Effectiveness of helmets in preventing severe injuries in a setting with poorly enforced quality standards

Helmets save lives, yet many countries do not have laws about their quality assessment or how they should be worn. We assessed the effectiveness of helmet use in preventing injuries in such a setting. The data were extracted from a large road traffic injury surveillance study in Karachi, Pakistan. We assessed the association of wearing helmets with several injury outcomes including deaths, injury severity (via New Injury Severity Score, NISS ≥ 9) and moderate or severe injury (via Abbreviated Injury Score, AIS ≥ 2) to head, face, or other regions of the body. The data about helmet use was available for about 109,210 riders injured between January 2007 and December 2013. Only 6% of riders wore helmets, whereas this proportion was less than one percent in pillion riders and women. The rates were also lower among those aged 18 years or younger (1%) and those aged 18 to 25 years (4%). About 2% of riders died; 34% had an injury to the head region, 30% to face, 1% to chest, 5% to abdominal, 46% to extremities, and 61% to external body regions. Likelihood of dying was low among helmet users (adjusted odds ratio [aOR] = 0.37, 95% confidence interval [CI] = 0.28 to 0.50). Helmets reduced the likelihood of moderate to severe injuries to the head (aOR = 0.68, 95% CI = 0.58 to 0.80) but not to the face region (aOR = 1.37, 95%CI = 1.17 to 1.62). Helmet users also had severer injuries in other body regions except for chest injuries. Helmets prevented deaths and severe head injuries but had limited effectiveness in preventing facial injuries in this setting with poor helmet use standards. More work is needed to understand the helmet wearing and rider behaviours in helmet users in this setting

Emergency care of traumatic brain injuries in Pakistan: a multicenter study

Background: This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan. Methods: Data on TBI patients were extracted from a four-month surveillance study conducted in the emergency departments (ED) of seven large teaching hospitals. Emergency care access to physicians and imaging facilities were compared with respect to ED outcomes (discharged, admitted or dead). Out-of-pocket treatment costs (in United States dollars [USD]) were compared among different patient strata. Results: ED outcomes were available for 1,787 TBI patients. Of them, most were males (79%), aged \u3c25 years (46%) and arrived by ambulances (32%). Nurses or paramedical staff saw almost all patients (95%). Physicians with practice privileges (medical officers, residents or consultants) saw about half (55%) of them. Computerized tomography (CT) scans were performed in two of five patients (40%). Of all, 26% (n = 460) were admitted and 3% died (n = 52). Emergency care factors significantly associated with being admitted or died were arriving by ambulance (adjusted odds ratio [aOR] = 2.37, 95% confidence interval (CI) [95%CI] = 1.78-3.16); seen by medical officer/residents (aOR = 2.11; 95%CI = 1.49-2.99); and had CT scan (aOR = 2.93; 95%CI = 2.25-3.83). Out-of-pocket treatment costs at the ED were reported in 803 patients. Average costs were USD 8, (standard deviation [SD] = 23). Costs were twice as high in those arriving in ambulances (USD 20, SD = 49) or who underwent CT scans (USD 16, SD = 37). Conclusion: TBI patients\u27 access to ambulance transport, experienced physicians, and imaging facilities during emergency care needs to be improved in Pakistan

Spatial variations in COVID-19 risk perception and coping mechanism in Pakistan

The outbreak of novel coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization, which instigated governments to impose lockdowns across their countries. Amidst the lockdown in Pakistan, this study comprised measures of the COVID-19 risk perception, coping mechanism, and spatial variations. The data from 40 selected indicators was collected using an online questionnaire and grouped into domains (4 risk perception and 3 coping mechanisms domains). The results revealed the spatial variations and the levels of risk perception and coping mechanisms within the study area. Relative to each other, overall risk perception was highest in Northern Areas (Gilgit-Baltistan and Azad Jammu and Kashmir) and Islamabad, and lowest in Balochistan province. Very little spatial variation was observed in terms of coping mechanisms. Age, gender, and marital status influenced the risk perception associated with COVID-19. The findings suggest spatial variation in risk perception, implying the need for localized and modified COVID-19 risk communication and risk reduction strategies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s41324-022-00498-7

Differences in Reporting of Violence and Deliberate Self Harm Related Injuries to Health and Police Authorities, Rawalpindi, Pakistan

Background: The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan. Methods/Principal Findings: Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital\u27s ED, or both in Rawalpindi city from July 1, 2007 to June 30, 2008 were included. In Rawalpindi city, 1 016 intentional injury victims reported to police whereas 3 012 reported to ED. Comparing violence related fatality estimates (N = 56, 95% CI: 46–64), police reported 75.0% and ED reported 42.8% of them. Comparing violence related injury estimates (N = 7 990, 95% CI: 7 322–8 565), police reported 12.1% and ED reported 33.2% of them. Comparing DSH related fatality estimates (N = 17, 95% CI: 4–30), police reported 17.7% and ED reported 47.1% of them. Comparing DSH related injury estimates (N = 809, 95% CI: 101–1 516), police reported 0.5% and ED reported 39.9% of them. Conclusion: In Rawalpindi city, police records were more likely to be complete for violence related deaths as compared to injuries due to same mechanism. As compared to ED, police reported DSH related injuries and deaths far less than those due to other types of violence

The impact of psychological distance to climate change and urban informality on adaptation planning

Climate change adaptation planning involves adjusting to the impacts of climate change and taking action to mitigate its adverse effects. Psychological distance, the separation between one's self-perception and actual events, can play a significant role in an individual's readiness to adapt to climate change impacts. This study aims to investigate the socioeconomic factors associated with psychological distance to climate change in formal and informal settlements of Lahore, Pakistan. Using a literature review, data indicators were selected and grouped into the psychological distance dimensions of spatial, temporal, social, and hypothetical. A questionnaire survey was conducted in the study area, resulting in a total of 400 responses. Descriptive statistics and sampled paired t-tests were used to measure differences between responses from formal and informal communities, and multivariate regression models were developed to identify socioeconomic factors associated with psychological distance to climate change. The results of the study indicate a significant difference between formal and informal settlements in spatial distance and hypothetical dimensions. Additionally, household size, average household income, number of children, and past experiences with extreme weather conditions were found to be significant factors. The study recommends that these factors be taken into account when engaging with the public, communicating risks, and devising relevant policies for effective adaptation planning

Dead on arrival in a low-income country: results from a multicenter study in Pakistan

BACKGROUND: This study assessed the characteristics of dead on arrival (DOA) patients in Pakistan. METHODS: Data about the DOA patients were extracted from Pakistan National Emergency Department Surveillance study (Pak-NEDS). This study recruited all ED patients presenting to seven tertiary care hospitals during a four-month period between November 2010 and March 2011. This study included patients who were declared dead-on-arrival by the ED physician. RESULTS: A total of 1,557 DOA patients (7 per 1,000 visits) were included in the Pak-NEDS. Men accounted for two-thirds (64%) of DOA patients. Those aged 20-49 years accounted for about 46% of DOA patients. Nine percent (n = 72) of patients were brought by ambulance, and most patients presented at a public hospital (80%). About 11% of DOA patients had an injury. Factors significantly associated (p \u3c 0.05) with ambulance use were men (adjusted odds ratio [aOR] = 2.72), brought to a private hospital (OR = 2.74), and being injured (aOR = 1.89). Cardiopulmonary resuscitation (CPR) was performed on 6% (n = 42) of patients who received treatment. Those brought to a private hospital were more likely to receive CPR (aOR = 2.81). CONCLUSION: This study noted a higher burden of DOA patients in Pakistan compared to other resourceful settings (about 1 to 2 per 1,000 visits). A large proportion of patients belonging to productive age groups, and the low prevalence of ambulance and CPR use, indicate a need for improving the prehospital care and basic life support training in pakistan

Concordance Between Road Mortality Indicators in High-Income and Low- and Middle-Income Countries

Objective: Compare concordance between road mortality indicators in high-income (HICs) and low-and middle-income countries (LMICs). Methods: Study Design: Ecological study. Population: The most recent (from 2001 to 2006) one-year road traffic data were extracted from the World Road Statistics report, 2008. Analyses: Three road mortality indicators: per 100 000 inhabitants (M1), per 10 000 vehicles registered (M2), per 100 million vehicle kilometers traveled (M3) were computed. Concordances between indicators were assessed using scatterplots and intraclass correlation coefficient (ICC). Results: Out of 192 countries, M1 was available for 125, M2 for 114, and M3 for 60. Despite significant concordances between indicators in HICs (All ICC \u3e= 0.42, P Conclusion: Indicators in LMICs were not concordant possibly due to methodological differences in measuring traffic exposition and underreporting of fatalities

Burden and factors associated with highway work-zone crashes, on a section of the Karachi-Hala Road, Pakistan

Objective: To assess the burden and factors associated with highway work-zone (HWZ) crashes.Design Historical cohort. Setting: Section of the Karachi-Hala Road, Pakistan (196 km). Data: Police-reported crashes and traffic statistics from January 2006 to December 2008. Analysis: Crash and death risk between the HWZ and other zones for a 50 km section were compared. Crash locations were described for a further 146 km section on which factors associated with HWZ crashes were assessed. Results: HWZ crashes accounted for 15.0% of traffic crashes (N=180) and 30.8% of road fatalities (N=91) on the 196 km section. Rates were higher in the HWZ than other zones for crashes (rate ratio (RR) 2.35, 95% CI=1.17 to 4.70) and deaths (RR 4.70, 95% CI=2.11 to 10.46). Opposite-direction crashes (adjusted OR (aOR)=10.65, 95% CI=3.22 to 35.25) and traffic crashes involving pedestrians (aOR=6.03, 95% CI=1.39 to 26.20) and on wet surfaces (aOR=7.26, 95% CI=4.15 to 48.89) were significantly associated with the HWZ. Conclusion: These results support the introduction of prevention measures such as strict traffic enforcement, traffic separation, improving pedestrian visibility, and hazard signage at HWZs in Pakistan. The feasibility and effectiveness of these measures remains to be evaluated

Emergency care outcomes of acute chemical poisoning cases in Rawalpindi

Objective: To assess the emergency care outcomes of acute chemical poisoning cases in tertiary care settings in Rawalpindi, Pakistan. Methods: The data were extracted from an injury surveillance study conducted in the emergency departments (ED) of three tertiary care hospitals of Rawalpindi city from July 2007 to June 2008. The World Health Organization standard reporting questionnaire (one page) was used for recording information. Associations of patients' characteristics with ED care outcomes, i.e., admitted vs. discharged were assessed using logistic regression models. Results: Of 62530 injury cases reported, chemical poisoning was identified in 434 (0.7%) cases. The most frequent patient characteristics were poisoning at home (61.9%), male gender (58.6%), involving self-harm (46.0%), and youth aged 20–29 years (43.3%). Over two-thirds of acute poisoning cases (69.0%) were admitted. Acute poisoning cases were more likely to be admitted if they were youth aged 10–19 years [odds ratio (OR) = 4.41], when the poisoning occurred at home (OR = 21.84), and was related to self-harm (OR = 18.73) or assault (OR = 7.56). Conclusions: Findings suggest that controlling access of poisonous substances in youth and at homes might reduce related ED care burden. Safety promotion agencies and emergency physicians can use these findings to develop safety messages