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This study aims to assess the burden and patterns of clothing-related motorcycle injuries in Karachi, Pakistan. Data were extracted from an ongoing traffic injury surveillance system. In three years (2007–2009), out of 99155 road traffic injury cases there were 986 (0.9%) cases of clothing-related motorcycle injuries. Most cases were females (73.9%) and pillion riders (80.6%). The crashes involving clothing-related injuries were mostly single vehicle (98.5%), and largely resulted in injuries to the external body (60.3%), limbs (51.0%), head (41.5%) and face (35.9%). One-third of injuries were either moderate (26.7%) or severe (10.2%) while 10 (1.01%) deaths were reported. Female gender (11.4%), age ≥ 45 years (19.4%), pillion riding (11.3%) and crashes occurring at intersections (12.3%) were more likely to result in moderate or severe injury as compared to other users (P< 0.001). Injuries due to entanglement of loose fitting clothing in motorcycles are not uncommon in Karachi. Awareness campaigns for prevention of such injuries may involve promotion of appropriate dressing for motorcycle riding including close wrapping of clothes and encouraging installations of covers on the rear wheels and drive chains. [ABSTRACT FROM PUBLISHER]

Background The importance of emergency medical care for the successful functioning of health systems has been increasingly recognised. This study aimed to evaluate emergency and trauma care facilities in four districts of the province of Sindh, Pakistan. Method We conducted a cross-sectional health facility survey in four districts of the province of Sindh in Pakistan using a modified version of WHO's Guidelines for essential trauma care. 93 public health facilities (81 primary care facilities, nine secondary care hospitals, three tertiary hospitals) and 12 large private hospitals were surveyed. Interviews of healthcare providers and visual inspections of essential equipment and supplies as per guidelines were performed. A total of 141 physicians providing various levels of care were tested for their knowledge of basic emergency care using a validated instrument. Results Only 4 (44%) public secondary, 3 (25%) private secondary hospitals and all three tertiary care hospitals had designated emergency rooms. The majority of primary care health facilities had less than 60% of all essential equipments overall. Most of the secondary level public hospitals (78%) had less than 60% of essential equipments, and none had 80% or more. A fourth of private secondary care facilities and all tertiary care hospitals (n=3; 100%) had 80% or more essential equipments. The average percentage score on the physician knowledge test was 30%. None of the physicians scored above 60% correct responses. Conclusions The study findings demonstrated a gap in both essential equipment and provider knowledge necessary for effective emergency and trauma care. [ABSTRACT FROM AUTHOR]

Background: Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by community health workers (CHWs) are required to identify stroke in the community in a resource-strapped region such as this.Methods: The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire to Verify Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community-dwelling subjects using purposive sampling. Each CHW collected data independently, which was validated by a vascular neurologist who directly examined each participant. To assess the effect of audit and feedback, data from the final 10% of the subjects were collected after a second training session for the CHWs. Sensitivity, specificity, and Cohen kappa were determined for the CHW-administered questionnaire against neurovascular assessment.Results: Mean age of participants was 56.5 years with 71% of participants being women. The sensitivity and specificity of the questionnaire of detecting stroke was 77.1% (confidence interval [CI], 64.1-86.9) and 85.8% (CI, 83.5-87.5), respectively. The chance-corrected agreement using the Cohen kappa statistic was .51 (CI, .38-.60). Kappa ranged from .37 to .58 for each of the 7 stroke symptoms. Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms. The performance and agreement improved from moderate to substantial after audit and feedback.Conclusions: We found a reasonable sensitivity and specificity and moderate agreement between CHW-administered QVSFS and assessment by a vascular neurologist. [ABSTRACT FROM AUTHOR]

Background Prehospital care is a vital part of emergency medical care. Countries with decentralised ambulance systems, such as Pakistan, require patient knowledge as to when to call an ambulance and which service to call. Little is known about how patient perceptions of ambulance services affect ambulance usage in most low- and middle-income countries (ULMIC). The purpose of our study was to analyse patient perspectives of the ambulance system in Karachi to understand how to improve ambulance use. Methods In depth interviews were conducted with 30 individuals selected by convenience sampling representing patients who came to the emergency department by private transport versus one of two of the main ambulance service providers in Karachi. Results Similar to what has been shown in some ULMIC contexts, two of the major themes that emerged which affect patient decision making with regard to ambulance use were a mistrust of the ambulance system or providers and a sense of inadequacy of the local system as compared with international standards. In addition, which has not been shown in previous studies, there was a fundamental misunderstanding of the role of ambulance services in the health care infrastructure. Conclusions Insight into the main issues affecting patient decisions to use an ambulance service offers possible targets for patient education that could result in an increase in the proper usage of ambulances and thus optimise outcomes from serious injury and illness in an ULMIC context. [ABSTRACT FROM AUTHOR]

Background: Given the increased number of four wheel drive (4WD) vehicles in Qatar and their involvement in crashes, casualties and road fatalities, it is important to understand the association between risky driving behavior and 4WD crashes. Aim/Objective: This study aimed to determine the association between risky driving behaviours and 4WD vehicles and its impact on road traffic accidents in the State of Qatar. Materials and Methods: A cross sectional survey was conducted using a multistage stratified cluster sampling technique to recruit 1824 drivers of two wheel drive (small cars) and 4WD across different primary health centres (PHCs) in Qatar. The Driver Behaviour Questionnaire (DBQ) and Driver Skill Inventory (DSI) were used to collect the data. Information regarding socio-demographic and road traffic crashes during last three years was also obtained. Multivariate logistic regression was used to analyse the data. Results: 762 (41.8%) owned 4WD vehicles. Drivers of 4WD were significantly higher between 30-50 years age (P < 0.001), urban dwellers (P = 0.003), having more driving experience (atleast 5 years) (P < 0.001) and annual mileage higher than the drivers of small cars (P < 0.001). A significantly higher proportion of 4WD drivers had previous penalties for traffic violations such as crossing a red traffic signal (51.6% vs. 21.4%; P < 0.001) or exceeding the speed limit (35% vs. 27.8%; P < 0.001). A higher proportion of 4WDs' drivers reported previous involvement in accidents as compared to the drivers of small cars (42.4% vs. 35.7%; p 0.004). The risk of accident involvement was 1.21 times higher among drivers of 4WD as compared to the counterparts (OR 1.21; 95%CI; 1.01-1.46). Besides, excessive speed, annual mileage, male gender, traffic violations, lapses, errors and driving skills were significantly associated with crashes. Conclusion: The drivers of 4WD cars are at higher risk of crashes as compared to the drivers of small cars. Also, they have significantly more traffic violations, lapses, and errors. Future interventions and control measures should target the drivers of 4WD for better results. [ABSTRACT FROM AUTHOR]

Background: Globally, more than 875 000 children under the age of 18 die due to injury every year. The rate of child injury death is 3.4 times higher in low-income and middle-income countries than in high-income countries. Objectives: To study injury mortality burden among children under the age of 5 in Pakistan. Methods: Demographic and Health Survey in Pakistan was conducted from September 2006 until February 2007. It included 95 000 households, out of which 3232 households had death of a child under the age of 5 from January 2005 onwards. The Child Verbal Autopsy Questionnaire (CVAQ) was administered to these households with a response rate of 96%. Results: For age group 0-5 years, injury was the sixth leading cause of death and was responsible for 2.5% of all deaths (n=73). For age group 1-5 years, injury was found to be the third leading cause of death (11%) after diarrhoea (18%) and pneumonia (17%). The overall under fives mortality rate due to injury was estimated at 39.5 per 100 000 per year in Pakistan. Drowning (22%), road traffic injuries (12%), burns (11%) and falls (10%) were the most common types of injury. The mortality rate was twice as high in rural areas (32 per 100 000; 95% CI 18 to 45), compared to the urban areas (15 per 100 000; 95% CI 0.3 to 29). Conclusions: Injury is the third leading cause of deaths among children 1-5 in Pakistan. The burden is twice as high in rural areas. [ABSTRACT FROM AUTHOR]

Objective: To pilot an in-home unintentional injury hazard assessment tool and to quantify potential injury risks for young children in a low-income urban setting. Methods: Two low-income neighbourhoods in Karachi, Pakistan, were mapped, and families with at least one child between the ages of 12 and 59 months were identified. Using existing available home injury risk information, an in-home injury risk assessment tool was drafted and tailored to the local setting. Home injury assessments were done in June-July 2010 after obtaining informed consent. Results: Approximately 75.4% of mothers were educated through at least grade 12. The main risks identified were stoves within the reach of the child (n=279, 55.5%), presence of open buckets in the bathroom (n=240, 47.7%) within the reach of the child, and pedestal fans accessible to the child (n=242, 48.1%). In terms of safety equipment, a first-aid box with any basic item was present in 70% of households, but only 4.8% of households had a fire extinguisher in the kitchen. Conclusions: This was the first time that an in-home, all-unintentional injury risk assessment tool was tailored and applied in the context of a low-income community in Pakistan. There was a significant burden of hazards present in the homes in these communities, representing an important opportunity for injury prevention. This pilot may have future relevance to other LMICs where child injury prevention is a critical need. [ABSTRACT FROM AUTHOR]

Background The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. Methods Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. Findings 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. Interpretation Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns. [ABSTRACT FROM AUTHOR]