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

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

Views of professional stakeholders on readiness for a safe road system in Nepal; an exploratory qualitative study

Road traffic injuries in Nepal are increasing despite being largely preventable. Little evidence exists regarding the barriers and facilitators to a safer road system. This study aimed to explore the perspectives of professionals whose jobs had the potential to influence road safety in Nepal regarding challenges and potential solutions. Semi-structured interviews with eight informants from diverse roles were analysed thematically. Three themes were identified: Modifying behaviours of road users; Road planning, construction and maintenance; and the Governance of roads and traffic. All participants considered the primary cause of crashes to be the negligent behavior of the road users, suggesting that improved knowledge would influence their decisions. Poor road design, building and maintenance, together with poor vehicle standards, and lack of investment and enforcement of existing road safety legislation, needed to be addressed through greater coordination of the agencies. The study identified a range of areas for future inquiry and action

Road safety and heavy goods vehicle driving in LMICs: Qualitative evidence from Nepal

Background: Heavy goods vehicle drivers are an influential driving population in Nepal, with over 90% of goods in the country are transported by road. Due to the time spent on the road, drivers have long periods of exposure to the risk of crash involvement. The study explores the perceptions and experiences of heavy goods vehicle drivers and representatives from their professional association regarding road danger. Methods: We conducted semi-structured interviews with fifteen heavy goods vehicle drivers regularly driving on the East-West highway of Makwanpur District, Nepal. A focus group was conducted with eleven members from a major transportation entrepreneur's association in Nepal. The focus group and interviews were audio-recorded, transcribed, translated, and analyzed using thematic analysis. Results: Four themes were developed- assumptions of blame; perceptions of safety culture in the trucking industry; influence of road infrastructure; and behaviours of road users. The road and traffic environment, enforcement, and the safety culture in the heavy vehicle industry not only influenced the attitudes of the road users towards traffic safety but also legitimized and encouraged behaviours that affect safety. General and industry-related road safety improvements suggested by participants included: making provision for heavy good vehicles parking areas, separating the highway with a median strip, improving crash investigation capacity, conducting road safety awareness and training programs, strictly enforcing the speed limit and laws about driving under the influence of alcohol/drugs, and formulating strategies to create a safe, supportive working environment in the heavy vehicle industry. Conclusion: Heavy goods vehicle drivers and members of the professional association can provide rich information regarding the barriers and facilitators of road risk in Nepal. Their perceptions and opinions can contribute to devising interventions at individual, societal, organizational, and governmental levels, and inform efforts to develop a positive safety culture within the heavy vehicle transport industry

Experience of living near a highway in Nepal: Community perceptions of road dangers in Makwanpur district

Introduction: Road traffic injuries are a major but neglected global challenge. There are high and rising rates of road traffic injuries in Nepal. Most of the studies reporting these injuries in Nepal have used quantitative methods to describe the injury burden. Little qualitative research has been conducted to describe the contexts and social processes surrounding crashes, or public perceptions of risks and potential solutions. The aim of this study was to explore the perceptions of road dangers from communities living alongside a major highway in Nepal. Methods: In this qualitative study we recruited members of neighbourhood development committees and a mother's group to take part in focus groups exploring their views. Data were audio-recorded, transcribed, translated and analysed thematically. Results: Four focus groups were conducted involving 34 participants aged 24-65. Our study findings highlight the challenges faced by people living near a major highway and their fear of getting injured on the road. Five themes that emerged were: risky behaviours of road users, infrastructure for safer behaviour, poor condition and maintenance of roads and vehicles, limited adherence and enforcement of traffic laws, and the need for road safety awareness programmes. Conclusion: The community groups expressed multiple concerns regarding the safety of members of their communities and lived-in fear of death and injury on the road where they lived. There is an urgent need for government agencies to understand these concerns and to take action in relating to infrastructure provision, regulation and behavioural change programmes

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

Home-related and work-related injuries in Makwanpur district, Nepal: A household survey

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ. Objective: To describe the epidemiology of home-related and work-related injuries, their mechanisms, inequalities and costs associated with these injuries. Methods: A household survey was undertaken in three palikas of Makwanpur district between April and June 2019. Data were collected electronically on non-fatal injuries that occurred in the previous 3 months and fatal injuries that occurred in the previous 5 years. Findings: 17 593 individuals were surveyed from 3327 households. Injury rates were 8.0 per 1000 population for home injuries and 6.4 per 1000 for work-related injuries; 61.0% of home injuries were among women and 69.9% of work-related injuries among men. Falls were the cause of 48% home injuries, affecting 50.9% of men and 46.5% of women. Burns/scalds were higher in women than men, affecting 17.4% of women reporting home injuries. Cuts and piercings accounted for 39.8% of all work-related injuries and 36.3% were falls. Injury incidence varied by ethnic group: home injuries were highest in Brahmin (12.0 per 1000) and work-related injuries highest in Rai groups (21.0 per 1000). The total mean costs (transport and treatment) of work-related injury was US$143.3 (SD 276.7), higher than for home injuries (US$130.4, SD 347.6). The number of home (n=74, 64.9%) and work-related (n=67, 77.9%) injuries were higher in families below the poverty line than families in the next income bracket (home: n=22, 19.3%; work: n=11, 12.8%). Conclusions: Home-related and work-related fall injuries are common. The inequalities in injury identified in our study by rurality, age, sex, income level and ethnic group can help target injury prevention interventions for vulnerable groups

EN-BIRTH Data Collector Training - Handbook and Manual

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains the EN-BIRTH_Trainer's Manual (14 June 2017) and EN-BIRTH_Training Handbook (23 May 2017)

EN-BIRTH Data Collector Training - Supporting Annexes

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains consent forms and participant information, in addition to standard operating procedures (SOP) for adverse clinical events, and managing distress in interviews. The full complement of annex files used during the training can be requested via this site if required

EN-BIRTH Data Collection Tools

The EN-BIRTH study aims to validate selected newborn and maternal indicators for routine facility-based tracking of coverage and quality of care for use at district, national and global levels. The item contains the following data collection tools: Register data extraction, Observation checklist (labour and delivery ward), Observation checklist (kangaroo mother care), Patient record verification tools for antenatal corticosteroid administration, Patient record verification tools for antibiotic administration, and the Maternal recall survey