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Baltimore Highlands, MD, United States

Hyder A.A.,International Injury Research Unit | Razzak J.A.,Aga Khan University
Public Health

Injuries and trauma are a major cause of mortality and morbidity in low and middle income countries (LMICs). In Pakistan, a low income South Asian developing country, they are among the top ten contributors to disease burden and causes of disabilities, with the majority of the burden falling on younger people in the population. This burden of injuries comes with a high social and economic cost. Several distal and proximal determinants, such as poverty, political instability, frequent natural disasters, and the lack of legislation and enforcement of preventive measures, make the Pakistani population susceptible to injuries. Historically, there has been a low level of investment in the prevention of injuries in Pakistan. Data is limited and while a public sector surveillance project has been initiated in one major urban centre, the major sources of information on injuries have been police and hospital records. Given the cost-effectiveness of injury prevention programs and their success in other LMICs, it is essential that the public sector invest in injury prevention through improving national policies and creating a strong evidence-based strategy while collaborating with the private sector to promote injury prevention and mobilizing people to engage in these programs. © 2013 The Royal Society for Public Health. Source

Juillard C.,University of California at Los Angeles | Labinjo M.,World Health Organization | Kobusingye O.,World Health Organization | Hyder A.A.,International Injury Research Unit
Injury Prevention

Background Road traffic injuries (RTIs) are increasingly contributing to the burden of disease in sub-Saharan Africa, yet little is known about the economic consequences and disability associated with them. Objective To explore cost and disability consequences of RTIs in Nigeria. Design A population-based survey using two-stage stratified cluster sampling. Subject/setting Information on care-seeking choice, cost of treatment, ability to work, reduction in earnings, and disability were collected on 127 subjects who had suffered an RTI, of 3082 study subjects in seven Nigerian states. Outcome measures Univariate analysis was used to estimate frequency of disability, types of care sought, and trends for work lost, functional ability and cost of treatment. Unadjusted bivariate analysis was performed to explore care-seeking, cost of care, and work lost among disabled and non-disabled people. Results RTIs resulted in disability for 29.1% of subjects, while 13.5% were unable to return to work. Of the disabled people, 67.6% were unable to perform activities of daily living, 16.7% consequently lost their jobs, and 88.6% had a reduction in earnings. Private physician and hospital treatment were the most common forms of initial treatment sought, but traditional treatment was the most common second form of care sought. Average direct costs of informal and formal treatment were US $6.65 and US$35.64, respectively. Disabled people were more likely to seek formal care (p1/40.003) and be unable to work (p1/40.002). Conclusions Economic and functional ramifications must be included in the spectrum of consequences of RTIs to fully appreciate the extent of the burden of disease, implying that health systems should not only address the clinical consequences of RTIs, but the financial ones as well. Source

Jafar T.H.,National University of Singapore | Jafar T.H.,Aga Khan University | Haaland B.A.,Quantitative Medicine | Haaland B.A.,National University of Singapore | And 8 more authors.
The Lancet

Non-communicable diseases, including cardiovascular diseases, cancers, respiratory diseases, diabetes, and mental disorders, and injuries have become the major causes of morbidity and mortality in Pakistan. Tobacco use and hypertension are the leading attributable risk factors for deaths due to cardiovascular diseases, cancers, and respiratory diseases. Pakistan has the sixth highest number of people in the world with diabetes; every fourth adult is overweight or obese; cigarettes are cheap; antismoking and road safety laws are poorly enforced; and a mixed public-private health-care system provides suboptimum care. Furthermore, almost three decades of exposure to sociopolitical instability, economic uncertainty, violence, regional conflict, and dislocation have contributed to a high prevalence of mental health disorders. Projection models based on the Global Burden of Disease 2010 data suggest that there will be about 3•87 million premature deaths by 2025 from cardiovascular diseases, cancers, and chronic respiratory diseases in people aged 30-69 years in Pakistan, with serious economic consequences. Modelling of risk factor reductions also indicate that Pakistan could achieve at least a 20% reduction in the number of these deaths by 2025 by targeting of the major risk factors. We call for policy and legislative changes, and health-system interventions to target readily preventable non-communicable diseases in Pakistan. Source

Hyder A.A.,International Injury Research Unit | Vecino-Ortiz A.I.,International Injury Research Unit
Bulletin of the World Health Organization

Brazil, the Russian Federation, India, China and South Africa - the countries known as BRICS - are currently undergoing a deep epidemiological transition that is mainly driven by rapid economic growth and technological change. The changes being observed in the distribution of the burden of diseases and injuries - such as recent increases in the incidence of road traffic injuries - are matters of concern. BRICS may need stronger institutional capacity to address such changes in a timely way. In this paper, we present data on road traffic injuries in BRICS and illustrate the enormous challenge that these countries currently face in reducing the incidence of such injuries. There is an urgent need to improve road safety indicators in every country constituting BRICS. It is imperative for BRICS to invest in system-wide road safety interventions and reduce the mortality and morbidity from road traffic injuries. Source

Alonge O.,International Injury Research Unit | Hyder A.A.,International Injury Research Unit
Archives of Disease in Childhood

Among 1-19-year olds, unintentional injuries accounted for 12% of 5.1 million global deaths from injuries in 2010. Despite this high burden, childhood injuries have not received much attention in global health. This paper describes the major causes of deaths from childhood unintentional injuries and provides a review of interventions for reducing this burden. About 627 741 deaths were due to unintentional injuries in 2010 among 1-19-year olds. The proportionate mortality increased with age - from 12.6% among 1-4-year olds to 28.8% among 15-19-year olds. Deaths from Western sub-Saharan Africa and South Asia accounted for more than 50% of all deaths. Rates in these regions are 68.0 and 36.4 per 100 000 population, respectively, compared to 6.4 in Western Europe. Road traffic injuries (RTI) are the commonest cause of death, followed by deaths from drowning, burns and falls. Male children are more predisposed to unintentional injuries except for burns which occur more frequently among females in low and middle income countries (LMICs). Effective solutions exist - including barriers for preventing drowning; safer stoves for burns; child restraint systems for RTI - but the effectiveness of these measures need to be rigorously tested in LMICs. The general lack of a coordinated global response to the burden of childhood unintentional injuries is of concern. The global community must create stronger coalitions and national or local plans for action. Death rates for this paper may have been underestimated, and there is need for longitudinal studies to accurately measure the impact of injuries in LMICs. Source

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