Incidence, characteristics and risk factors for household and neighbourhood injury among young children in semiurban Ghana: a population-based household survey

Injury epidemiology and emergency department length of stay in trauma hospital in Addis Ababa, Ethiopia

BACKGROUND

Injuries are a major cause of health problems in low- and middle-income countries than in high-income nations. This study aimed to describe injuries and identify factors associated with the emergency department (ED) length of stay (LoS).

METHODS

This study was conducted at the Addis Ababa Burn, Emergency, and Trauma (AaBET) hospital in Addis Ababa, Ethiopia. All injured patients who visited the ED between April 1, 2021, and March 30, 2022, were included in the study. Data were collected through a retrospective medical record review. Descriptive statistics were used to present the data and a multivariable binary logistic regression model was used to assess factors associated with LoS in the ED.

RESULTS

A total of 6991 (86.8%) injured patients were studied out of 8055 patients who visited the ED. The majority of the patients were male, 5184 (74.2%), and aged between 18-44 years, 4368 (62.4%). The most common mechanism of injury was road traffic accidents, 2693 (38.5%), followed by falls, 1523 (21.8%). The most commonly reported injured body parts were the head (2179, 31.2%). Of the total injured patients, 101 (1.8%) died. The LoS in the ED was greater than 24 hours for 24.4% (95% CI: 23.3-25.5) of the injured patients, with a mean duration of 2.51 (SD = 5.18) days. Factors significantly associated with a prolonged LoS (>24 hours) in the ED included being residing in outside Addis Ababa in Oromia [AOR: 1.61, 95% CI (1.38-1.88)], Amhara [AOR: 1.56, 95% CI (1.14-2.14)] and other [AOR: 3.93, 95% CI (2.73-5.64)], male [AOR: 1.30, 95% CI (1.09-1.54)], aged 60 years or older [AOR: 1.38, 95% CI (1.03-1.85)]; sustaining injuries from road traffic accident [AOR: 2.43, 95% CI (1.19-4.94)], being triaged to orange [AOR: 3.03, 95% CI (2.40-3.83)] and red zones [AOR:3.37, 95% CI (2.65-4.28)]; having fracture injuries [AOR: 1.95, (1.34-2.83)]; and experiencing contusions and crushing injuries [AOR: 2.63 (1.57-4.42)].

CONCLUSIONS

Injuries are the major share of cases among ED patients at AaBET hospital. Patients were staying in the ED for longer than the recommended 24 hours by the Ethiopian health system. Intervention measures focusing on injury prevention are necessary to reduce the patient burden on the hospital and strengthen the hospital's capacity to reduce prolonged LoS.

Prevalence, types and outcome of injuries among abattoir workers in Ghana

BACKGROUND

In many places in the world, workers in the meat processing industry report high incidence of injuries. Details of such injuries are not well known for Ghana or much of Africa.

METHODS

A cross-sectional survey involving 300 workers from three major meat processing facilities in the Kumasi metropolis of Ghana was carried out using a structured questionnaire from April to June 2023. The prevalence, types and outcome of injuries among workers were assessed. Test of association was established by Chi square analysis.

RESULTS

Over the prior 6 months, the prevalence of injury was 83.0%. Among the various injury types, lacerations had the highest prevalence (46.0%) followed by musculoskeletal pain (16.7%) bone fractures (14.0%), swelling (13.0%), burns and scalds (7.3%), and dislocations/sprains/strains (6.7%). More than half (58.9%) of injuries sustained were moderately severe (2-7 days of lost work) and nearly half (42.0%) required immediate medical attention. Gender, employment status, wages, availability and use of safety equipment were significantly associated with injuries among abattoir workers.

CONCLUSIONS

The incidence of injuries among abattoir workers in Kumasi, Ghana demonstrates a large public health burden requiring attention and improved enforcement through occupational safety interventions.

Epidemiological and clinical characteristics of hospitalized unintentional injuries among children in central China from 2017-2023

Objectives

To examine the epidemiological and clinical characteristics of hospitalized unintentional injuries among children in Central China and theoretically propose preventive and control measures.

Methods

We conducted a retrospective study of children aged 0-18 years with unintentional injuries who were admitted to a tertiary hospital in Central China from January 2017 to December 2023. We examined various aspects of the unintentional injuries, including age, gender, urban-rural distribution, external causes, trends, location of injury, cost, and length of stay.

Results

A total of 20,166 children with hospitalized unintentional injuries were enrolled. The median age with IQR was 2.8 (1.6, 5.1) years, with majority of the patients (57.0%) were aged 1-3 years, while the fewest were aged 11-18 years. The male-to-female ratio was 1.8:1, and the urban-to-rural ratio was 1.1:1. The most common external causes were foreign bodies (41.7%), exposure to inanimate mechanical forces (25.1%), and falls (22.1%). The most frequently injured body parts were head (72.5%). The total number of unintentional injuries exhibited an increasing trend from 2017-2022, and a decreasing trend from 2022-2023. The urban-rural distribution reversed after 2020. The overall hospitalization cost was 20,810,870.4 USD, with an median cost of 758.7 (556.4, 1,186.2) USD per person.

Conclusion

Unintentional injuries imposed a heavy burden on society and families. However, the number of cases and the urban-rural distribution showed significant trend changes from 2017-2023. The external causes varied by age group, gender, and region, while prevention and control measures should be developed accordingly.

Whether occupational injuries of the industrial workers can be prevented: an analysis from the slums of West Bengal-India?

A lack of research exists concerning the heterogeneity of the occupational injuries of slum dwellers across industries which has a close link with health expenditure and hence livelihood. It necessitates analysing their occupational injuries and associated out-of-pocket health expenditures. Multi-stage random sampling is used to collect the primary data and the logit model is used for data analyses. Permanent non-fatal injuries in the civil-mechanical industries and temporary non-fatal injuries in textile industries are common. The share of health expenditure of the injured workers seeking medical consultations remains 59% of their average monthly income. Average monthly income, parental occupation, types of industry, job security, risk intensity, and salary basis are significant estimates of occupational injuries. The differences in the nature and extent of the occupational injuries of the workers across industries in the light of the socio-demographic and working environment context provide significant insight into the policy implications.

Caregiver accounts of unintentional childhood injury events in rural Uganda

OBJECTIVE

Complex environmental, social, and individual factors contribute to unintentional childhood injury events. Understanding context-specific antecedents and caregiver attributions of childhood injury events can inform the development of locally-targeted interventions to reduce injury risk in rural Uganda.

METHODS

Fifty-six Ugandan caregivers were recruited through primary schools and completed qualitative interviews regarding 86 unintentional childhood injury events. Descriptive statistics summarized injury characteristics, child location and activity, and supervision at time of injury. Qualitative analyses informed by grounded theory identified caregiver attributions of injury causes and caregiver actions to reduce injury risk.

RESULTS

Cuts, falls, and burns were the most common injuries reported. At the time of injury, the most common child activities were farming and playing and the most common child locations were the farm and kitchen. Most children were unsupervised. In cases where supervision was provided, the supervisor was typically distracted. Caregivers most often attributed injuries to child risk-taking but also identified social, environmental, and chance factors. Caregivers most often made efforts to reduce injury risk by teaching children safety rules, but also reported efforts to improve supervision, remove hazards, and implement environmental safeguards.

CONCLUSION

Unintentional childhood injuries have a significant impact on injured children and their families, and caregivers are motivated to reduce child injury risk. Caregivers frequently perceive child decision-making a primary factor in injury events and respond by teaching children safety rules. Rural communities in Uganda and elsewhere may face unique hazards associated with agricultural labor, contributing to a high risk of cuts. Interventions to support caregiver efforts to reduce child injury risk are warranted.

The state of surgery, obstetrics, trauma, and anaesthesia care in Ghana: a narrative review

Background

Conditions amenable to surgical, obstetric, trauma, and anaesthesia (SOTA) care are a major contributor to death and disability in Ghana. SOTA care is an essential component of a well-functioning health system, and better understanding of the state of SOTA care in Ghana is necessary to design policies to address gaps in SOTA care delivery.

Objective

The aim of this study is to assess the current situation of SOTA care in Ghana.

Methods

A situation analysis was conducted as a narrative review of published scientific literature. Information was extracted from studies according to five health system domains related to SOTA care: service delivery, workforce, infrastructure, finance, and information management.

Results

Ghanaians face numerous barriers to accessing quality SOTA care, primarily due to health system inadequacies. Over 77% of surgical operations performed in Ghana are essential procedures, most of which are performed at district-level hospitals that do not have consistent access to imaging and operative room fundamentals. Tertiary facilities have consistent access to these modalities but lack consistent access to oxygen and/or oxygen concentrators on-site as well as surgical supplies and anaesthetic medicines. Ghanaian patients cover up to 91% of direct SOTA costs out-of-pocket, while health insurance only covers up to 14% of the costs. The Ghanaian surgical system also faces severe workforce inadequacies especially in district-level facilities. Most specialty surgeons are concentrated in urban areas. Ghana’s health system lacks a solid information management foundation as it does not have centralized SOTA databases, leading to incomplete, poorly coded, and illegible patient information.

Conclusion

This review establishes that surgical services provided in Ghana are focused primarily on district-level facilities that lack adequate infrastructure and face workforce shortages, among other challenges. A comprehensive scale-up of Ghana’s surgical infrastructure, workforce, national insurance plan, and information systems is warranted to improve Ghana’s surgical system.

Risk factors for falls among children aged 0-18 years: a systematic review

BACKGROUND

Accidental falls are the most common cause of injury in children. These falls not only result in pain and injury to children but also can pose a significant financial burden to their families and society. The aim of this study is to identify risk factors for falls in children.

METHODS

We conducted a systematic review of the literature describing falls in children aged 0-18 years. Studies of falls from a height of 1 m or more were excluded from the analysis. We analyzed the included studies to identify risk factors for falls.

RESULTS

A total of 1496 articles were initially retrieved, leading to an included set of nine articles, which were published from 1995 to 2021. Risk factors related to fall injury in children aged 0-18 years included age, sex, extroversion, rural areas, history of falls, family factors, caregiver factors, medication use, intravenous therapy, tests requiring movement, disease factors and long hospital stay.

CONCLUSION

We identified 12 risk factors affecting falls in children, including individual characteristics and family and social factors.

Too serious to ignore: The epidemiologic and economic burden of home injuries in the Southwest Region of Cameroon—A community-based study

Background

Home injuries are an important cause of morbidity and mortality in high-income countries. In Sub-Saharan Africa, including Cameroon, many people live in unplanned settlements with poorly constructed houses, predisposing them to home injuries. However, little is known about the epidemiology and care-seeking behaviors of the domestically injured. In this study, our objective was to determine the epidemiology and care-seeking behaviors of home injuries in the Southwest Region of Cameroon.

Methods

A sub-analyses of a larger descriptive cross-sectional community-based study on injury epidemiology in the preceding 12 months was conducted. Sampling was done using three-stage cluster sampling technique. Differences between groups were evaluated using Chi-squared and Adjusted Wald tests.

Results

Of 8065 participants, 157 suffered home injuries giving an incidence of 19.6 (16.8–23.0 95% CI) cases per 1000-person years. Home injuries comprised 31.2% of all 503 injuries and affected more females (60.8%) and younger individuals (mean age (SE) 25.1 years (2.0)) than non-home injuries. The most common activity and mechanism of home injury was leisure/play (51%) and falls (37.9%) respectively. Amongst those with home injuries, 37.6% did not seek care from any care provider (versus 25.0% of non-home injuries, p = 0.004) and were more likely to seek treatment within the family or at home (p = 0.008) or at church (p = 0.010). Those with home injuries experienced a median of 14 disability days and 22.9% of families faced difficulties affording basic expenses (p = 0.001).

Conclusion

Home injuries comprise about a third of the Southwest Region of Cameroon’s burden of injury and likely have a profound socioeconomic impact. Though these injuries cause severe disabilities, a large proportion of victims do not seek care from providers. Prevention efforts should address the design of homes and victims of home injury should be encouraged to utilize formal care services.

Incidence of childhood injuries and modifiable household risk factors in rural Ghana: a multistage, cluster-randomised, population-based, household survey

OBJECTIVE

We aimed to describe the incidence of childhood household injuries and prevalence of modifiable household risk factors in rural Ghana to inform prevention initiatives.

SETTING

357 randomly selected households in rural Ghana.

PARTICIPANTS

Caregivers of children aged <5 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Childhood injuries that occurred within 6 months and 200 metres of the home that resulted in missed school/work, hospitalisation and/or death. Sampling weights were applied, injuries were described and multilevel regression was used to identify risk factors.

RESULTS

Caregivers from 357 households had a mean age of 35 years (SD 12.8) and often supervised ≥2 children (51%). Households typically used biomass fuels (84%) on a cookstove outside the home (79%). Cookstoves were commonly <1 metre of the ground (95%). Weighted incidence of childhood injury was 542 per 1000 child-years. Falls (37%), lacerations (24%), burns (12%) and violence (12%) were common mechanisms. There were differences in mechanism across age groups (p<0.01), but no gender differences (p=0.25). Presence of older children in the home (OR 0.15, 95% CI 0.09 to 0.24; adjusted OR (aOR) 0.26, 95% CI 0.13 to 0.54) and cooking outside the home (OR 0.28, 95% CI 0.19 to 0.42; aOR 0.25, 95% CI 0.13 to 0.49) were protective against injury, but other common modifiable risk factors (eg, stove height, fuel type, secured cabinets) were not.

CONCLUSIONS

Childhood injuries occurred frequently in rural Ghana. Several common modifiable household risk factors were not associated with an increase in household injuries. Presence of older children was a protective factor, suggesting that efforts to improve supervision of younger children might be effective prevention strategies.

Unintentional falls among children in rural Ghana and associated factors: a cluster-randomized, population-based household survey

INTRODUCTION

falls contribute to almost one-fifth of injury-related deaths. The majority of these occur in low- and middle-income countries. The impact of fall injury in low- and middle-income countries is greater in younger individuals. We aimed to determine the epidemiology of falls among rural Ghanaian children.

METHODS

from March to May, 2018, we conducted a cluster-randomized household survey of caregivers in a rural Ghanaian sub-district, regarding household child falls and their severity. We utilized a previously validated survey tool for household child injury. Associations between household child falls and previously described predictors of household child injury were examined with multivariable logistic regression. These included age and gender of the child, household socioeconomic status, caregiver education, employment status, and their beliefs on why household child injuries occur.

RESULTS

three hundred and fifty-seven caregivers of 1,016 children were surveyed. One hundred and sixty-four children under 18 years had sustained a household fall within the past six months, giving a household child fall prevalence of 16% (95% C.I, 14%-19%). Mean age was 4.4 years; 59% were males. Ground level falls were more common (80%). Severity was mostly moderate (86%). Most caregivers believed household child injuries occurred due to lack of supervision (85%) or unsafe environment (75%); only 2% believed it occurred because of fate. Girls had reduced odds of household falls (adjusted O.R 0.6; 95% C.I 0.4-0.9). Five to nine year-old and 15-17 year-old children had reduced odds of household falls (adjusted O.R 0.4; 95% C.I 0.2-0.7 and 0.1; 95% C.I 0.02-0.3, respectively) compared to 1-4 year-olds. Caregiver engagement in non-salary paying work was associated with increased odds of household child falls (adjusted O.R 2.2; 95% C.I 1.0-4.7) compared to unemployed caregivers. There was no association between household child falls and caregiver education, socioeconomic status and beliefs about why household child injuries occurred.

CONCLUSION

the prevalence of household child falls in rural Ghana was 16%. This study confirms the need to improve supervision of all children to reduce household falls, especially younger children and particularly boys. Majority of caregivers also acknowledge the role of improper child supervision and unsafe environments in household child falls. These beliefs should be reinforced and emphasized in campaigns to prevent household child falls in rural communities.

Factors Associated with Serious Injuries among Adolescents in Ghana: Findings from 2012 Global School Health Survey

Introduction

Injuries are of public health concern and the leading cause of residual disability and death among teenagers, especially in low- and middle-income countries (LMICs). In Ghana, the burden of injury among adolescents is under-reported. Hence, the study sought to determine the prevalence of serious injuries (SI) and the potential factors influencing these injuries among school children in Ghana.

Methods

This study was conducted in Ghana among Junior High School (JHS) and senior high school students (SHS) using the 2012 Global School-Based Student Health Survey (GSHS) data. The GSHS employed two-stage cluster sampling method. Serious injuries (SI) and independent factors were measured via self-administered questionnaires. Pearson chi-square test between each explanatory variable and serious injuries was conducted and the level of statistical significance was set at 5%. The significant variables from the chi-square test were selected for multiple logistic regression analysis. Multiple logistic regression was performed to estimate the adjusted odds ratio (AOR) at 95% confidence interval (CI).

Results

The prevalence of SI in the past 12 months was 66% [CI=61.8-70.2] . The most common cause of SI was fall, 36%. The common types of injuries were cut/stab wounds and broken/dislocated bone. In the multiple logistic regression analysis, after controlling for other variables, educational level (AOR = 0.64, CI = 0.44-0.90, p < 0.015), suicidal ideation (AOR = 1.58, CI = 1.00-2.48, p < 0.002), suicidal attempt (AOR = 1.88, CI = 1.29-2.72, p < 0.001), having at least one close friend (AOR = 1.49, CI = 1.17-1.89, p < 0.002), school truancy (AOR = 1.66, CI = 1.31-2.09, p < 0.000), smoking marijuana (AOR = 2.64, CI = 1.22-5.69), and amphetamine use (AOR = 2.95, CI = 1.46-5.69) were independently associated with SI.

Conclusion

The findings of the study established a high prevalence of SI among adolescents in Ghana, with cut/stab wound and broken/dislocated bone being the most reported type of injuries. This study also revealed that factors such as educational level, suicidal ideation, suicidal attempt, at least one close friend, school truancy, smoking marijuana, and amphetamine use are associated with SI among the adolescents. Therefore, pragmatic interventional programs should be targeted at these factors to curb the rate of SI among junior and senior school students.

Comparison of Intentional and Unintentional Injuries Among Chinese Children and Adolescents

BACKGROUND

The patterns and risk factors of intentional injuries compared to unintentional injuries among Chinese children and adolescents have not been examined in depth. This work comprehensively describes patterns of intentional injuries in China, for which little information has been previously published.

METHODS

All cases involving individuals 0-17 years old registered at emergency rooms and outpatient clinics were examined using data submitted to the National Injury Surveillance System from 2006 through 2017. A logistic regression model was performed to explore the risk factors related to intentional injuries compared to unintentional injuries.

RESULTS

A total of 81,459 (95.1%) unintentional injuries, 4,218 (4.9%) intentional injuries (4,013 violent attacks and 205 self-mutilation/suicide) cases were identified. Blunt injuries accounted for 59.4% of violent attacks, while cuts and poisoning accounted for 37.1% and 23.4% of injuries involving self-mutilation/suicide, respectively. For unintentional injuries, falls (50.4%) ranked first. Additional risk factors for intentional injuries included being male (odds ratio [OR] 1.6), coming from rural areas (OR 1.9), being staff or workers (OR 2.2), and being a student (OR 1.8). As the age of the patients increased, so did the risk of intentional injuries (OR 5.0 in the 15-17 age group). Intentional injuries were more likely to occur at 00:00-03:00 am (OR 2.0).

CONCLUSIONS

Intentional injuries affected more males, rural and older children, school students, and staff or workers. The mechanisms and occurrence times differed according to age group. Preventive measures should be taken to reduce the dropout of rural students, strengthen the school's violence prevention plan, and reduce self-harm.

Unintentional Injuries and Sociodemographic Factors among Households in Ethiopia

Background

Unintentional injuries are a public health problem throughout the world including Africa. Most of the injury studies in Ethiopia are from the healthcare facility or workplace that does not reflect the problem at the community level. Therefore, this study aimed to assess the unintentional injuries and sociodemographic factors among households in Ethiopia.

Methods

This study was done from the Ethiopian Demographic and Health Survey conducted in 2016. The survey collected information about unintentional injuries and injury mechanisms in the past 12 months among 16,650 households. The selection of households was from nine regions and two city administrations of Ethiopia using a stratified cluster sampling procedure. Descriptive statistics were used to characterize the data and the chi-square test was applied as a test of significance and a p value of <0.05 was considered statistically significant.

Result

Of the 16,650 households that participated in the study, 394 (2.4%) reported that at least one household member suffered from an unintentional injury in the past 12 months. The leading mechanisms of injury were unintentional falls (152 falls, 33.2%) and road traffic incidents (96 incidents, 21.0%). Among household members who were injured, 84.3% survived and 15.7% died because of the injury. Divorce marital status of the household head [AOR: 2.12, 95% CI (1.12–4.41)] and family size of the household ≥ 6 [AOR:1.65, 95% CI (1.21–2.26)] were associated with high likelihood of occurrence of an injury, while lowest household wealth index [AOR: 0.69, 95% CI (0.50–0.95)] was protective against injuries.

Conclusion

A low prevalence of unintentional injury was found from the community in this survey, which might be due to the tendency of the community to report severe injuries. Fall and road traffic accidents were the leading mechanisms of selected sociodemographic factors of the households that were associated with unintentional injuries. Injury prevention efforts should focus on falls and transportation injuries with special attention to the sociodemographic context of the communities.

Injuries among children and adolescents in a rapidly growing urban African metropolis: a cross-sectional survey of 1,968 households in Dar es Salaam, Tanzania

Objectives

To assess the patterns and incidence of child and adolescent injury and explore associations with household deprivation and child characteristics in a low-income urban setting.

Study Design

Cross-sectional household survey in Dar es Salaam, Tanzania.

Methods

Data collection took place during July 2009. Injuries requiring medical attention were recorded with a one month period of recall. A total of 1,968 households representing 3,927 children and adolescents were visited by health workers. Gender-, age-, and type-specific injury incidence was compiled. Odds ratios were calculated to measure associations with child injury, perceived deprivation, household characteristics and child characteristics.

Results

One household in five reported injuries. The estimated incidence was 3.2 per 10,000 child-years. The most common identifiable injuries were falls (41%), cuts (22%) and burns (16%). Male and younger children aged 1-4 years were at higher risk (respectively OR = 1.36; p = 0.004; OR = 1.47; p ≤ 0.001).

Conclusions

In Dar e Salaam injuries are common. Future investigations should take into account both subjective and objective measurements of relative household deprivation and a clear criteria for the assessment of injury severity in community-based survey contexts.

Incidence of childhood burn injuries and modifiable household risk factors in rural Ghana: A cluster-randomized, population-based, household survey

BACKGROUND

We aimed to determine the incidence of childhood burn injuries in rural Ghana and describe modifiable household risk factors to inform prevention initiatives.

METHODS

We performed a cluster-randomized, population-based survey of caregivers of children in a rural district in Ghana, representing 2713 households and 14,032 children. Caregivers were interviewed regarding childhood burn injuries within the past 6 months and household risk factors.

RESULTS

357 households were sampled. Most used an open fire with biomass fuel for cooking (85.8%). Households rarely cooked in a separate kitchen (10%). Stove height was commonly within reach of children under five years (<1 m; 96.0%). The weighted annualized incidence of CBI was 63 per 1000 child-years (6.4% of children per year); reported mean age was 4.4 years (SD 4.0). The most common etiology was flame burn. Older age (OR 0.89, 95% CI 0.8-1.0) and households with an older sibling ≥12 years (OR 0.58, 95% CI 0.3-1.3) seemed to be associated with lower odds of CBI.

CONCLUSIONS

Childhood burn injury is common in rural Ghana. Opportunities exist to reduce the risk of childhood burn injury childhood burns in rural settings by supporting the transition to safer cooking arrangements, child barrier apparatuses in homes without older children, and/or development of formal childcare programs.

Multiple-scale spatial analysis of paediatric, pedestrian road traffic injuries in a major city in North-Eastern Iran 2015-2019

Background

Paediatric, pedestrian road traffic injuries (PPRTIs) constitute a major cause of premature death in Iran. Identification of high-risk areas would be the primary step in designing policy intervention for PPRTI reduction because environmental factors play a significant role in these events. The present study aims to determine high-risk areas for PPRTIs at three different geographical scales, including the grid network, the urban neighbourhood and the street levels in Mashhad, Iran during the period 2015–2019.

Methods

This cross-sectional retrospective study was based on all pedestrian accidents with motor vehicles involving children (less than 18 years of age) between March 2015 and March 2019 in the city of Mashhad, which is the second-most populous city in Iran. The Anselin Local Moran’s I statistic and Getis-Ord Gi* were performed to measure spatial autocorrelation and hotspots of PPRTIs at the geographical grid network and neighbourhood level. Furthermore, a spatial buffer analysis was used to classify the streets according to their PPRTI rate.

Results

A total of 7390 PPRTIs (2364 females and 4974 males) were noted during the study period. The children’s mean age was 9.7 ± 5.1 years. Out of the total PPRTIs, 43% occurred on or at the sides of the streets, 25 of which labelled high-risk streets. A high-high cluster of PPRTI was discovered in the eastern part of the city, while there was a low-low such cluster in the West. Additionally, in the western part of the city, older children were more likely to become injured, while in the north-eastern and south-eastern parts, younger children were more often the victims.

Conclusions

Spatial analysis of PPRTIs in an urban area was carried out at three different geographical scales: the grid network, the neighbourhood and the street level. The resulting documentation contributes reliable support for the implementation and prioritization of preventive strategies, such as improvement of the high-risk streets and neighbourhoods of the city that should lead to decreasing numbers of PPRTIs.

Predisposing factors influencing occupational injury among frontline building construction workers in Ghana

OBJECTIVE

This study aims to examine the predisposing factors influencing occupational injuries among frontline construction workers in Ghana. A cross-sectional survey was carried out with 634 frontline construction workers in Kumasi metropolis of Ghana using a structured questionnaire. The study was conducted from December 2016 to June 2017 using a household-based approach. The respondents were selected through a two-stage sampling approach. A multivariate logistics regression model was employed to examine the association between risk factors and injury. Data was analyzed employing descriptive and inferential statistics with STATA version 14.

RESULTS

The study found an injury prevalence of 57.91% among the workers. Open Wounds (37.29%) and fractures (6.78%) were the common and least injuries recorded respectively. The proximal factors (age, sex of worker, income) and distal factors (e.g. work structure, trade specialization, working hours, job/task location, and monthly off days) were risk factors for occupational injuries among frontline construction workers. The study recommends that policymakers and occupational health experts should incorporate the proximal and distal factors in the design of injury prevention as well as management strategies.

Benchmarking Global Trauma Care: Defining the Unmet Need for Trauma Surgery in Ghana

BACKGROUND

The Lancet Commission on Global Surgery recommended 5000 operations/100,000 persons annually, but did not define condition-specific guidelines. New Zealand, Lancet Commission on Global Surgery's benchmark country, documented 1158 trauma operations/100,000 persons, providing a benchmark for trauma surgery needs. We sought to determine Ghana's annual trauma operation rate compared with this benchmark.

METHODS

Data on all operations performed in Ghana from June 2014 to May 2015 were obtained from representative sample of 48/124 district (first level), 8/11 regional, and 3/5 tertiary hospitals and scaled up for nationwide estimates. Trauma operations were grouped by hospital level and categorized into "essential" (most cost-effective, highest population impact) versus "other" (specialized) as per the World Bank's Disease Control Priorities Project. Ghana's annual trauma operation rate was compared with the New Zealand benchmark to quantify current met needs for trauma surgery.

RESULTS

About 232,776 operations were performed in Ghana; 35,797 were for trauma. Annual trauma operation rate was 134/100,000 (95% UI: 98-169), only 12% of the New Zealand benchmark. District hospitals performed 62% of all operations in the country, but performed only 38% of trauma operations. Eighty seven percentage of trauma operations were deemed "essential". Among specialized trauma operations, only open reduction and internal fixations had even modest numbers (3483 operations). Most other specialized trauma operations were rare.

CONCLUSIONS

Ghana has a large unmet need for operative trauma care. The low percentage of trauma operations in district hospitals indicates an even greater unmet need in rural areas. Future global surgery benchmarking should consider benchmarks for trauma and other specialties, as well as for different hospital levels.

The Cost of Managing Occupational Injuries Among Frontline Construction Workers in Ghana

BACKGROUND

The cost burden of occupational injuries has significant effects on the social well-being of workers. Although there seems to be growing evidence on the cost burden on other public health issues, little is known about occupational injuries, especially in low- to middle-income countries including Ghana.

OBJECTIVE

This study, therefore, sought to estimate the cost burden of managing occupational injuries among frontline construction workers.

METHODS

A prevalence-based cost of illness approach was used to estimate the cost burden of construction injuries. A structured questionnaire was used to collect cost-related data from 640 frontline construction workers. Descriptive statistics were used to estimate direct and indirect cost of injuries using Microsoft Excel and STATA version 14.

RESULTS

Overall, a worker spends an average of GHC 104.84 ($24.52) and GHC 180.89 ($42.31) as direct and indirect costs, respectively. Compared with other injuries, fracture had the highest average cost, GHS 343.33 ($80.30), and concussion and internal injury recorded the lowest cost. Also, compared with other trade specialties, carpenters had the highest average cost burden and laborers had the lowest burden.

CONCLUSION

There is high direct and indirect cost for managing occupational injury among construction workers. Advocacy and awareness about workplace insurance and regulatory policies should adequately be strengthened and prioritized through periodic monitoring and evaluations.

Different anatomical sites of the foreign body injury with 2999 children during 2012-2016

PURPOSE

This study aimed to analyze the clinical characteristic of different foreign body injuries in children and offer the preventions.

METHODS

A retrospective study and the demographic information, injury causes, foreign body injury types and other clinical factors were recorded and analyzed.

RESULTS

Of the 2999 patients, 1877 (62.6%) were boys and 1122 (37.4%) were girls. The majority (72.8%, n = 2184) of the injuries were found in 1-3 years old children. The most common anatomical site was the respiratory tract (73.4%, n = 2201) followed by the digestive tract (18.6%, n = 558), the genitourinary tract (1.93%, n = 58) and other sites (6.07%, n = 182). There were 60.4% of the in-patients from rural areas and 53.2% of the patients without medical insurance, the rate of cost by medical insurance increased with age. The medians of length of hospital stay and hospitalization cost were four days and 4767.3 CNY respectively. Most of the patients had surgical treatment (90.6%, n = 2717) and 64.9% of them had the complications (n = 1946). The cure rates of the all foreign body injuries types were above 90%, especially in genitourinary tract (98.3%).

CONCLUSION

Different types of the foreign body injuries had dissimilar clinical characteristics. The effective prevention and control measures should be taken according to the variety of high-risk population, incidence season and foreign body injury types.

Non-adult child supervision practices in Lao People's Democratic Republic

Researchers have paid little attention to non-adult child supervision and the prevalence and factors influencing this practice in low-income countries. A better understanding of this phenomenon is needed to inform the development and implementation of policies and interventions to enhance child supervision in those settings. This study explores the prevalence and factors associated with young children being home alone or under the care of another young child in Lao People's Democratic Republic. Using the 2011-2012 Lao Social Indicator Survey (N = 10,740 for the subsample of 'child was home alone' and N = 10,539 for the subsample of 'child cared by another child < 10 years of age'), multi-level Poisson regressions were performed to determine the number of days children under five years of age were home alone or under the care of another child younger than 10 years of age. Large discrepancies across provinces and between urban and rural populations within each province were found. Children living in rural areas were more than five times more likely to be unsupervised than children living in urban settings (incidence rate ratio, IRR 5.2; 95% CI: 1.8-15.2), and children living in rural areas were nearly twice more likely to be under the care of another child than children living in urban settings (IRR 1.9; 95% CI: 1.3-2.8). Age was also a common factor in explaining variation in both dependent variables. Policies aimed at facilitating adequate child care and supervision should consider rurality to increase children's protection.

Incidence and characteristics of unintentional injuries among children in a resource limited setting in Kampala, Uganda

Given that little is known about the epidemiology of unintentional injuries in children in low-income countries, this study sought to determine the incidence and characteristics of unintentional injuries among children aged ≤18 years in a slum community in Uganda. From a household survey, the incidence and odds ratios for factors associated with unintentional injury characteristics were calculated. Of 1583 children, 706 had suffered 787 unintentional injuries yielding an annual incidence rate of 497 injuries per 1000 children. Commonest injuries were cuts, bites or open wounds (30.6%) and bruises or superficial injuries (28.6%) with majority (75.5%) occurring at home. Boys were more likely to be injured at school (AOR 4.34; 95% CI 1.22-15.54) and to be injured from falls (AOR 1.41; 95% CI 1.01-1.96). Older children (12-18 years) were more likely to suffer from fractures (AOR 2.37; 95% CI 1.26-4.43), concussions and organ system injuries (AOR 3.58; 95% CI 1.03-12.39) and cuts, bites or open wounds (AOR 2.05; 95% CI 1.21-3.48). Older children were less likely to suffer burns or scalds as compared to the young children (AOR: 0.23; 95% CI 0.11-0.50). Unintentional injury incidence rate was high among children with most occurring in the homes.

Unintentional Childhood Injuries in Urban and Rural Ujjain, India: A Community-Based Survey

Injuries are a major global public health problem. There are very few community-based studies on childhood injury from India. The objective of this cross-sectional, community-based survey was to identify the incidence, type, and risk factors of unintentional childhood injuries. The study was done in seven villages and ten contiguous urban slums in Ujjain, India. World Health Organization (WHO) tested tools and definitions were used for the survey, which included 2518 households having 6308 children up to 18 years of age, with 2907 children from urban households and 3401 from rural households. The annual incidence of all injuries was 16.6%, 95% Confidence Interval 15.7-17.5%, (n = 1049). The incidence was significantly higher among boys compared to girls (20.2% versus 12.7%, respectively), was highest in age group 6-10 years of age (18.9%), and in urban locations (17.5%). The most commonly identified injury types were: physical injuries (71%), burns (16%), poisonings (10%), agriculture-related injuries (2%), near drowning (2%), and suffocations (2%). The most common place of injury was streets followed by home. The study identified incidence of different types of unintentional childhood injuries and factors associated with increased risk of unintentional injuries. The results can help in designing injury prevention strategies and awareness programs in similar settings.

Fatal and non-fatal injury outcomes: results from a purposively sampled census of seven rural subdistricts in Bangladesh

BACKGROUND

90% of the global burden of injuries is borne by low-income and middle-income countries (LMICs). However, details of the injury burden in LMICs are less clear because of the scarcity of data and population-based studies. The Saving of Lives from Drowning project, implemented in rural Bangladesh, did a census on 1·2 million people to fill this gap. This Article describes the epidemiology of fatal and non-fatal injuries from the study.

METHODS

In this study, we used data from the baseline census conducted as part of the Saving of Lives from Drowning (SoLiD) project. The census was implemented in 51 unions from seven purposively sampled rural subdistricts of Bangladesh between June and November, 2013. Sociodemographic, injury mortality, and morbidity information were collected for the whole population in the study area. We analysed the data for descriptive measures of fatal and non-fatal injury outcomes. Age and gender distribution, socioeconomic characteristics, and injury characteristics such as external cause, intent, location, and body part affected were reported for all injury outcomes.

FINDINGS

The census covered a population of 1 169 593 from 270 387 households and 451 villages. The overall injury mortality rate was 38 deaths per 100 000 population per year, and 104 703 people sustained major non-fatal injuries over a 6-month recall period. Drowning was the leading external cause of injury death for all ages, and falls caused the most number of non-fatal injuries. Fatal injury rates were highest in children aged 1-4 years. Non-fatal injury rates were also highest in children aged 1-4 years and those aged 65 years and older. Males had more fatal and non-fatal injuries than females across all external causes except for burns. Suicide was the leading cause of injury deaths in individuals aged 15-24 years, and more than 50% of the suicides occurred in females. The home environment was the most common location for most injuries.

INTERPRETATION

The burden of fatal and non-fatal injuries in rural Bangladesh is substantial, accounting for 44 050 deaths and 21 million people suffering major events annually. Targeted approaches addressing drowning in children (especially those aged 1-4 years), falls among the elderly, and suicide among young female adults are urgently needed to reduce injury deaths and morbidity in Bangladesh.

FUNDING

Bloomberg Philanthropies.

Incidence, patterns and risk factors for injuries among Ugandan children

There is limited epidemiological data on childhood injuries in developing countries. This study assessed the incidence, patterns and risk factors for injuries among children aged 0-5 years in Wakiso District, Uganda. To determine differences, chi-square and Wilcoxon rank sum tests were used. Risk factors were assessed using Poisson regression. Overall, information from 359 children of mean age 32 months (SD: 18.4) was collected. Annual incidence of injuries was 69.8 per 1000 children/year (95% CI 58.8-80.8). One fatal injury due to burns was reported. Incidence of injuries was less associated with being female (IRR: 0.56, 95% CI 0.34-0.90) and increasing age of the caretaker (IRR: 0.96, 95% CI 0.92-0.99). The high incidence of childhood injuries necessitates the need for interventions to reduce injuries among children.

Orthopaedic Trauma Care Capacity Assessment and Strategic Planning in Ghana: Mapping a Way Forward

BACKGROUND

Orthopaedic conditions incur more than 52 million disability-adjusted life years annually worldwide. This burden disproportionately affects low and middle-income countries, which are least equipped to provide orthopaedic care. We aimed to assess orthopaedic capacity in Ghana, describe spatial access to orthopaedic care, and identify hospitals that would most improve access to care if their capacity was improved.

METHODS

Seventeen perioperative and orthopaedic trauma care-related items were selected from the World Health Organization's Guidelines for Essential Trauma Care. Direct inspection and structured interviews with hospital staff were used to assess resource availability and factors contributing to deficiencies at 40 purposively sampled facilities. Cost-distance analyses described population-level spatial access to orthopaedic trauma care. Facilities for targeted capability improvement were identified through location-allocation modeling.

RESULTS

Orthopaedic trauma care assessment demonstrated marked deficiencies. Some deficient resources were low cost (e.g., spinal immobilization, closed reduction capabilities, and prosthetics for amputees). Resource nonavailability resulted from several contributing factors (e.g., absence of equipment, technology breakage, lack of training). Implants were commonly prohibitively expensive. Building basic orthopaedic care capacity at 15 hospitals without such capacity would improve spatial access to basic care from 74.9% to 83.0% of the population (uncertainty interval [UI] of 81.2% to 83.6%), providing access for an additional 2,169,714 Ghanaians.

CONCLUSIONS

The availability of several low-cost resources could be better supplied by improvements in organization and training for orthopaedic trauma care. There is a critical need to advocate and provide funding for orthopaedic resources. These initiatives might be particularly effective if aimed at hospitals that could provide care to a large proportion of the population.

Fires in refugee and displaced persons settlements: The current situation and opportunities to improve fire prevention and control

INTRODUCTION

We aimed to describe the burden of fires in displaced persons settlements and identify interventions/innovations that might address gaps in current humanitarian guidelines.

METHODS

We performed a systematic review of: (i) academic and non-academic literature databases; and (ii) guidelines from leading humanitarian agencies/initiatives regarding fire prevention/control.

RESULTS

Of the 1521 records retrieved, 131 reports described settlement fires in 31 hosting countries since 1990. These incidents resulted in 487 deaths, 790 burn injuries, displacement of 382,486 individuals and destruction of 50,509 shelters. There was a 25-fold increase in the rate of settlement fires from 1990 to 2015 (0.002-0.051 per 100,000 refugees, respectively). Only 4 of the 15 leading humanitarian agencies provided recommendations about fire prevention/control strategies. Potentially useful interventions/innovations included safer stoves (e.g. solar cookers) and fire retardant shelter materials.

CONCLUSION

The large and increasing number of fires in displaced persons settlements highlights the need to redress gaps in humanitarian fire prevention/control guidelines. The way forward includes: (i) developing consensus among aid agencies regarding fire prevention/control strategies; (ii) evaluating the impact of interventions/innovations on the burden of fires; and (iii) engaging agencies in a broader discussion about protecting camp residents from armed groups.

Barriers to Essential Surgical Care in Low- and Middle-Income Countries: A Pilot Study of a Comprehensive Assessment Tool in Ghana

BACKGROUND

Beyond resource deficiencies, other barriers to care prevent patients from receiving surgery in low- and middle-income countries (LMICs). This study aimed to develop and pilot a comprehensive, generalizable tool for assessing the barriers to surgical care.

METHODS

Sociodemographic, clinical and 38 questions regarding potential barriers to surgical care were asked during a surgical outreach to two district and one regional hospital in Upper East Region, Ghana. Sites were selected to capture individuals with prolonged unmet surgical needs and represent geographic, socioeconomic, and healthcare development differences. Results were indexed into three dimensions of barriers to care (i.e., 'acceptability,' 'affordability,' and 'accessibility') so that communities could be compared and targeted interventions developed.

RESULTS

The tool was administered to 148 participants (98 % response rate): Bolgatanga 54 (37 %); Amiah 16 (11 %); and Sandema 78 (52 %). Amiah had the fewest barriers to surgical care (median index 8.3; IQR 7.6-9.3), followed by Sandema (8.2; IQR 5.3-9.2) and Bolgatanga (6.7; IQR 3.9-9.5). Individual dimension scores (i.e., acceptability, affordability, accessibility) ranged from 10.8 to 18 out of 18 possible points. Main factors contributing to low dimension scores were different between communities: Bolgatanga-cost and healthcare navigation; Amiah-social marginalization and poor medical understanding; Sandema-distance to surgically capable facility.

CONCLUSION

This study identified a number of significant barriers, as well as successes for patients' ability and willingness to access surgical care that differed between communities. The tool itself was well accepted, easy to administer and provided valuable data from which targeted interventions can be developed.

Prevalence of preventable household risk factors for childhood burn injury in semi-urban Ghana: A population-based survey

OBJECTIVE

Childhood burns are a leading cause of injury in low- and middle-income countries; most of which are preventable. We aimed to describe the prevalence of household risk factors for childhood burn injury (CBI) in semi-urban Ghana to inform prevention strategies for this growing population.

METHODS

We conducted a population-based survey of 200 households in a semi-urban community in Ghana. Households were randomly selected from a list of 6520 households with children aged <18 years. Caregivers were interviewed about CBI within the past 6 months and potentially modifiable household risk factors.

RESULTS

Of 6520 households, 3856 used charcoal for cooking (59%) and 3267 cooked indoors (50%). In 4544 households (70%), the stove/cooking surface was within reach of children under-five (i.e., <1m). Higher household wealth quintiles (OR 0.95; 95%CI 0.61-1.49) and increasing age (OR 0.82; 95%CI 0.68-0.99) were associated with lower odds of CBI. Living in uncompleted accommodation (OR 11.29; 95%CI 1.48-86.18 vs rented room) and cooking outside the house (OR 1.13; 95%CI 0.60-2.14 vs cooking indoors) were also predictive of CBI.

CONCLUSIONS

This study identified a high prevalence of CBI risk factors in semi-urban households that may benefit from targeted community-based prevention initiatives.

Pediatric First Aid Practices in Ghana: A Population-Based Survey

INTRODUCTION

Children in low- and middle-income countries (LMIC) often receive care outside the formal medical sector. Improving pre-hospital first aid has proven to be highly cost-effective in lowering trauma mortality. Few studies in LMIC have examined home first aid practices for injured children.

METHODS

We conducted a representative population-based survey of 200 caregivers of children under 18 years of age, representing 6520 households. Caregivers were interviewed about their first aid practices and care-seeking behaviors when a child sustained an injury at home. Injuries of interest included burns, lacerations, fractures and choking. Reported practices were characterized as recommended, low-risk, and potentially harmful.

RESULTS

For common injuries, 75-96% of caregivers reported employing a recommended practice (e.g., running cool water over a burn injury). However, for these same injuries, 13-61% of caregivers also identified potentially harmful management strategies (e.g., applying sand to a laceration). Choking had the highest proportion (96%) of recommended first aid practice: (e.g., hitting the child's back) and the lowest percent (13%) of potentially harmful practices (e.g., attempting manual removal). Fractures had the lowest percent (75%) of recommended practices (e.g., immediately bringing the child to a health facility). Burns had the highest percent (61%) of potentially harmful practices (e.g., applying kerosene).

CONCLUSIONS

While most caregivers were aware of helpful first aid practices to administer for a child injury, many parents also described potentially harmful practices or delays in seeking medical attention. As parents are the de facto first responders to childhood injury, there are opportunities to strengthen pre-hospital care for children in LMICs.

Routine systemic antibiotic prophylaxis for burn injuries in developing countries: A best evidence topic (BET)

BACKGROUND

Burns are common in low- and middle-income countries (LMICs) and complicated by unhygienic conditions, malnutrition, use of high-risk homemade dressings and delayed presentation. Resultantly, use of routine systemic antibiotic prophylaxis (SAP) to prevent wound infection is common practice despite this intervention being abandoned in high-income countries due to increased antimicrobial resistance and non-bacterial suprainfection.

METHODS

A best evidence topic (BET) was constructed using a structured protocol. The question addressed was: In LMICs, does routine use of SAP reduce burn wound infection, morbidity or mortality?

RESULTS

From 704 retrieved records, 48 reports met criteria to be examined. Of those, 3 studies represented the best available evidence. Together, two randomized clinical trials (RCTs) and a retrospective cohort study reported no difference in the proportion of wound infection, any infection or length of hospital stay between SAP groups and controls. One RCT described a greater proportion of wounds infected with P. aeruginosa among SAP arms compared to controls. The studies had few participants and significant methodological weaknesses.

CONCLUSION

On the basis of limited, currently available evidence, the use of SAP cannot be recommended for patients in LMICs that present soon after burn injury.