89 results found
Keshri VR, Abimbola S, Parveen S, et al., 2023, Navigating health systems for burn care: Patient journeys and delays in Uttar Pradesh, India., Burns
BACKGROUND: India has one of the highest burden of burns. The health systems response to burn care is sometimes patchy and highly influenced by social determinants. Delay in access to acute care and rehabilitation adversely affects recovery outcomes. Evidence on underlying factors for delays in care are limited. In this study, we aim to explore patients' journeys to analyse their experiences in accessing burn care in Uttar Pradesh, India. METHODS: We conducted qualitative inquiry using the patient journey mapping approach and in-depth interviews (IDI). We purposively selected a referral burn centre in Uttar Pradesh, India and included a diverse group of patients. A chronological plot of the patient's journey was drawn and confirmed with respondents at the end of the interview. A detailed patient journey map was drawn for each patient based on interview transcripts and notes. Further analysis was done in NVivo 12 using a combination of inductive and deductive coding. Similar codes were categorised into sub-themes, which were distributed to one of the major themes of the 'three delays' framework. RESULTS: Six major burns patients (4 female and 2 males) aged between 2 and 43 years were included in the study. Two patients had flame burns, and one had chemical, electric, hot liquid, and blast injury, respectively. Delay in seeking care (delay 1) was less common for acute care but was a concern for rehabilitation. Accessibility and availability of services, costs of care and lack of financial support influenced delay (1) for rehabilitation. Delay in reaching an appropriate facility (delay 2) was common due to multiple referrals before reaching an appropriate burn facility. Lack of clarity on referral systems and proper triaging influenced this delay. Delay in getting adequate care (delay 3) was mainly due to inadequate infrastructure at various levels of health facilities, shortage of skilled health providers, and high costs of care. COVID-19-related protocols and restric
Peden AE, Cullen P, Bhandari B, et al., 2023, A systematic review of the evidence for effectiveness of interventions to address transport and other unintentional injuries among adolescents, Journal of Safety Research, ISSN: 0022-4375
Introduction: Globally, injuries are a leading cause of mortality and morbidity for adolescents, which disproportionately affect the disadvantaged. To build an investment case for adolescent injury prevention, evidence is needed as to effective interventions. Methods: A systematic review of peer-reviewed original research published between 2010–2022 was conducted. CINAHL, Cochrane Central, Embase, Medline and PsycINFO databases were searched for studies reporting the effectiveness of unintentional injury prevention interventions for adolescents (10–24 years), with assessment of study quality and equity (e.g., age, gender, ethnicity, socio-economic status). Results: Sixty-two studies were included; 59 (95.2%) from high-income countries (HIC). Thirty-eight studies (61.3%) reported no aspect of equity. Thirty-six studies (58.1%) reported prevention of sports injuries (commonly neuromuscular training often focused on soccer-related injuries, rule changes and protective equipment). Twenty-one studies (33.9%) reported prevention of road traffic injury, with legislative approaches, commonly graduated driver licensing schemes, found to be effective in reducing fatal and nonfatal road traffic injury. Seven studies reported interventions for other unintentional injuries (e.g., falls). Discussion: Interventions were strongly biased towards HIC, which does not reflect the global distribution of adolescent injury burden. Low consideration of equity in included studies indicates current evidence largely excludes adolescent populations at increased risk of injury. A large proportion of studies evaluated interventions to prevent sports injury, a prevalent yet low severity injury mechanism. Findings highlight the importance of education and enforcement alongside legislative approaches for preventing adolescent transport injuries. Despite drowning being a leading cause of injury-related harm among adolescents, no interventions were identified. Conclusion: This review prov
Tingvall C, Michael JP, Larsson P, et al., 2022, Saving lives beyond 2020: The next steps, The Vision Zero Handbook: Theory, Technology and Management for a Zero Casualty Policy, Pages: 789-839, ISBN: 9783030765040
Road safety analysis can be used to understand what has been successful in the past and what needs to be changed in order to be successful to reduce severe road trauma going forward and ultimately what's needed to achieve zero. This chapter covers some of the tools used to retrospectively evaluate real-life benefits of road safety measures and methods used to predict the combined effects of interventions in a road safety action plan as well as to estimate if they are sufficient to achieve targets near-term and long-term. Included are also a brief overview of methods to develop boundary conditions on what constitutes a Safe System for different road users. Further to that, the chapter lists some arguments for the need of high-quality mass and in-depth data to ensure confidence in the results and conclusions from road safety analysis. Finally, a few key messages are summarized.
Peden M, Ameratunga S, Mytton J, et al., 2022, The Step Safely guidelines: a catalyst to address the burden of falls in children and adolescents, The Lancet Child & Adolescent Health, Vol: 6, Pages: 673-674, ISSN: 2352-4642
Keshri VR, Peden M, Jain T, et al., 2022, Impact of COVID-19 and containment measures on burn care: A qualitative exploratory study, Burns, Vol: 48, Pages: 1497-1508, ISSN: 0305-4179
BACKGROUND: Burn care in India is limited by multiple constraints. The COVID-19 pandemic and the containment measures restricted access to non-COVID emergency conditions, including burns. The aim of this study was to explore the impact of the pandemic on burn care in India. METHODS: Using the qualitative exploratory methods, we conducted in-depth interviews (IDI) with plastic and general surgeons representing burn units from across India. Participants were selected purposively to ensure representation and diversity and the sample size was guided by thematic saturation. Thematic analysis was undertaken adopting an inductive coding using NVivo 12 Pro. RESULTS: 19 participants from diverse geographic locations and provider types were interviewed. Three major emerging themes were, change in patient and burn injury characteristics; health system barriers, adaptation, and challenges; and lessons and emerging recommendations for policy and practice. There was change in patient load, risk factors, and distribution of burns. The emergency services were intermittently disrupted, the routine and surgical services were rationally curtailed, follow-up and rehabilitation services were most affected. Measures like telemedicine and decentralising burn services emerged as the most important lesson. CONCLUSIONS: The ongoing pandemic has compounded the challenges for burns care in India. Urgent action is required to prioritise targeted prevention, emergency transport, decentralise service delivery, and harnessing technology for ensuring resilience in burns services.
GBD 2019 Adolescent Transport and Unintentional Injuries Collaborators, 2022, Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019., The Lancet Public Health, Vol: 7, Pages: e657-e669, ISSN: 2468-2667
BACKGROUND: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. METHODS: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. FINDINGS: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport
Rosen HE, Bari I, Paichadze N, et al., 2022, Global road safety 2010-18: an analysis of global status reports, Injury, ISSN: 0020-1383
BackgroundRoad traffic injuries (RTIs) pose a significant health burden with 1.35 million individuals dying on the world's roads annually. Nearly a decade ago, based on agreed road safety indicators, global commitments were encouraged to dramatically reduce this burden as part of the United Nation's Decade of Action for Road Safety 2011–2020.MethodsThe analysis was based on global level data from three Global Status Reports on Road Safety published by the World Health Organization in 2013, 2015, and 2018. A total of 161 countries that consistently reported statistics for all three reports were included in the analysis. Descriptive analyses, t-test, Wilcoxon rank-sum test, and Spearman's rank correlation were performed to evaluate past and current trends in road traffic deaths and countries’ progress in achieving key road safety indicators.ResultsWe found no significant decline in global road traffic death rates from 2010 to 2016 and in fact, death rates increased in low-income countries (LICs) and the African Region. Death rates were highly dependent on income level of the country, with deaths higher in low- and middle-income countries (LMICs) when compared to high-income countries (HICs). We found that the strength of enforcement of speed laws and child restraint laws increased from 2011 to 2017. However, we did not find a correlation between enforcement of the five key prevention policies (speeding, drink-driving, seatbelts, helmets, and child restraints) and death rate. In terms of advancement in achieving key road safety indicators, there was slow progress in adopting most of the recommended policies and practices based on the five pillars (road safety management, safer roads and mobility, safer vehicles, safer road users, and post-crash response).ConclusionDespite global efforts during the past decade, road traffic deaths remain disproportionally high in LMICs and African countries as shown by global reports, and progress in achieving global road sa
Hyder AA, Hoe C, Hijar M, et al., 2022, The political and social contexts of global road safety: challenges for the next decade, The Lancet, Vol: 400, Pages: 127-136, ISSN: 0140-6736
The goal of this Series paper is to show how road safety has evolved as a global public health issue over the past two decades and to discuss the political and economic dynamics that led to this change. Specifically, the key stakeholders, influences, networks, issue framing, actor power, and synergistic interactions that have contributed to how road safety has evolved as a global public health issue will be discussed. In doing so, we capture the important chronology of events and discuss a set of challenges that highlight the complexity of road safety. We posit that the global road safety community needs to re-evaluate its role and strategy for the next decade and focus more on implementation and country action to achieve reductions in road traffic injuries. We call for an open and inclusive process to ensure that such a reflection occurs before the end of the current decade.
Puvanachandra P, Ssesumugabi C, Balugaba B, et al., 2022, The epidemiology and characteristics of injuries to under 5’s in a secondary city in Uganda: a retrospective review of hospital data, International Journal of Injury Control and Safety Promotion, Vol: 29, Pages: 550-555, ISSN: 1566-0974
Child injuries are largely preventable yet cause significant mortality and morbidity globally. Injury data from low-income countries is limited for children under the age of 5 and therefore the current understanding of the magnitude of injuries in this age group is low. Hospital-based registries are one mechanism by which injury data can be gathered. This paper presents findings from a retrospective hospital record review of 4 hospitals in Jinja, a rural setting in Uganda, involving the extraction of data for children under the age of 5-years who sustained an injury during a 6-month period in 2019.A total of 225 injury cases were retrieved from the hospitals. Over half (57.3%) of the events occurred among males. The majority (92%) suffered one injury per injury event. Most of the injuries occurred among those aged 13 to 24 months (32.9%). Burns (32% ) and cuts (20%) were the most common cause of injury.This study presents a hospital-based analysis of injuries amongst under 5’s in rural Uganda. It provides information on the characteristics of children entering healthcare facilities in Uganda and highlights the burden of paediatric injuries in the hospital setting.
Prinsloo M, Hunter K, Matzopoulos R, et al., 2022, Non-fatal injuries among boys and girls presenting to Red Cross War Memorial Children's Hospital, Cape Town, SAMJ SOUTH AFRICAN MEDICAL JOURNAL, Vol: 112, Pages: 465-471, ISSN: 0256-9574
Peden M, Puvanachandra P, Keller M-E, et al., 2022, How the Covid-19 pandemic has drawn attention to the issue of active mobility and co-benefits in Latin American cities, Salud Pública de México, Vol: 64, Pages: S14-S21, ISSN: 0036-3634
The Covid-19 pandemic has brought to the fore many issues that will impact public health for years to come –one such impact is on the nexus between transportation and health. Promoting safe, active transport is an activity that has many physical and mental health benefits. During lockdowns, many cities in Latin America imposed infrastructural and legislative changes in order to abide with public health and social measures to reduce virus spread. These ranged from additional bike lanes to reduced speed limits or incentives to purchase bicycles. These cities showed reduced motorized transport, improved air quality and increased active transport, all of which have multiple health and equity benefits. As countries “build back better”, promoting active transport offers the most value for investment and improves health and well-being while continuing to offer social distancing. Quantified case studies are needed to have a more comprehensive understanding of the impact of active transport in various contexts.
Tingvall C, Michael J, Larsson P, et al., 2022, Saving Lives Beyond 2020: The Next Steps, The Vision Zero Handbook, Publisher: Springer International Publishing, Pages: 1-52, ISBN: 9783030231767
<jats:title>Abstract</jats:title><jats:p>Road safety has come a long way in our lifetimes, and there are steps in this progress that mark their place in history. Many of these were technical innovations, such as seat belts, electronic stability control, and geofencing for vehicle speed control. Also important, though perhaps fewer in number, were innovations in strategies to achieve change. These include the public health model of Dr. William Haddon, the introduction of Vision Zero, the World Report on Road Traffic Injury Prevention from WHO and the World Bank, and more recently, the Decade of Action 2011–2020. I am sure that the work and recommendations presented in this report will deserve their place in a “Hall of Fame” for strategic innovation in saving lives across the globe.</jats:p>
Gupta M, Bhaumik S, Roy S, et al., 2021, Determining child drowning mortality in the Sundarbans, India: applying the community knowledge approach, Injury Prevention, Vol: 27, Pages: 413-418, ISSN: 1353-8047
Background The Sundarbans in India is a rural, forested region where children are exposed to a high risk of drowning due to its waterlogged geography. Current data collection systems capture few drowning deaths in this region.Methods A community-based survey was conducted in the Sundarbans to determine the drowning mortality rate for children aged 1 to 4 years and 5 to 9 years. A community knowledge approach was used. Meetings were held with community residents and key informants to identify drowning deaths in the population. Identified deaths were verified by the child’s household through a structured survey, inquiring on the circumstances around the drowning death.Results The drowning mortality rate for children aged 1 to 4 years was 243.8 per 100 000 children and for 5 to 9 years was 38.8 per 100 000 children. 58.0% of deaths were among children aged 1 to 2 years. No differences in rates between boys and girls were found. Most children drowned in ponds within 50 metres of their homes. Children were usually unaccompanied with their primary caretaker engaged in household work. A minority of children were treated by formal health providers.Conclusions Drowning is a major cause of death among children in the Sundarbans, particularly those aged 1 to 4 years. Interventions keeping children in safe spaces away from water are urgently required. The results illustrate how routine data collection systems grossly underestimate drowning deaths, emphasising the importance of community-based surveys in capturing these deaths in rural low- and middle-income country contexts. The community knowledge approach provides a low-resource, validated methodology for this purpose.
Ismaili S, Odland ML, Malik A, et al., 2021, The relationship between psychosocial circumstances and injuries in adolescents: An analysis of 87,269 individuals from 26 countries using the Global School-based Student Health Survey, PLOS MEDICINE, Vol: 18, ISSN: 1549-1277
Ma T, Peden AE, Peden M, et al., 2021, Out of the silos: embedding injury prevention into the Sustainable Development Goals, Injury Prevention, Vol: 27, Pages: 166-171, ISSN: 1353-8047
Globally, unintentional injuries contribute significantly to disability and death. Prevention efforts have traditionally focused on individual injury mechanisms and their specific risk factors, which has resulted in slow progress in reducing the burden. The Sustainable Development Goals (SDGs) represent a global agenda for promoting human prosperity while respecting planetary boundaries. While injury prevention is currently only recognised in the SDG agenda via two road safety targets, the relevance of the SDGs for injury prevention is much broader. In this State of the Art Review, we illustrate how unintentional injury prevention efforts can be advanced substantially within a broad range of SDG goals and advocate for the integration of safety considerations across all sectors and stakeholders. This review uncovers injury prevention opportunities within broader global priorities such as urbanisation, population shifts, water safeguarding and corporate social responsibility. We demonstrate the relevance of injury prevention efforts to the SDG agenda beyond the health goal (SDG 3) and the two specific road safety targets (SDG 3.6 and SDG 11.2), highlighting 13 additional SDGs of relevance. We argue that all involved in injury prevention are at a critical juncture where we can continue with the status quo and expect to see more of the same, or mobilise the global community in an 'Injury Prevention in All Policies' approach.
Kakar IS, Peden M, Jagnoor J, 2021, Intersectionality based policy analysis: Equity in mobility in India, Transport Policy, Vol: 101, Pages: 14-22, ISSN: 0967-070X
Access to affordable, reliable, good quality transport is necessary for accessing socio-economic opportunities and resources. Transportation inequities have serious implications for public health, and thus transport policy becomes an important social determinant of health. This research studies how needs of vulnerable populations are constructed and addressed in transportation policies in India at the national and sub-national (Delhi) level. Thirty-four National and Delhi level policies were analysed using an intersectional lens to understand how policies identify and address mobility inequities faced by vulnerable groups.Intersectionality states that an understanding of individual experiences based on a single aspect of identity (such as class, gender, ability, age, etc.) is unrepresentative of individual needs. Adopting an intersectional lens for analysing policies allows for a deeper understanding of the impact of multi-level interacting social locations and structures of domination that shape human experience. Thus, helping in creating more effective policies to make transportation accessible to vulnerable groups.The research found that policies focussed on a unitary understanding of population groups and therefore did not capture the complexities of transportation inequities experienced by vulnerable groups. While equity was a stated concern, policies fell short of addressing structural factors and interlocking systems of power and oppression which give rise to inequities. Policy documents were also found to stigmatise groups based on disability and gender. The policy making process was found to be exclusionary and ‘expert’ driven. Voices of vulnerable groups and civil society were left out of the policy making process. In terms of evidence, policies did not detail what evidence was relied upon. All the above has negative implications for the operationalisation of equity and social justice.In order to advance a social justice agenda, an intersection
Jagnoor J, Peden M, 2021, Injuries as Global Health Risk Factor: Causes, Burden, and Prevention, Handbook of Global Health: With 362 Figures and 152 Tables, Pages: 823-854, ISBN: 9783030450083
Injuries are most commonly categorized as unintentional or intentional, based on the perpetrator’s intent or intentionality of the act. Unintentional injuries comprise both transport and nontransport injuries. This chapter examines in detail the risk factors for the leading causes of unintentional injuries, namely, road injuries, falls, drowning, burns, and poisoning. It places injuries in a global context, briefly presents the burden, and then goes on to discuss, in detail, the known risk factors for unintentional injuries in high-, low-, and middle-income countries (LMICs). A consistent theme for every category of cause-specific, unintentional injury is the dearth of reliable evidence from LMICs on risk factors, and thus the challenges informing development of evidence-based interventions, and costeffective approaches to prevention.
Gupta M, Kakar IS, Peden M, et al., 2021, Media coverage and framing of road traffic safety in India, BMJ GLOBAL HEALTH, Vol: 6, ISSN: 2059-7908
- Author Web Link
- Citations: 1
Bhaumik S, Hunter K, Matzopoulos R, et al., 2020, Facilitators and barriers to child restraint use in motor vehicles: a qualitative evidence synthesis, INJURY PREVENTION, Vol: 26, Pages: 478-493, ISSN: 1353-8047
- Author Web Link
- Citations: 6
Jagnoor J, Prinja S, Ha N, et al., 2020, Mortality and health-related quality of life following injuries and associated factors: a cohort study in Chandigarh, North India, INJURY PREVENTION, Vol: 26, Pages: 315-323, ISSN: 1353-8047
- Author Web Link
- Citations: 5
Hunter K, Bestman A, Dodd M, et al., 2020, Overloaded and Unrestrained: A Qualitative Study with Local Experts Exploring Factors Affecting Child Car Restraint Use in Cape Town, South Africa, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol: 17
- Author Web Link
- Citations: 5
Peden M, 2020, Saving lives through vehicle safety., The Lancet Global Health, Vol: 8, Pages: e746-e747, ISSN: 2214-109X
Curtis K, Brysiewicz P, Shaban RZ, et al., 2020, Nurses responding to the World Health Organization (WHO) priority for emergency care systems for universal health coverage, INTERNATIONAL EMERGENCY NURSING, Vol: 50, ISSN: 1755-599X
Puvanachandra P, Janmohammed A, Mtambeka P, et al., 2020, Affordability and availability of child restraints in an under-served population in South Africa, International Journal of Environmental Research and Public Health, Vol: 17, Pages: 1-13, ISSN: 1660-4601
Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.
Peden MM, Puvanachandra P, 2019, Looking back on 10 years of global road safety, International Health, Vol: 11, Pages: 327-330, ISSN: 1876-3405
Every year more than 1.35 million people lose their lives on the road and tens of millions more are injured, some permanently. Since the early 2000s there has been renewed focus on the issue, with the United Nations, World Health Organization and the World Bank placing the issue higher on their agendas. Guided by the United Nations General Assembly, World Health Assembly resolutions and ministerial-level conferences on the global road safety crisis, multisectoral partnerships have synthesised the evidence, advocated for action (there are two Sustainable Development Goal targets with an ambitious goal of reducing deaths and injuries from road traffic crashes by 50%), raised public awareness, generated funding, piloted interventions and monitored progress. And yet the total number of deaths has plateaued despite some sporadic country-level successes. More needs to be done—more people need to be trained in countries to deliver, monitor and evaluate a systems approach to road safety, more solid evidence of what works in low-resource settings is needed (including sustainable transportation options) and there needs to be a greater focus on optimising care and support for those injured in crashes—if we are to begin to see numbers come down in the next decade.
Janmohammed A, Attwood P, Mtambeka P, et al., 2019, The need for stronger child restraint laws, SAMJ South African Medical Journal, Vol: 109, Pages: 545-545, ISSN: 0256-9574
Clay C, Van As AB, Hunter K, et al., 2019, Latest results show urgent need to address child restraint use., SAMJ South African Medical Journal, Vol: 109, Pages: 66-66, ISSN: 0256-9574
Peden MM, Khayesi M, 2018, Save LIVES technical package: 22 interventions that could make a difference, INJURY PREVENTION, Vol: 24, Pages: 381-383, ISSN: 1353-8047
- Author Web Link
- Citations: 6
Borges G, Monteiro M, Cherpitel CJ, et al., 2017, Alcohol and Road Traffic Injuries in Latin America and the Caribbean: A Case-Crossover Study, ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, Vol: 41, Pages: 1731-1737, ISSN: 0145-6008
- Author Web Link
- Citations: 18
Peden M, Di Pietro G, 2017, Saving lives by improving road safety, PUBLIC HEALTH, Vol: 144, Pages: S3-S4, ISSN: 0033-3506
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