Background
Traumatic injury affects nearly 5.8 million people annually and causes 10% of the
world's deaths. In this study we aimed to estimate injury prevalence, to describe
risk-factors and mechanisms of injury, and to estimate the number of injury-related
deaths in Nepal, a low-income South Asian country.
Methods
A cluster randomized, cross-sectional nationwide survey using the Surgeons OverSeas
Assessment of Surgical Need tool was conducted in Nepal in 2014. Questions were structured
anatomically and designed around a representative spectrum of operative conditions.
Two-stage cluster sampling was performed: 15 of 75 districts were chosen randomly
proportional to population; within each district, after stratification for urban and
rural populations, 3 clusters were randomly chosen. Injury-related results were analyzed.
Results
A total of 1,350 households and 2,695 individuals were surveyed verbally, with a response
rate of 97%. A total of 379 injuries were reported in 354 individuals (13.1%, 95%
confidence interval 11.9–14.5%), mean age of 32.6. The most common mechanism of injury
was falls (37.5%), road traffic injuries (19.8%), and burns (14.2%). The most commonly
affected anatomic site was the upper extremity (42.0%). Of the deaths reported in
the previous year, 16.3% were injury-related; 10% of total deaths may have been averted
with access to operative care.
Conclusion
This study provides baseline data on the epidemiology of traumatic injuries in Nepal
and is the first household-based countrywide assessment of injuries in Nepal. These
data provide valuable information to help advise policymakers and government officials
for allocation of resources toward trauma care.
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References
- Injuries and violence: the facts.World Health Organization, Geneva2010
- Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2095-2128
- Estimating operative disease prevalence in a low-income country: results of a nationwide population survey in Rwanda.Surgery. 2013; 153: 457-464
- Untreated surgical conditions in Sierra Leone: a cluster randomised, cross-sectional, countrywide survey.Lancet. 2012; 380: 1082-1087
- Surgical care in Nepal: Conditions, preventable deaths, procedures and validation of a countrywide survey.British Journal of Surgery. 2015; (In press)
- Traumatic injuries in developing countries: report from a nationwide cross-sectional survey of Sierra Leone.JAMA Surgery. 2013; 148: 463-469
- Injury, Disability and Access to Care in Rwanda: Results of a Nationwide Cross-Sectional Population Study.World J Surg. 2015; 39: 62-69
The World Bank. Nepal Data. 2014. Available from: http://data.worldbank.org/country/nepal. Accessed September 22, 2014.
- Epidemiology of surgical admissions to a children's disability hospital in Nepal.World J Surg. 2010; 34: 954-962
- Pilot testing of a population based survey tool in Sierra Leone.World J Surg. 2010; 36: 771-774
Department of Health Services. Ministry of Health and Population, Nepal. Annual Report. 2012. Available from: http://phpnepal.org/index.php?listId=453-.U6R7iJSSy2E. Accessed August 4, 2014
- Surgical needs of Nepal: pilot study of population based survey in Pokhara, Nepal.World J Surg. 2014; 38: 3041-3046
- A study of injuries and violence related articles in Nepal.JNMA J Nepal Med Assoc. 2009; 48: 209-216
- Assessing quality of existing data sources on road traffic injuries (RTIs) and their utility in informing injury prevention in the Western Cape Province, South Africa.Traffic Inj Prev. 2013; 14: 267-273
- Nepal may have enough doctors but they're in the wrong place.BMJ. 2014; 349: 4913
- Guidelines for essential trauma care.World Health Organization, Geneva2004
- The International Assessment of Capacity for Trauma (INTACT): an index for trauma capacity in low-income countries.J Surg Res. 2014; 190: 522-527
- Development of a novel global trauma system evaluation tool and initial results of implementation in the Republic of South Sudan.Injury. 2014; 45: 1731-1735
- Systematic review of trauma system effectiveness based on registry comparisons.J Trauma. 1999; 47: S46-S55
- Systematic review of published evidence regarding trauma system effectiveness.J Trauma. 1999; 47: S25-S33
- Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation.J Trauma. 2000; 48: 25-31
- Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development.J Trauma. 1998; 44 (discussion 812-4): 804-812
- Layperson trauma training in low- and middle-income countries: a review.J Surg Res. 2014; 190: 104-110
- Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program.World J Surg. 2009; 33: 2512-2521
- Trained lay first responders reduce trauma mortality: a controlled study of rural trauma in Iraq.Prehosp Disaster Med. 2010; 25: 533-539
- Prioritizing injury care: a review of trauma capacity in low and middle-income countries.J Surg Res. 2015; 193: 217-222
- The World Bank: working for a world free of poverty. Nepal transport sector.The World Bank, Washington (DC)2013 (Available from:) (Accessed November 13, 2014)
- Managing the injury burden in Nepal.Clin Orthop Relat Res. 2008; 466: 2343-2349
- The utility of the kampala trauma score as a triage tool in Sub-Saharan African trauma cohort.World J Surg. 2015; 39: 356-362
Article info
Publication history
Accepted:
December 3,
2014
Footnotes
The Association for Academic Surgery 2014 Global Surgery Research Fellowship Award and Surgeons OverSeas provided funding for logistics and transportation.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
