR = 12 [7–45]), “asphyxia and poisoning” (PR = 4 [2.4–12]), “transport and handling” (PR = 2.4 [1.9–5]), “falling objects” (PR = 2.3 [1.4–3.7]), and “employee fall” (PR = 1.2 [1.1–1.5]). Although, rural areas were at higher risk to “asphyxia and poisoning” (PR = 3.6 [1.1–11.4]), “transport and handling” (PR = 2.5 [1.3–5.4]), and “burns” (PR = 1.3 [1.1–3]). It is important that effective interventions be developed to minimize the impact of falls and “struck by objects.” The most vulnerable categories to occupational injury are less educated men, rural residents aged between 15 years and 24 years, and elderly employees (55 years and over). Thus, our findings can contribute to the planning of prevention intervention programs that should expand to the most vulnerable categories.

Universal Health Coverage in Rural Ecuador: A Cross-sectional Study of Perceived Emergencies

INTRODUCTION

In many low- and middle-income countries emergency care is provided anywhere in the health system; however, no studies to date have looked at which providers are chosen by patients with perceived emergencies. Ecuador has universal health coverage that includes emergency care. However, earlier research indicates that patients with emergencies tend to seek private care. Our primary research questions were these: What is the scope of perceived emergencies?; What is their nature?; and What is the related healthcare-seeking behavior? Secondary objectives were to study determinants of healthcare-seeking behavior, compare health expenditure with expenditure from the past ordinary illness, and measure the prevalence of catastrophic health expenditure related to perceived emergencies.

METHODS

We conducted a cross-sectional survey of 210 households in a rural region of northwestern Ecuador. The households were sampled with two-stage cluster sampling and represent an estimated 20% of the households in the region. We used two structured, pretested questionnaires. The first questionnaire collected demographic and economic household data, expenditure data on the past ordinary illness, and presented our definition of perceived emergency. The second recorded the number of emergency events, symptoms, further case description, healthcare-seeking behavior, and health expenditure, which was defined as being catastrophic when it exceeded 40% of a household's ability to pay.

RESULTS

The response rate was 85% with a total of 74 reported emergency events during the past year (90/1,000 inhabitants). We further analyzed the most recent event in each household (n=54). Private, for-profit providers, including traditional healers, were chosen by 57.4% (95% confidence interval [CI] [44-71%]). Public providers treated one third of the cases. The mean health expenditure per event was $305.30 United States dollars (USD), compared to $135.80 USD for the past ordinary illnesses. Catastrophic health expenditure was found in 24.4% of households.

CONCLUSION

Our findings suggest that the provision of free health services may not be sufficient to reach universal health coverage for patients with perceived emergencies. Changes in the organization of public emergency departments and improved financial protection for emergency patients may improve the situation.

Assessment of Rehabilitation Infrastructure in Peru

OBJECTIVE

To assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks.

DESIGN

Anonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input.

SETTING

Large public hospitals and referral centers and an online survey platform.

PARTICIPANTS

Convenience sample of hospital personnel working in rehabilitation and neurology (N=239), recruited through existing contacts and professional societies.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Outcome measures were for 4 WHO domains: health workforce, health service delivery, essential medical products and technologies, and health information systems.

RESULTS

Regarding the domain of health workforce, 47% of physical therapists, 50% of occupational therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists (70%). At hospitals without speech-language pathologists, physical therapists (49%) or nobody (34%) perform speech-language pathology roles. At hospitals without occupational therapists, physical therapists most commonly (59%) perform occupational therapy tasks. Alternate prosthetist/orthotist task performers are occupational therapists (26%), physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding the domain of health services, the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding the domain of health information systems, 28% reported rehabilitation service data collection. Regarding the domain of essential medical products and technologies, electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent.

CONCLUSIONS

Rehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of physical therapists and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing's role in Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies.

Population-based epidemiology of non-fatal injuries in Tehran, Iran

Background: Our aim in this survey was to explore descriptive epidemiology of injuries in Tehran in 2012 and to report the recalled estimates of injury incidence rates.

Methods: A population survey was conducted in Tehran during 2012, within which a total of 8626 participants were enrolled. The cluster sampling was used to draw samples in 100 clusters with a pre-specified cluster size of 25 households per cluster. Data were collected on demographic features, accident and injury characteristics based on the International Classification of Diseases (ICD10).

Results: A total of 618 injuries per 3 months were reported, within which 597 cases (96.6%)were unintentional injuries. More than 82% of all injuries were those caused by exposure to inanimate mechanical forces, traffic accidents, falls and burns. Above 80% of the traffic injuries happened among men (P<0.001). About 43% of the unintentional injuries were mild injuries.After the age of 40, women, unlike men, had higher risks for being injured. The estimated annual incidence rate for all types of injuries was 284.8 per 1000 (95% CI: 275.4-294.4) and for unintentional injuries was 275.2 per 1000.

Conclusion: Injuries are major health problems in Tehran with a highly reported incidence. The status is not substantially improved over the recent years which urges the need to be adequately and emergently addressed. As the incidence rate was estimated based on participant recalls, the real incidence rate may even be higher than those reported in the current study.

Parents' Attitudes and Adherence to Unintentional Injury Prevention Measures in Ankara, Turkey

Background:

Childhood unintentional injuries are perceived as a leading public health issue since they are one of the preventable causes of paediatric mortality and morbidity. Whether and how parental factors are related to childhood injury has been researched insufficiently.

Aims:

To investigate parents’ attitudes to preventive measures of unintentional childhood injury, and the parental adherence to these measures.

Study Design:

Cross-sectional, descriptive study.

Methods:

The data were collected from the parents of children younger than ten years of age admitted to university hospital outpatient clinics for any reason and who agreed to be involved in the study. The first part of the questionnaire included sociodemographic profiles of participating children. Serious injuries were considered to be any injury that requires hospital admission. The second part of the questionnaire was prepared to evaluate parents’ adherence to injury prevention rules. A total score calculation about the adherence of the parents to the injury prevention rules was worked out the addition of the scores of each answer given in each age group. Answers for each item given by the parents were scored as wrong (0), sometimes (1) or correct (2). The score for each item was added and the result normalized to 100 points. Only complete questionnaires were used for analysis.

Results:

A total of 1126 children and parent pairs agreed to participate in the survey. It was found that 13.8% of the participating children had experienced at least one serious injury. Although three-quarters of the parents had received information about injury prevention, the overall injury prevention scores were found to be low. As children’s age increased, the total injury prevention scores of parents decreased significantly. Injury prevention scores were shown to increase significantly with high education and maternal occupation. However, scores were shown to decrease significantly with increased child age and family size.

Conclusion:

Our study shows that parental adherence to the child safety measures aimed at decreasing the unintentional injury risk of children is not satisfactory in Turkey. In particular, parents of 5-9-year-old children, big families (more than five people), parents with less than 8 years of education and non-working mothers should be the main target groups for intervention strategies according to our study results.

Sex Differences in Civilian Injury in Baghdad From 2003 to 2014: Results of a Randomized Household Cluster Survey

OBJECTIVE

To examine sex differences in injury mechanisms, injury-related death, injury-related disability, and associated financial consequences in Baghdad since the 2003 invasion of Iraq to inform prevention initiatives, health policy, and relief planning.

BACKGROUND

Reliable estimates of injury burden among civilians during conflict are lacking, particularly among vulnerable subpopulations, such as women.

METHODS

A 2-stage, cluster randomized, community-based household survey was conducted in May 2014 to determine the civilian burden of injury in Baghdad since 2003. Households were surveyed regarding injury mechanisms, healthcare required, disability, deaths, connection to conflict, and resultant financial hardship.

RESULTS

We surveyed 900 households (5148 individuals), reporting 553 injuries, 162 (29%) of which were injuries among women. The mean age of injury was higher among women compared with men (34 ± 21.3 vs 27 ± 16.5 years; P < 0.001). More women than men were injured while in the home [104 (64%) vs 82 (21%); P < 0.001]. Fewer women than men died from injuries [11 (6.8%) vs 77 (20%); P < 0.001]; however, women were more likely than men to live with reduced function [101 (63%) vs 192 (49%); P = 0.005]. Of intentional injuries, women had higher rates of injury by shell fragments (41% vs 26%); more men were injured by gunshots [76 (41%) vs 6 (17.6%); P = .011).

CONCLUSIONS

Women experienced fewer injuries than men in postinvasion Baghdad, but were more likely to suffer disability after injury. Efforts to improve conditions for injured women should focus on mitigating financial and provisional hardships, providing counseling services, and ensuring access to rehabilitation services.

Injuries, Death, and Disability Associated with 11 Years of Conflict in Baghdad, Iraq: A Randomized Household Cluster Survey

Background

The objective of this study was to characterize injuries, deaths, and disabilities arising during 11 years of conflict in Baghdad.

Methods

Using satellite imagery and administrative population estimated size for Baghdad, 30 clusters were selected, proportionate to population size estimates. Interviews were conducted during April and May 2014 in 900 households containing 5148 persons. Details about injuries and disabilities occurring from 2003 through May 2014 and resultant disabilities were recorded.

Findings

There were 553 injuries reported by Baghdad residents, 225 of which were intentional, and 328 unintentional. For intentional injuries, the fatality rate was 39.1% and the disability rate 56.0%. Gunshots where the major cause of injury through 2006 when blasts/explosions became the most common cause and remained so through 2014. Among unintentional injuries, the fatality rate was 7.3% and the disability rate 77.1%. The major cause of unintentional injuries was falls (131) which have increased dramatically since 2008, followed by traffic related injuries (81), which have steadily increased. The proportion of injuries ending in disabilities remained fairly constant through the survey period.

Interpretation

Intentional injuries added substantially to the burden of unintentional injuries for the population. For Baghdad, the phases of the Iraqi conflict are reflected in the patterns of injuries and consequent deaths reported. The scale of injuries during conflict is most certainly under-reported. Difficulties recalling injuries in a survey covering 11 years is a limitation, but it is likely that minor injuries were under-reported more than severe injuries. The in- and out-migration of Baghdad populations likely had effects on the events reported which we could not measure or estimate. Damage to the health infrastructure and the flight of health workers may have contributed to mortality and morbidity. Civilian injuries as well as mortality should be measured during conflicts, though not currently done.

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.

Unintentional injuries: magnitude, prevention, and control

The World Health Organization estimates injuries accounted for more than 5 million deaths in 2004, significantly impacting the global burden of disease. Nearly 3.9 million of these deaths were due to unintentional injury, a cause also responsible for more than 138 million disability-adjusted life years (DALYs) lost in the same year. More than 90% of the DALYs lost occur in low- and middle-income countries (LMICs), highlighting the disproportionate burden that injuries place on developing countries. This article examines the health and social impact of injury, injury data availability, and injury prevention interventions. By proposing initiatives to minimize the magnitude of death and disability due to unintentional injuries, particularly in LMICs, this review serves as a call to action for further investment in injury surveillance, prevention interventions, and health systems strengthening.

Population based estimates of non-fatal injuries in the capital of Iran

Background

Fatal injuries are at the top of the injury pyramid; however, non-fatal injuries are quite common and impose huge medical expenses on the population. Relying on hospital data will underestimate the incidence of non-fatal injuries. The aim of this study was to estimate the annual incidence and out of pocket medical expenses of all injuries in urban population of Tehran (the capital city of Iran).

Methods

Using the cluster random sampling approach, a household survey of residents of greater Tehran was performed on April 2008. At randomly selected residential locations, interviewers asked one adult person to report all injuries which have occurred during the past year for all household members, as well as the type of injury, place of occurrence, the activity, cause of accidents resulting in injuries, the amount of out of pocket medical expenses for injury, and whether they referred to hospital.

Results

This study included 2,450 households residing in Tehran during 2007-8. The annual incidence of all injuries was 188.7 (180.7-196.9), significant injuries needing any medical care was 68.8 (63.7-74.2), fractures was 19.3 (16.6 - 22.4), and injuries resulted in hospitalization was 16.7 (14.2 - 19.6) per 1000 population. The annual incidence of fatal injuries was 33 (7-96) per 100,000 Population. In children aged 15 or less, the annual incidence of all injuries was 137.2 (120.0 - 155.9), significant injuries needing any medical care was 64.2 (52.2 - 78.0), fractures was 21.8 (15.0 - 30.7), and injuries resulted in hospitalization was 6.8 (3.3 - 12.5) per 1000 population. The mean out of pocket medical expense for injuries was 19.9 USD.

Conclusion

This population based study showed that the real incidence of non-fatal injuries in the capital of Iran is more than the formal hospital-based estimates. These injuries impose non trivial medical and indirect cost on the community. The out of pocket medical expense of non-fatal injuries to Tehran population is estimated as 27 million USD per year. Effective strategies should be considered to minimize these injuries and decrease the great financial burden to public and the health system.

The use of hospital medical records for child injury surveillance in northern Malawi

Our study evaluates the usefulness and the limitations of using the medical records of a central referral hospital to develop a child injury surveillance system in northern Malawi. The most prevalent types of injury were falls (29.6%), road traffic injuries (22.0%), burns (21.4%) and poisoning (15.1%). Older children (aged 5-14 years), in the cool-dry season (May to August) and the hot-dry season (September to October), were significant predictors for total injury admissions. Our study indicated that hospital medical records are a valuable component of a child injury surveillance system and can illustrate the trends and patterns of moderate to severe injuries as well as suggest potential prevention strategies for local settings. Combined with a specially designed trauma registry form, it is possible for developing countries at local level to combat the emerging public health issues.

The association of psychological symptoms with unintentional injuries among retired employees of a university in China

To investigate the association of psychological symptoms with injury risk, psychological symptoms were measured using symptom checklist-90 revised (SCL-90-R) and the unintentional injury information was followed up for 1 year among retired employees at a university in China. The injury rate had a significant difference between groups of raw mean score > or =2.0 and <2.0 for SCL-90-R global factor and subscale factors of obsessive compulsiveness, interpersonal sensitivity, depression and anxiety. After accounting for the factors of daily housework, physical activities, living alone and demographic factors, SCL-90-R global factor (odds ratio (OR) = 1.87, 95% CI: 1.20-2.91) and subscales factors of obsessive compulsiveness (OR = 1.93, 95% CI: 1.31-2.85), interpersonal sensitivity (OR = 2.05, 95% CI: 1.09-3.02), depression (OR = 2.09, 95% CI: 1.40-3.12) and anxiety (OR = 1.58, 95% CI: 1.03-2.44) were still significantly associated with an elevated risk of unintentional injury among the retired employees. In order to reduce the risk of unintentional injuries among the elderly, a psychological health service should be provided in the community.

Unintentional injuries in the rural population of Twiserkan, Iran: a cross-sectional study on their incidence, characteristics and preventability

BACKGROUND

Knowledge is sparse concerning injuries affecting rural populations in low and middle-income countries in general and in Iran in particular. This study documents the incidence and characteristics of severe injuries affecting rural people in the Iranian district of Twiserkan and it investigates these people's suggestions for injury prevention and control.

METHODS

An interview-based investigation was undertaken that comprised all unintentional injuries leading to hospitalization (more than 6 hours) or death that had occurred within a twelve month period and that were identified in the files of the 62 "health houses" of the Twiserkan district. For each case, semi-structured interviews were conducted at the households of the injured people (134 injuries affecting 117 households were identified).

RESULTS

The incidence rates of fatal and non-fatal injuries were respectively 4.1 and 17.2 per 10 000 person-years and, as expected, men were more affected than women (77.6% of all injury cases). Traffic injuries (in particular among motorcyclists) were as common as home-related injuries but they were far more fatal. Among common suggestions for prevention, people mentioned that the authorities could work on the design and engineering of the infrastructure in and around the village, that the rural health workers could contribute more with local information and education and that the people themselves could consider behaving in a safer manner.

CONCLUSION

Not only domestic injuries but also those in traffic are an important cause of severe and fatal injury among rural people. Health workers may play an important role in injury surveillance and in identifying context-relevant means of prevention that they or other actors may then implement.

The Nicaraguan Health and Demographic Surveillance Site, HDSS-Leon: a platform for public health research

AIM

To describe the Health and Demographic Surveillance System (HDSS) in León, Nicaragua and to present results from the 2002-2003 baseline.

DESIGN AND METHODS

A 22% sample of the total population in León, both urban and rural, was selected in 1993. This sample was updated in 2002 and will be followed up on a biannual basis with regard to births, deaths, in-migration, and out-migration. A group of 18 female fieldworkers perform 10 household interviews per day, 20 days per month. They use a map that is produced by a Geographical Information System. It shows all the households, and is the main means of the interviewers finding the households. An extensive data quality control system is used.

RESULTS

In total, 54,647 persons lived in the area of the surveillance system, and they resided in 10,994 households. The mean age was 26 years; the sex ratio was 0.93. The infant and neonatal mortality rates were 25.4 and 20.5 per 1,000 live births, respectively. In total, 2,034 people out-migrated from the study area and 3,377 in-migrated. Of the households, 53% were classified as non-poor, 41% as poor, and 6% as extremely poor. Six per cent of the population did not have a toilet or a latrine, and only 16% in the rural area had indoor running water. The surveillance system revealed that 10% were illiterate.

CONCLUSIONS

The HDSS in León has shown that it can serve as a platform for further intervention studies as well as for research training.

Monitoring the "tip of the iceberg'': ambulance records as a source of injury surveillance

AIMS

The aim of this study was to describe the epidemiology of moderate and severe injury morbidity in a defined population on the basis of ambulance records, and to validate ambulance records as a potential source of surveillance.

METHODS

A geographical target area was defined; the county of Värmland, Sweden. All ambulance attendances and hospitalizations for unintentional and intentional injury in 2002 were selected, analysed, and compared.

RESULTS

Ambulance data comprised 3,964 injury cases (14.5/1,000). Most injuries for which ambulance attention was sought occurred in road traffic areas (27%), followed by residential areas (20%), school and institutional areas (14%), and sports areas (8%). An ecological comparison between ambulance-based data and hospitalizations showed that ambulance services captured approximately the same amount of injury cases (3,235 ambulance reports, as compared to 3,456 hospital discharges) with a similar profile.

CONCLUSIONS

This study provides epidemiological support for ambulance services as a potential source of regular surveillance data on moderate and severe injuries. However, at a population level, our results indicate that ambulance data tend to overestimate some injury categories, and underestimate others, as compared to hospital data. The significance of these differences for preventive work, as well as other practical aspects of the feasibility of regular injury surveillance, will be analysed and discussed on the basis of general criteria for evaluation of surveillance systems in a forthcoming paper.

Unintentional non-fatal home-related injuries in Central Anatolia, Turkey: frequencies, characteristics, and outcomes

Injuries constitute a major public health problem worldwide. Homes are an important setting for non-fatal unintentional injuries. The aim of this study is to determine the frequency, the characteristics, and the outcome of unintentional non-fatal injuries in the household, and to describe the related risk factors through a community-based survey. The study was conducted using a household-based survey design. Eight hundred inhabitants were sampled from the entire population in the city centre by a stratified sampling method in 2004. All unintentional non-fatal home-related injuries occurring in the previous year were registered and examined, making special note of the mechanism of the injuries, the time and place of the incidents and their outcomes. The frequency of unintentional non-fatal home-related injuries requiring some form of medical attention was established as 10.8%. Falls were the most common injuries among all the study groups. Injury rates were highest among the oldest (aged > or =65) and youngest (aged <15) age groups, females, adults having incomes under euro 500, individuals living alone, or the unemployed. Contact with hot objects/substances or hot liquid/gas was the leading mechanism in children 4 years of age or younger, falls ranking second. Falls are a significant problem particularly among older adults. Multiple analysis revealed that participants with low incomes, living alone and single or divorced had a high risk for injury at home. The findings related to disability highlighted a need to focus attention on the prevention of residential falls among the elderly, and the burns and falls among young children. Preventive measures should be prioritised to risk groups such as individuals with low incomes and those living alone.

Falls among children in the developing world: a gap in child health burden estimations?

AIM

To estimate the incidence and mortality rates for unintentional fall injuries in children under 5 years of age in three developing regions of the world.

METHODS

This is a systematic review of literature on unintentional childhood fall injuries. A computerized PUBMED search of literature published between 1980 and 2006 was conducted and a manual search of journals was also completed.

RESULTS

Over 140,000 injuries to children under 19 years were reported in 56 studies (21 from Asia, 20 from Africa and 15 from South America); on an average 36% of injuries (52 575) were due to falls. The median incidence is estimated at 137.5 fall injuries per 100,000 children. The incidence of falls specific to the under-5 age group was reported in 16 studies with a median incidence of 40.6 falls per 100,000. The overall average incidence rate for childhood falls is highest in South America at 1315 followed by Asia at 1036 and Africa at 786 per 100,000, respectively. Average mortality rates were highest for Asia at 27 followed by Africa at 13.2 per 100,000, respectively.

CONCLUSION

This review demonstrates that the burden of falls on children has not been well documented, and is most likely under-reported. With the large and growing population of children in developing countries, the public health implications of the observed results are tremendous. Appropriate prevention relies on accurate statistics.

Characteristics of non-fatal injuries in Leon, Nicaragua – 2004

This article describes the epidemiology of injuries collected in the Injury Surveillance System in Leon Hospital in Nicaragua. A total of 6659 persons were treated for injuries in 2004. It was discovered that 88% of all injuries were unintentional, 9% involved interpersonal violence, 2% were self-inflicted and 0.2% was undetermined. Men accounted for 64.7% of the cases, with the highest rate among 20 - 24 year olds (5625.8 per 100,000 inhabitants). Among women, the highest rate was in those aged 64 years and older (5324.2 per 100 000 inhabitants). The most common mechanisms were falls (33.9%), blunt force (26.8%), cut/pierce/stab (15.1%) and transportation-related (12.8%). These results indicate the need to identify prevention strategies for those injuries that were most commonly treated in emergency, such as unintentional falls among older women, self-inflicted poisoning among young women and blunt force and transportation-related injuries among young men.