Community-based home injury risk assessment in rural Nepal

ABSTRACTBackground: Unintentional injuries in the home are an important cause of death and disability among young children globally. However, in many parts of the world, particularly in the Low and Middle-Income Countries (LMICs) like Nepal, there is dearth of data regarding home injuries and home hazards to guide the development of effective interventions, and policies for preventing childhood home injuries. Aims: To explore the environmental risks associated with unintentional injuries amongst children aged 0-59 months in the Makwanpur district of Nepal, and to explore the potential for changes to the home environment to prevent injury occurrence.Methods: This study employed a multi-method approach. First, a literature review was undertaken to understand what environmental hazards had previously been identified and whether environmental change interventions are effective in reducing home hazards or home injuries in LMICs. Next, community-based studies were designed to collect both quantitative and qualitative information to best understand the problem of home injury risks in the study area. For this, quantitative data were collected through a community-based household survey (740 households) to understand home injury hazards and the injuries, and qualitative data were collected through five focus groups (FGs) to obtain perceptions on injuries and community-identified solutions to improve the safety of the home environment.Results: The literature review highlighted the limited evidence available from studies exploring the effectiveness of environmental change interventions in reducing childhood home injuries or injury hazards in LMICs. The household survey and home hazard assessment revealed a significant burden of hazards for childhood injuries within the home environment. Total of 242/1042 childre

Assessment of home hazards for non-fatal childhood injuries in rural Nepal: A community survey

Background: Unintentional injuries in and around the home are important causes of preventable death and disability among young children globally. In Nepal, there is a lack of data regarding home injuries and home hazards to guide the development of effective interventions for preventing childhood home injuries. This study aimed to determine the burden of unintentional home injuries in children < 5 years in rural Nepal and quantify the injury hazards in their homes.Methods: A survey was conducted in 740 households in rural areas of the Makwanpur district during February and March 2015. The primary carer reported home injuries which occurred in the previous 3 months and data collector observation identified the injury hazards. Injury incidence, mechanism and the proportion of households with different hazards were described. Multivariable logistic regression explored associations between the number and type of home hazards and injuries.Results: Injuries severe enough to need treatment, or resulting in non-participation in usual activities for at least a day, were reported in 242/1042 (23.2%) children < 5 years. The mean number of injury hazards per household was 14.98 (SD=4.48), range of 3–31. Regression analysis found an estimated increase of 31% in the odds of injury occurrence associated with each additional injury hazard found in the home (adjusted OR 1.31; 95% CI 1.20 to 1.42).Conclusions: A high proportion of young children in rural Nepal sustained injuries severe enough to miss a day of usual activities. Increased frequency of hazards was associated with an increased injury risk

Improving estimates of injury burden in Nepal: A qualitative study

Background: Routinely collected injury data can help to identify populations at risk of injury, circumstances surrounding those injuries, and can be used to develop targeted interventions. However, routinely collected injury data in Nepal are at risk of being incomplete or poorly coded and are underutilised. Therefore, this study aimed to explore the strengths, and opportunities for improvement, of systems that routinely measure injury incidence in Nepal.Methods: This study employed a qualitative design where data were collected through interviews with personnel working in four routine data systems; the Health Management Information System, the Road Accident Reporting System, the Daily Incident Reporting System, and the Civil Registration System. Interviews were conducted with front-line data collectors as well as strategic decision makers working in these data systems. Interviews were audio-recorded, transcribed, translated into English and analysed using framework analysis.Results: A total of 32 interviews were completed, 19 interviews with front-line data collectors and 13 interviews with strategic decision makers. The data recording and reporting process of the four systems were identified and described. The analysis of data yielded 11 themes that described the strengths and limitations of the data collected through the four systems, challenges for effective data systems, and user recommendations for system improvement.Conclusions: This study identified the strengths, limitations, system challenges, and opportunities to improve data quality of each of the four routine data collection systems. These findings may be useful in engaging stakeholders in strengthening existing routine injury data collection systems or implementing alternative systems

Establishing injury surveillance in emergency departments in Nepal: Protocol for mixed methods prospective study

Background: Globally, injuries cause more than 5 million deaths annually, a similar number to those from HIV, Tuberculosis and Malaria combined. In people aged between 5 and 44 years of age trauma is the leading cause of death and disability and the burden is highest in low- and middle-income countries (LMICs). Like other LMICs, injuries represent a significant burden in Nepal and data suggest that the number is increasing with high morbidity and mortality. In the last 20 years there have been significant improvements in injury outcomes in high income countries as a result of organised systems for collecting injury data and using this surveillance to inform developments in policy and practice. Meanwhile, in most LMICs, including Nepal, systems for routinely collecting injury data are limited and the establishment of injury surveillance systems and trauma registries have been proposed as ways to improve data quality and availability. Methods: This study will implement an injury surveillance system for use in emergency departments in Nepal to collect data on patients presenting with injuries. The surveillance system will be introduced in two hospitals and data collection will take place 24 h a day over a 12-month period using trained data collectors. Prospective data collection will enable the description of the epidemiology of hospital injury presentations and associated risk factors. Qualitative interviews with stakeholders will inform understanding of the perceived benefits of the data and the barriers and facilitators to embedding a sustainable hospital-based injury surveillance system into routine practice. Discussion: The effective use of injury surveillance data in Nepal could support the reduction in morbidity and mortality from adult and childhood injury through improved prevention, care and policy development, as well as providing evidence to inform health resource allocation. This study seeks to test a model of injury surveillance based in emergency departments and explore factors that have the potential to influence extension to additional settings

Home environmental change for child injury prevention in Nepal: A qualitative study

In Nepal, unintentional home injury is a leading reason for death and disability among pre-school children. However, there is a lack of evidence to inform culturally appropriate interventions to reduce home injuries. This study explored the potential for home environmental change at a community level to prevent unintentional home injury in children and identified the barriers to, and facilitators of, such changes. Focus groups were conducted in the Nepali language with mothers, fathers, teachers, school students and community health volunteers in rural areas of Makwanpur district in Nepal. The discussions were audio-recorded, transcribed, translated into English and analysed thematically. NVivo software was used to support coding and identification of themes. Five focus groups, involving forty-seven participants, were completed leading to the development of four themes. Overall, the findings highlight that community people perceive injuries to be a normal part of childhood and, therefore few prevention measures were considered. Parents were however, able to identify ways to change their environment that made it safer. Changes included removing hazards or adding safety equipment, adapting the home or restricting access to potential hazards. Barriers to implementation included limited awareness about injury hazards and risk management, poor quality housing and financial constraint. Facilitators included raising community awareness, acquiring resources and financial support and involving the family and community. Development of interventions to prevent injuries at home in pre-school children should reflect local context and culture; this is best achieved through engagement with parents

Epidemiology of paediatric injuries in Nepal: Evidence from emergency department injury surveillance

BACKGROUND: Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS: A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS: The total number of childre

The epidemiology of injuries in adults in nepal: Findings from a hospital-based injury surveillance study

This study aimed to develop and evaluate a model of hospital-based injury surveillance and describe the epidemiology of injuries in adults. One-year prospective surveillance was conducted in two hospitals in Hetauda, Nepal. Data were collected electronically for patients presenting to emergency departments (EDs) with injuries between April 2019 and March 2020. To evaluate the model's sustainability, clinical leaders, senior managers, data collectors, and study coordinators were interviewed. The total number of patients with injuries over one year was 10154, representing 30.7% of all patients visiting the EDs. Of patients with injuries, 7458 (73.4%) were adults 18 years and over. Most injuries (6434, 86%) were unintentional, with smaller proportions due to assault (616, 8.2%) and self-harm (408, 5.5%). The median age of adult patients was 33 years (IQR 25-47). Males had twice the rate of ED presentation compared with females (40.4 vs 20.9/1000). The most common causes were road traffic (32.8%), falls (25.4%), and animal/insect related (20.1%). Most injured patients were discharged after treatment (80%) with 9.1% admitted to hospital, 8.1% transferred to other hospitals and 2.1% died. In Nepal, hospital-based injury surveillance is feasible, and rich injury data can be obtained by embedding data collectors in EDs

Nepali migrant workers and their occupational health hazards in the workplace: a scoping review

An increasing number of people are relocating to search for work, leading to substantial implications for both local and global health. Approximately 3.6% of the global population (281 million) migrates annually. Nepal has experienced a notable surge in labour migration in recent years, with a substantial proportion of its residents actively seeking work opportunities abroad. Understanding work-related risks is crucial for informing policies, interventions, and practices that can improve the welfare of this hard-to-reach population. This scoping review aims to systematically identify and analyse occupational health hazards encountered by Nepali migrant workers employed overseas. Medline, Scopus, Directory of Open Access Journals (DOAJ), and the NepJOL databases were systematically searched for primary research papers published in English up to July 2024. Relevant data, including workplace hazards and their impact on health outcomes, were extracted and narratively synthesised by highlighting key themes in the existing literature. A total of 24 articles met the inclusion criteria and were included in this review. Of these, twelve studies were conducted in Nepal, five in Gulf countries, four in Malaysia, two in Hong Kong, and one each in India and Korea. Workplace injuries (motor vehicle injuries, machinery injuries, falls from a height, and falls on a heavy object), poor working environment (including long working hours, work without leave, discrepancy in pay scale, limited access to drinking water and toilet/bathroom facilities), workplace abuse, sexual abuse, and torture were identified as key occupational health hazards faced by the Nepali migrant workers abroad. Multi-level intervention strategies, such as safety training standards, improving working conditions, and eliminating exploitative labour practices, are critical to improving occupational health and safety standards for Nepali migrant workers abroad. This includes creating a supportive working environment where employees can easily and timely access health services as needed

Burden of injuries in Nepal, 1990–2017: Findings from the Global Burden of Disease Study 2017

Background: Nepal is a low-income country undergoing rapid political, economic and social development. To date, there has been little evidence published on the burden of injuries during this period of transition.Methods: The Global Burden of Disease Study (GBD) is a comprehensive measurement of population health outcomes in terms of morbidity and mortality. We analysed the GBD 2017 estimates for deaths, years of life lost, years lived with disability, incidence and disability-adjusted life years (DALYs) from injuries to ascertain the burden of injuries in Nepal from 1990 to 2017.Results: There were 16 831 (95% uncertainty interval 13 323 to 20 579) deaths caused by injuries (9.21% of all-cause deaths (7.45% to 11.25%)) in 2017 while the proportion of deaths from injuries was 6.31% in 1990. Overall, the injury-specific age-standardised mortality rate declined from 88.91 (71.54 to 105.31) per 100 000 in 1990 to 70.25 (56.75 to 85.11) per 100 000 in 2017. In 2017, 4.11% (2.47% to 6.10%) of all deaths in Nepal were attributed to transport injuries, 3.54% (2.86% to 4.08%) were attributed to unintentional injuries and 1.55% (1.16% to 1.85%) were attributed to self-harm and interpersonal violence. From 1990 to 2017, road injuries, falls and self-harm all rose in rank for all causes of death.Conclusions: The increase in injury-related deaths and DALYs in Nepal between 1990 and 2017 indicates the need for further research and prevention interventions. Injuries remain an important public health burden in Nepal with the magnitude and trend of burden varying over time by cause-specific, sex and age group. Findings from this study may be used by the federal, provincial and local governments in Nepal to prioritise injury prevention as a public health agenda and as evidence for country-specific interventions

Usefulness of hospital emergency department records to explore access to injury care in Nepal

© 2016, Bhatta et al. Background: Injuries are a major public health problem worldwide. Despite increasing morbidity and mortality from injuries in Nepal, it is not recognised in the government’s policy and programmes and few population-based studies have been published. This study describes the usefulness of hospital emergency department records to explore access to injury care in Nepal. Methods: A retrospective ED-based study was conducted at a governmental hospital in Nepal to review the routinely collected data for 1year (1 January 2010 to 31 December 2010). The study was designed to provide cross-sectional data to describe the distribution of injuries by age, gender, ethnic group and injury mechanism. Results: Results showed that twice as many males as females attended the emergency department (14.6 vs. 7.0 per 1000), attendance varied by age with most (39.8%) attendances in young adults of working age and over half of attendances were from just two ethnic groups (Brahmin (26%) and Tamang (25.5%). Road traffic injuries were the most common cause of injury (37.6%). Conclusions: This study therefore showed the feasibility of using routinely collected hospital emergency department data to monitor injury inequalities in Nepal