Mortality from External Causes and Behavioral Mechanisms : An examination of data from low- and middle-income countries

External causes of mortality are among the leading causes of mortality, especially in low- and middle-income countries. External causes of mortality disproportionately affect youth and young adults, including those who are economically active. The aim of the following study series was to investigate trends and demographic associations of the injury-related mortality burden and suicidal behavior in low- and middle-income countries. Study I examined trends of external causes of mortality in Seychelles over a period of 30 years using civil registration data. At least three-quarters of injury deaths occurred among males. The leading causes of mortality among males was drowning, followed by road traffic injuries; and other unintentional injuries among females. The injury mortality declined over time; however, the injuries from road traffic crashes increased, especially among males. Study II analyzed trends of traumatic brain injury (TBI) related mortality in Seychelles over a span of 30 years using civil registration data. Males were more likely to die from TBI related injuries. TBIs contributed to one in five deaths from all the recorded external causes. Road traffic crashes were the leading mechanism of TBI related mortality. Study III estimated the prevalence of suicidal behavior and the associated contextual factors among adolescents in low- and middle-income countries using the Global School-based Student Health Survey data. Ten to eleven percent of adolescents had considered suicide, made a suicide plan, or attempted suicide in each case. The lowest prevalence was reported in the South East Asian region, while a higher prevalence was recorded in the low-income country regions of the Americas. The findings imply that effective policies tailored for low- and middle-income countries are required to reduce the high rates of injury mortality. Reducing injury mortality will contribute towards each respective economy by minimizing the losses of income faced by the economically active age groups, which will in turn be beneficial for the countries.Ulkoiset kuolinsyyt ovat nuorten aikuisten merkittävimpiä kuolinsyistä matala- ja keskituloisissa maissa. Tässä väitöstutkimuksessa tutkittiin tapaturmaisten vammojen aiheuttaman kuolleisuusuuden ja itsemurhakäyttäytymisen ilmaantuvuuden muutoksia matala- ja keskituloisissa maissa. Tutkimuksessa I tutkittiin ulkoisten kuolinsyiden kehityssuuntia Seychellien tasavallassa 30 vuoden ajanjaksolla hyödyntäen väestöpohjaisia rekistereitä. Tapaturmien osuus kaikista kuolemista koko väestössä oli 8,5 %. Miesten kuolemat kattoivat lähes 3/4 kaikista tapaturmaisista kuolemantapauksista. Miehillä yleisin kuolinsyy oli hukkuminen, ja naisilla muut tahattomat vammat. Koko väestössä tapaturmaiset kuolemantapaukset vähenivät tarkasteluajanjakson aikana. Tutkimuksessa II tutkittiin tapaturmaisten aivovammojen aiheuttamien kuolemantapauksien määrien kehityssuuntia Seychellien tasavallassa 30 vuoden ajanjaksolla käyttäen väestöpohjaisia rekistereitä. Miehet kuolivat naisia todennäköisemmin aivovammoihin ja niihin liittyviin muihin vammoihin. Aivovammat aiheuttivat joka viidennen kuoleman kaikista kuolemista, joissa oli ulkoinen syy. Tieliikenneonnettomuudet olivat aivovammojen aiheuttamien kuolemien yleisin mekanismi. Tutkimuksessa III tutkittiin itsemurhakäyttäytymisen esiintyvyyttä ja siihen liittyviä tekijöitä eräiden matala- ja keskituloisten maiden nuorten keskuudessa hyödyntäen Global School Health Survey -aineistoa. 10–11 % nuorista oli harkinnut itsemurhaa, tehnyt itsemurhasuunnitelman tai yrittänyt itsemurhaa. Alhaisin esiintyvyys havaittiin Kaakkois-Aasian alueella, kun taas korkein esiintyvyys Väli- ja Etelä-Amerikan matalatuloisten maiden alueilla. Tulokset osoittavat, että matala- ja keskituloisille maille räätälöityjä käytäntöjä tarvitaan tapaturmakuolleisuuden vähentämiseksi. Tapaturmakuolleisuuden tehokas vähentäminen vähentää työikäisten ikäryhmien menetettyjä työvuosia ja tuottaa merkittäviä taloudellisia säästöjä

Urban drinking and driving:comparison of electric scooter and bicycle related accidents in facial fracture patients

In recent years, electric scooters (e-scooter) have emerged as an alternative mode of urban transport due to their availability and effortless use. However, e-scooter-related trauma and injuries, especially to the head, have received wide media coverage and raised public concern about their safety. We aim to determine and compare clinically relevant variables, incidence, and severity between bicycle and e-scooter-related facial fractures and potential protective measures for injury prevention. This retrospective study comprised all patients admitted to a tertiary trauma center with bicycle or e-scooter-related facial fractures between January 2019 and October 2020. Patient- and injury-related variables, including demographics, injury mechanisms, helmet use, influence of alcohol, types of facial injuries, types of other injuries, given treatment, and hospital stay, were collected, analysed, and compared between bicycle and e-scooter injuries. Altogether 169 patients with facial fractures, 124 bicycle-related injuries (73.4%) and 45 e-scooter-related injuries (26.6%) were included. Alcohol involvement was significantly higher in e-scooter patients (88.9%) than in bicycle patients (31.5%) (p<0.001). Driving under the influence of alcohol was associated with driving without a helmet in both groups (p<0.001). In multivariate analyses, e-scooter accidents were 18 times more likely to occur under the influence of alcohol (OR 17.85, p<0.001) and were more likely to involve collision with a stationary object (OR 3.81, p=0.028). E-scooter patients were significantly younger (OR 0.95, p<0.001) and had significantly more cranial fractures (OR 10.15, p=0.014) than bicycle patients. Compared with patients in bicycle accidents, facial fracture patients injured in e-scooter accidents are younger, are more likely under the influence of alcohol, and sustain more severe craniofacial skeleton fractures. Our results for both groups of patients advocate stricter adherence to helmet and road safety legislation as well as public education for injury prevention

Sports-based distribution of facial fractures - findings from a four-season country

Objective The aim of this study was to elucidate the relationship between injury mechanisms and sports-related facial fractures, and to evaluate the changes in incidence rates of facial fractures sustained in sports-related events in a 30-year period. Material and methods This retrospective cohort study included all patients sports-related facial fractures admitted to a tertiary trauma centre during 2013-2018. Specific fracture types, sports, injury mechanisms as well as patient- and injury related variables are presented. The results underwent evaluated statistically with logistic regression analysis. Results Facial fractures occurred most frequently while playing ice hockey and football. Unilateral zygomatic-maxillary-orbital and isolated mandibular fractures accounted for 74.2% of all fracture types. In total, 99 patients (46.5%) required surgical intervention for their facial injuries. About 12.7% of patients sustained associated injuries in addition to facial fractures. Overall, the number of sports-related facial fractures has increased during the last three decades mostly due to the surging rates of ice hockey- and football-related facial fractures. Conclusions Sport-related facial fractures have markedly increased in different sports disciplines during the past decades. The use of safety gear to protect the facial area should be enforced particularly in ice hockey.Peer reviewe

Associated Injuries Are Common Among Patients With Bicycle-Related Craniofacial Fractures

Purpose: Ample evidence exists on the relationship between bicycle injuries and craniofacial fractures. However, as the mechanism behind these injuries is often multifactorial, the presence of associated injuries (AIs) in this study population requires further examination. We hypothesized that patients with craniofacial fracture injured in bicycle accidents are at high risk of sustaining severe AIs, especially those of the head and neck region. Patients and Methods: The investigators performed a retrospective study on all patients with bicyclerelated craniofacial fracture admitted to a tertiary trauma centre during 2013 to 2018. The predictor variable was defined as any type of craniofacial fracture. The outcome variable was defined as any kind of AI. Other study variables included demographic and injury-related parameters. Variables were analyzed using bivariate and Firth's logistic regression analyses. Results: A total of 407 patients were included in the analysis. Our results revealed that AIs were present in 150 (36.9%) patients; there were multiple AIs in 47 cases. Traumatic brain injuries followed by upper limb injuries were the most frequent AIs. Severe head and neck injuries were present in 20.1% of all patients with craniofacial fracture. AIs were observed in 57.4% of patients with combined midfacial fractures (P < .001). Helmet use had a protective effect against traumatic brain injuries (P < .001). Conclusions: Our results suggest that AIs are relatively common in this specific patient population. Close co-operation in multidisciplinary trauma centers allowing comprehensive evaluation and treatment can be recommended for patients with bicycle-related craniofacial fracture. (C) 2021 American Association of Oral and Maxillofacial Surgeons.Peer reviewe

Substance use and sociodemographic correlates among adolescents in a low-income sub Saharan setting

Background: The present study investigated the social and behavioral correlates of substance use, specifically bang or cocaine or similar drugs among a school-based sample of adolescents in a low-income urban settingMethods: The study utilized data on 2,176 school-attending adolescents aged 11-16 years in Dar es Salaam (DES) to examine social and behavioral correlates for lifetime substance use. The correlates under investigation included, demographic - age and gender; social - poverty, parent-adolescent relationship; behavioral – truancy, aggressive behavior, injury risk; psychological - depression and suicide ideation. Bivariate and multivariate analyses were then carried out on several variables identified from the 2006 Tanzanian Global School-based Health Survey (GSHS) questionnaire.Results: Approximately seven percent of school-attending adolescents (n=144) reported having used an illicit substance at least once during their lifetime. After adding significantly associated covariates into a logistic regression model, we found that only truancy [OR= 2.29 (CI=1.07 – 4.90)], suicide ideation [OR=4.36 (2.32 – 8.19)] and parents who had checked their adolescents' homework (OR=0.56 (CI=0.32 – 1.00)] were significantly associated with reported substance use.Conclusions: Our results suggest that health promotion programs should simultaneously target multiple factors associated with substance use behaviors among school-attending adolescents in Dar es Salaam. They should take into account the range of psychosocial characteristics of school-attending adolescents which may be impacted by or result from substance use.</p

Lower Back Pain as an Occupational Hazard Among Ugandan Health Workers

Background: Lower back pain is a public health concern affecting 70–85% of the world's population. There is paucity of published data on the prevalence, disability and risk factors for lower back pain among health workers in Uganda.Objective: To determine the frequency rate (note that is it implicit that frequency is a rate like incidence so including rate seems redundant here. This is bounded by zero and infinity. In contrast, prevalence is bounded by 0 and 1 and is thus a proportion not a rate) of lower back pain and its associated risks amongst health professionals in the Arua District of Uganda.Methods: Cross-sectional descriptive study of 245 consecutive participants conducted during February-April 2020. We stratified risks as individual or work related and analyzed the data using IBM SPSS version 25. Chi-square was used to measure the significance of association between categorical variables at 95% confidence interval, regarding a p ≤ 0.05 as significant.Results: The mean age of participants was 40.87 years ± 8.74 (SD), with female predominance (69.8%). Majority were either general nurses or midwives (64.9%) and more than half had practiced for over 6–10 years. The frequency rate of lower back pain was 39.6% (n = 97). Individual factors associated with LBP were; cigarette smoking (X2 = 33.040; P ≤ 0.001), alcohol consumption (X2 = 13.581; P ≤ 0.001), age (X2 = 14.717; P = 0.002), and female gender (X2 = 4.802; P = 0.028). The work related factors significantly associated with lower back pain were: being a nurse/midwife (X2 = 9.829; P = 0.007), working in the outpatient department (X2 = 49.752; P ≤ 0.001), bending (X2 = 43.912; P ≤ 0.001), lifting (X2 = 33.279; P X2 = 40.096; P ≤ 0.001), being in awkward positions (X2 = 15.607; P= X2 = 21.999; P ≤ 0.001).Conclusion: The frequency rate of low back pain was high amongst health workers and its main associated individual and work related factors could have been prevented. Health workers should strike a balance between caring for their personal back-health and meeting clients' needs while manually handling patients. Ergonomic structuring, job organization, back health care courses and use of assistive equipment could reduce such occupational hazards in our low resourced settings.</p

Ugandan Men Exposed to Intimate Partner Violence: A Cross-Sectional Survey of Nationally Representative Data

Although women typically constitute the largest proportion of the population who experience the deleterious effects of intimate partner violence (IPV), understanding the bidirectional nature of IPV is important for developing nuanced prevention initiatives. This study examines data from the 2016 Ugandan Demographic and Health Survey. Participants were selected from households in all the 15 regions in Uganda using a two stage sampling design. A total of 2858 men who were in a heterosexual union or separated/divorced were included in the analysis. Univariate and multivariable logistic regression analyses were performed with the aim of identifying associations between selected demographic variables and male exposure to all forms of IPV combined, psychological violence, physical violence and sexual violence. The prevalence of lifetime IPV and during the 12 months preceeding the survey respectively was 43.6 and 30.5% in all forms, with 35.9 and 24.8% reporting psychological, 20.2 and 11.9% for physical and 8.2 and 5.7% sexual violence. The key factors associated with all forms of IPV were being afraid of their wife/partner most of the time (OR = 5.10, 95% CI 2.91, 8.96) controlling behaviour of the intimate partner (OR = 3.80, 95% CI 2.84, 5.07), bi-directional violence against the partner (OR = 3.20, 95% CI 2.49, 4.12), alcohol consumption by the intimate partner (OR = 1.85, 95% CI 1.40, 2.45). The factors associated with males who experience IPV appear to be modifiable and may warrant consideration for inclusion in programs supporting both males and females who experience IPV

Lay Counselors’ Mental Wellness in Suicide Prevention after Prolonged Mass Trauma: A Pre- and Post-Training Appraisal

Information on the mental wellness of lay counselors in Uganda is unavailable. Sixty representatives of three sub counties in Gulu District in Northern Uganda were equipped with counseling skills through 40 hours of training over 5 days. The trainees completed the 32-item Response Inventory for Stressful Life Events (RISLE) immediately before the commencement of the training and soon after the completion of the training. Pretest prevalence of suicide ideation was 9.3%, and posttest prevalence was 11.1%. Immediate post-training assessment showed better overall mental wellbeing as judged by overall RISLE scores, which were statistically significantly lower post-training than pre-training for gender (P = 0.05) and marital status (P = 0.001) on most RISLE scores. Qualitative assessment after 3 months of training showed that trainees were less suicidal, and they had improved psychosocial functioning. The current results point to the need to pay attention to the mental wellness of volunteer counselors and support them in their role in preventing suicide in areas of mass trauma. We recommend robust randomized community trials to determine the role of the mental wellbeing of volunteer lay counselors in the provision of psychological first aid to communities exposed to prolonged mass trauma

Self-reported involvement in road traffic crashes in Kenya: A cross-sectional survey of a nationally representative sample

BackgroundRoad traffic crashes (RTCs) are a global public health burden whose resulting morbidity and mortality disproportionately impact low- and middle-income countries with stressed health systems. There is a paucity of published studies that evaluate the sociodemographic distribution of RTCs using nationally representative samples from the African region.AimTo examine population-wide associations between sociodemographic factors and involvement in RTCs in Kenya. Methods Data were obtained from the 2014 Kenyan Demographic Health Survey, representing all 47 counties in Kenya, from May to October of 2014. We estimated the prevalence of RTCs and utilized logistic regression for bivariate and multivariable analyses to determine the sociodemographic factors associated with RTCs. Study variables included age, place of residence, household wealth index, educational attainment, and history of alcohol consumption. We computed odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).ResultsA higher prevalence was reported among men (8.76%) versus women (3.22%). The risk factors among men included being 20-34 years of age, living in a rural area (OR 1.38, 95% CI 1.09, 1.74), drinking alcohol (OR 1.33, 95% CI 1.11, 1.59), and having not higher than a primary (OR 1.90, 95% CI 1.19, 3.03) or secondary (OR 1.68, 95% CI 1.04, 2.71) education. The strongest risk factors for women included the being aged 45-49 (OR 2.30, 95% CI 1.44, 3.67) and 20-24 years (OR 1.81, 95% 1.17, 2.79) as well as being in the fourth wealth quintile (OR 1.83, 95% CI 1.15, 2.91).ConclusionMen and the most economically productive age groups were more likely to report being involved in RTCs. Strategies to reduce the occurrences of RTCs should prioritize the most vulnerable sociodemographic groups.</p

Correlates for Suicidality Among At-risk Youth Receiving Community-Based Mental Health Services

"At-risk" adolescents are at high risk of unsuccessfully transitioning into adulthood and are also at elevated risk for suicidal behavior. Though much research has been conducted on risk factors for suicidality among the general adolescent population, research on suicidality among "at-risk" adolescents is lacking. This is a notable gap in the literature given that "at-risk" adolescents may be three times more likely to exhibit suicidality. The present study addressed this research gap by examining correlates for suicidality among "at-risk" adolescents receiving mental health services in the community. Using Electronic Health Record (EHR) data, risk factors for suicidality were analyzed at the bivariate and multivariate levels. Sexual abuse was a significant predictor of suicidality, as well as impulsivity for suicide attempt only. These findings may serve as useful adjuncts in the design of suicidality-screening tools and follow-up practices within the context of community-based mental health organizations which target at-risk adolescents