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Prevention is a core value of any health system. Nonetheless, many health problems will continue to occur despite preventive services. A significant burden of diseases in developing countries is caused by time-sensitive illnesses and injuries, such as severe infections, hypoxia caused by respiratory infections, dehydration caused by diarrhoea, intentional and unintentional injuries, postpartum bleeding, and acute myocardial infarction. The provision of timely treatment during life-threatening emergencies is not a priority for many health systems in developing countries. This paper reviews evidence indicating the need to develop and/or strengthen emergency medical care systems in these countries. An argument is made for the role of emergency medical care in improving the health of populations and meeting expectations for access to emergency care. We consider emergency medical care in the community, during transportation, and at first-contact and regional referral facilities. Obstacles to developing effective emergency medical care include a lack of structural models, inappropriate training foci, concerns about cost, and sustainability in the face of a high demand for services. A basic but effective level of emergency medical care responds to perceived and actual community needs and improves the health of populations.

Objective To determine the frequency and nature of childhood injuries and to explore the risk factors for such injuries in low-income countries by using emergency department (ED) surveillance data. Methods This pilot study represents the initial phase of a multi-country global childhood unintentional injury surveillance (GCUIS) project and was based on a sequential sample of children < 11 years of age of either gender who presented to selected EDs in Bangladesh, Colombia, Egypt and Pakistan over a 3-4 month period, which varied for each site, in 2007. Findings Of 1559 injured children across all sites, 1010 (65%) were male; 941 (60%) were aged [greater than or equal to] 5 years, 32 (2%) were < 1 year old. Injuries were especially frequent (34%) during the morning hours. They occurred in and around the home in 56% of the cases, outside while children played in 63% and during trips in 11%. Of all the injuries observed, 913 (56%) involved falls; 350 (22%), road traffic injuries; 210 (13%), burns; 66 (4%), poisoning; and 20 (1%), near drowning or drowning. Falls occurred most often from stairs or ladders; road traffic injuries most often involved pedestrians; the majority of burns were from hot liquids; poisonings typically involved medicines, and most drowning occurred in the home. The mean injury severity score was highest for near drowning or drowning (11), followed closely by road traffic injuries (10). There were 6 deaths, of which 2 resulted from drowning, 2 from falls and 2 from road traffic injuries. Conclusion Hospitais in low-income countries bear a substantial burden of childhood injuries, and systematic surveillance is required to identify the epidemiological distribution of such injuries and understand their risk factors. Methodological standardization for surveillance across countries makes it possible to draw international comparisons and identify common issues. Objectif Determiner la frequence et la nature des traumatismes touchant les enfants et etudier les facteurs de risque pour ces traumatismes dans des pays a faible revenu en utilisant les donnees de surveillance des services d&apos;urgence. Methodes Cette etude pilote represente la phase initiale d&apos;un projet multi-pays de surveillance des traumatismes non intentionnels de l&apos;enfant (GCUIS) era ete menee a partir d&apos;un echantillon sequentiel d&apos;enfants de moins de 11 ans de l&apos;un et l&apos;autre sexe, qui ont ete presentes dans des services d&apos;urgence selectionnes du Bangladesh, de Colombie, d&apos;Egypte et du Pakistan, sur une periode de 3-4 mois, variable selon les sites, au cours de rannee 2007. Resultats Parmi les 1559 enfants victimes de traumatisme accueillis sur l&apos;ensemble ales sites, 1010 (65%) etaient de sexe masculin, 941 (60%) etaient ages de 5 ans et plus et 32 (2%) avaient moins d&apos;un an. Les traumatismes etaient particulierement frequents (34%) pendant la matinee. Ilis se produisaient a l&apos;interieur et autour du domicile dans 56% des cas, a l&apos;exterieur pendant les jeux des enfants dans 63% des cas et au cours de deplacements dans 11% des cas. Sur l&apos;ensernble des traumatismes observes, 913 (56%) etaient lies a des chutes, 350 (22%) a des accidents de la circulation, 210 (13%) a des brulures, 66 (4%) a des empoisonnements et 20 (1%) a des << presque-noyades >> ou a des noyades. Les chutes impliquaient le plus souvent des escaliers ou des echelles et les accidents de la circulation des pietons, la majorite des brulures etaient dues a dos liquides chauds, les empoisonnements faisaient intervenir habituellement des medicaments et la plupart des noyades se produisaient au domicile. Le score de gravite moyen des traumatismes etait maximal pour les noyades et les presquenoyades (11), ce score etant suivi de pres par celui des accidents de la circulation (10). L&apos;etude a recense 6 deces, dont 2 resultant d&apos;une noyade, 2 d&apos;une chute et 2 d&apos;un accident de la circulation. Conclusion Les hopitaux des pays a faible revenu font face a une charge substantielle de traumatismes infantiles et une surveillance systematique est necessaire pour determiner la distribution epidemiologique de ces traumatismes et connaitre les facteurs de risque associes. La standardisation methodologique de la surveillance entre les pays permet de dresser des comparaisons internationales et d&apos;identifier des problemes communs. Objetivo Determinar la frecuencia y naturaleza de las lesiones infantiles y explorar sus factores de riesgo en paises de bajos ingresos, utilizando para ello los datos de vigilancia de los departamentos de urgencias (DU). Metodos Este estudio piloto representa la fase inicial de un proyecto plurinacional de vigilancia mundial de las lesiones infantiles no intencionales y se baso en una muestra secuencial de menores de 11 anos, de ambos sexos, que se presentaron en 2007 en DU seleccionados de Bangladesh, Colombia, Egipto y Pakistan alo largo de un periodo de 3 a 4 meses, variable segun el centro. Resultados De 1559 ninos lesionados observados en todos los centros, 1010 (65%) eran varones; 941 (60%) tenian [mayor que o igual a] 5 anos, y 32 (2%) < 1 ano. Las lesiones fueron especialmente frecuentes (34%) por la manana. En el 56% de los casos se produjeron dentro de casa o en sus alrededores, en el 63% fuera, mientras jugaban, y en el 11% en viaje. De todas las lesiones observadas, 913 (56%) consistieron en caidas; 350 (22%) en lesiones causadas por el trafico; 210 (13%) en quemaduras; 66 (4%) en intoxicaciones, y 20 (1%) en ahogamiento o casi ahogamiento. Las caidas mas frecuentes se produjeron en escaleras; en el caso de las lesiones causadas por el trafico, la mayoria de las victimas fueron peatones; la mayoria de las quemaduras se produjeron con liquidos calientes; las intoxicaciones mas frecuentes se debieron a medicamentos, y la mayoria de los ahogamientos se produjeron en casa. Las lesiones con mayores puntuaciones de gravedad fueron los ahogamientos o casi ahogamientos (11), seguidos de cerca por las lesiones causadas por el trafico (10). Hubo 6 casos mortales: 2 por ahogamiento, 2 por caidas y 2 por lesiones causadas por et trafico. Conclusion Los hospitales de los paises de bajos ingresos tienen una carga considerable de lesiones infantiles. Es necesaria una vigilancia sistematica para identificar la distribudion epidemiologica de esas lesiones y comprender sus factores de riesgo. La normalizacion metodologica de la vigilancia en los diferentes paises permite establecer comparaciones internacionales e identificar problemas comunes., Introduction Unintentional injuries are a leading cause of death among children and young adults. (1) Over 875 000 children [less than or equal to] 18 years of age die annually [...]

Abstract Background Road Traffic Injuries (RTIs) are one of the leading causes of death and disability worldwide with 90% of global mortality concentrated in the low and middle income countries. RTI surveillance is recommended to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This paper shares the experience of setting up an urban RTI surveillance program in the emergency departments of five major hospitals in Karachi, Pakistan. Method We describe the process of establishing a surveillance system including assembling a multi-institution research group, developing a data collection methodology, carrying out data collection and analysis and dissemination of information to the relevant stakeholders. In the absence of a road safety agency, the surveillance system required developing individual partnerships with industry, police, city government, media and many other stakeholders. Impact of the surveillance is demonstrated by some initiatives in the local trauma system and improvements in road design to effect hazard reduction. Conclusion We demonstrated that a functional RTI surveillance program can be established, and effectively managed in a developing country, despite lack of infrastructure and limitation of resources. Data utilization in the absence of well defined road safety infrastructure within the government is a challenge. More effective actions are hampered by the limited capacity in the transport and health sectors to do in-depth analysis through road safety audits and trauma registries.

Abstract Background A significant proportion of road traffic crashes are attributable to alcohol and marijuana use while driving globally. Sale and use of both substances is illegal in Pakistan and is not considered a threat for road traffic injuries. However literature hints that this may not be the case. We did this study to assess usage of alcohol and marijuana in Pakistani commercial drivers. Methods A sample of 857 commercial bus and truck drivers was interviewed in October 2008 at the largest commercial vehicle station in Rawalpindi and Islamabad, Pakistan. Time location cluster sampling was used to select the subjects and a structured questionnaire was used to assess the basic demographic profile, substance abuse habits of the drivers while on the road, and reasons for usage of illicit substances while driving were recorded. Self reported information was collected after obtaining informed consent. Chi square and fisher exact tests were used to assess differences between groups and logistic regression was used to identify significant associations between driver characteristics and alcohol and marijuana use. Results Almost 10% of truck drivers use alcohol while driving on Pakistani roads. Marijuana use is almost 30% in some groups. Statistically different patterns of usage are seen between population subgroups based on age, ethnicity, education, and marital status. Regression analysis shows association of alcohol and marijuana use with road rage and error behaviours, and also with an increased risk of being involved in road crashes. The reported reasons for using alcohol or marijuana show a general lack of awareness of the hazardous nature of this practice among the commercial driver population. Conclusion Alcohol and marijuana use is highly prevalent in Pakistani commercial drivers. The issue needs to be recognized by concerned authorities and methods such as random breath tests and sobriety check points need to be employed for proper law enforcement.

Abstract Background Childhood injuries, an important public health issue, globally affects more than 95% of children living in low-and middle-income countries. The objective of this study is to describe the epidemiology of childhood unintentional injuries in Karachi, Pakistan with a specific focus on those occurring within the home environment. Methods This was a secondary analysis of a childhood unintentional injury surveillance database setup in the emergency department of the Aga Khan Hospital, Karachi, Pakistan for 3 months. The data was collected by interviewing caretakers of children under 12 years of age presenting with an unintentional injury to the emergency departments of the four major tertiary care hospitals of Karachi, Pakistan. Results The surveillance included 566 injured children of which 409 (72%) injuries had taken place at/around home. Of 409 children, 66% were males and mostly between 5 and 11 years of age. Injuries commonly occurred during play time (51%). Fall (59%), dog bites (11%) and burns (9%) were the commonest mechanisms of injury. The majority of the children (78%) were directly discharged from the emergency room with predicted short term disability (42%). There were 2 deaths in the emergency department both due to falls. Conclusion Childhood injury surveillance system provides valuable in-depth information on child injuries. The majority of these unintentional childhood injuries occur at home; with falls, dog bites and burns being the most common types of unintentional childhood home injuries. Specific surveillance systems for child injuries can provide new and valuable information for countries like Pakistan.