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Drowning was one of the most prevalent causes of death worldwide for children under five in 2020. Drowning was the second leading cause of death for children under five in Bangladesh, while 58% of all deaths in the 1–5 years old age group resulted from drowning. Adult supervision helps prevent child drowning in rural areas where water bodies are easily accessible and located very close to homes. This paper aims to assess caregivers’ compliance and perception of community daycare centers in rural Bangladesh, piloted as a child drowning prevention intervention. In this longitudinal study, each child enrolled in the daycare intervention was visited and data on compliance and satisfaction with the daycare were collected. Descriptive statistics on daycare attendance, patterns of supervision, and caregivers’ perceptions about daycare were reported. When inquired about daycare attendance (n = 226,552), a total of 77.4% of children (n = 175,321) were found to attend daycare. The distance from homes and an adult’s unavailability to take the child to daycare were the most common reasons for not attending or discontinuing enrollment. The majority of children (76.4%) were supervised by their mothers during daycare closures. A total of 67.7% of respondents perceived daycare to be a safe place, where children also developed cognitive (51.7%) and social skills (50.6%). There were no incidences of drowning among children while attending daycare. Rural families were found to be compliant with the daycare and professed it to be a safe place protecting children from drowning and other injuries, while allowing them to focus on household chores or income-generating activities. These findings indicate a potential for the expansion of this intervention in rural Bangladesh and similar settings.

Background: Road traffic injuries (RTIs) are the leading cause of death among 15-29-year olds, of which 22% are pedestrians. In Uganda, pedestrians constitute 43% of RTIs. Over 52% of these injuries occur in Greater Kampala Metropolitan Area (GKMA). However, information on geospatial distribution of RTIs involving pedestrians and associated factors is scanty. We established the geospatial distribution of pedestrian injuries and associated factors in GKMA, Uganda. Methods: We conducted a mixed methods cross sectional study in three districts of GKMA. We used a structured questionnaire to interview 332 injured pedestrians at ten purposively selected health facilities from May to July 2017. We used a modified Australian Walkability Audit Tool to assess road characteristics and videography to capture road user behaviour at reported injury sites. Injury location (outcome) was categorized into three locations according to primary land use: residential areas, commercial/business areas and bar & entertainment areas. The injury hotspots were then mapped out using Quantum Geographic Information System (QGIS). Multinomial logistic regression was used to identify factors associated with injury location and adjusted prevalence ratios (APR) reported at 95% confidence interval. Results: Males represented 66.5% (221/332) of the sample. Pedestrian injuries were most prevalent among 15-29-year olds (45.5%, 151/332). Most (47.2%, 157/332) injuries occurred in commercial and business areas. Namasuba-Zana (13%, 43/332) followed by Nakawa-Kireka on Jinja road (9.7%, 32/332) had the highest number of injuries. Presence of speed humps was protective (APR=0.13, 95%CI 0.01-0.93). However, zebra crossings (APR=6.41, 95% CI: 1.14-36.08) and clear traffic (APR=6.39, 95%CI: 2.75-14.82) were associated with high prevalence of pedestrian injuries. Conclusion: Presence of speed humps was safer for pedestrians but zebra crossings and clear traffic had more than 6-fold risk for injuries. Findings suggest that constructing speed humps on the roads in busy areas and sensitizing motorists to respect zebra crossings could reduce pedestrian injuries.

BACKGROUND: Injuries are a significant public health problem but poorly quantified especially in low and middle-income countries. In Uganda, the burden of injuries is poorly quantified with most of the data reported being facility and mortality based. Many non-fatal injuries, therefore, remain unreported in communities. We conducted a household survey in Mbarara Municipality to identify and describe all non-fatal injury events and the associated factors. METHODS: We conducted a cross-sectional study of non-fatal injuries among 966 household members in Mbarara Municipality, from May to June 2017. The most recent non-fatal injury (within a six-month recall period; December 2016 to June 2017) resulting in loss of at least one day of usual daily operating activity was considered. We conducted a descriptive statistical analysis to estimate the counts and frequencies of non-fatal injuries. We identified factors associated with non-fatal injuries using a modified Poisson regression model. RESULTS: The prevalence of non-fatal injuries was 18.2% (176/966) with 92% (162/176) of the non-fatal injuries being unintentional. Falls 27.3% (48/176) were the most common cause of injury followed by road traffic injuries (RTI), 26.7% (47/176), burns 16.5% (29/176) and the least being poisoning 2.8% (5/176). Occupation as casual laborer (Adjusted PR=2.1, 95% CI: 1.2 - 3.7), urban residency (Adjusted PR=1.5, 95% CI: 1.1 - 1.9) and being a non-native of the study area (Adjusted PR=1.7, 95% CI: 1.3 - 2.3) were independently associated with non-fatal injuries. CONCLUSION: Almost one out of five people had suffered a non-fatal injury in the past six months in Mbarara Municipality. Majority of the non-fatal injuries were unintentional, caused by falls and RTIs, and were amongst casual labourers and urban residents. These findings reveal a gap in injury prevention in Uganda that needs to be addressed to improve the quality of life.

Background Vietnam9s 2007 comprehensive motorcycle helmet policy increased helmet use from about 30% of riders to about 93%. We aimed to simulate the effect that this legislation might have on: (a) road traffic deaths and non-fatal injuries, (b) individuals’ direct acute care injury treatment costs, (c) individuals’ income losses from missed work and (d) individuals’ protection against medical impoverishment. Methods and findings We used published secondary data from the literature to perform a retrospective extended cost-effectiveness analysis simulation study of the policy. Our model indicates that in the year following its introduction a helmet policy employing standard helmets likely prevented approximately 2200 deaths and 29 000 head injuries, saved individuals US$18 million in acute care costs and averted US$31 million in income losses. From a societal perspective, such a comprehensive helmet policy would have saved $11 000 per averted death or $830 per averted non-fatal injury. In terms of financial risk protection, traffic injury is so expensive to treat that any injury averted would necessarily entail a case of catastrophic health expenditure averted. Conclusions The high costs associated with traffic injury suggest that helmet legislation can decrease the burden of out-of-pocket payments and reduced injuries decrease the need for access to and coverage for treatment, allowing the government and individuals to spend resources elsewhere. These findings suggest that comprehensive motorcycle helmet policies should be adopted by low-income and middle-income countries where motorcycles are pervasive yet helmet use is less common.

BackgroundWorldwide, fifteen percent (15%) of the world’s population or one (1) billion people live with some form of disability. In Uganda, 12.4% of the Uganda’s population lives with some form of disability and Kawempe division accounts for (22.6%) of all persons with disabilities living in Kampala district. Rehabilitation services are provided within Kawempe division at Mulago hospital physiotherapy department and Katalemwa rehabilitation center in Kampala district, Uganda at a free and a subsidized cost to help to improve the function, independence, and quality of life of persons with physical disabilities. However, many people with physical disabilities do not utilize the services and the reasons are not clear.MethodsThe study design was a descriptive cross-sectional study employing quantitative methods of data collection. A total of 318 participants were included in the study. Simple random sampling was used to select the study participants. Ethical issues were maintained at all levels during data collection and dissemination of results.ResultsThe study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Kampala, Uganda. Factors that were significantly associated with utilization of rehabilitation services among people with physical disabilities at multivariable logistic regression analysis included; age (AOR: 0.30; 95% CI: 0.12–0.74), socioeconomic status (AOR: 2.13; 95% CI: 1.03–4.41), education level (AOR: 4.3; 95% CI: 1.34–13.91) and awareness of the participants about the rehabilitation services (AOR: 5.1; 95% CI: 2.74–9.54) atpvalue ≤0.05.ConclusionThe study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Uganda. Factors that were significantly associated with utilization of rehabilitation services included; age, socioeconomic status, education level and awareness of the participants about the services. Therefore, the government and other relevant stake holders should increase sensitization and awareness of rehabilitation services, their benefits and facilities providing such services to people with physical disabilities, healthcare professionals and the general public.

Road traffic injuries (RTIs) remain a leading cause of morbidity and mortality in Southeast Asia. We aim to estimate the prevalence and predictors of rear seatbelt use, a key behavioural risk factor for RTI, in Bandung and Bangkok, two cities in Southeast Asia. Roadside observational studies were conducted to provide a representative picture of the prevalence in each city. From eight rounds of observations (July 2015 to April 2019), 39,479 and 7,207 rear-seat passengers were observed in Bandung and Bangkok. Across all rounds, 4.2% of rear-seat passengers used seatbelts in Bandung, compared to 8.4% in Bangkok. In both cities, males and adults, as compared to females and adolescents (aged 12-17 years), had higher odds of rear seatbelt use, as did passengers with a restrained driver. Findings highlight the need for rear seatbelt laws in Bandung and improved enforcement of existing rear seatbelt laws in Bangkok.

Background Road crashes are a major cause of death among all age groups and the leading cause of death among persons 5–29 years, according to the World Health Organization. One key risk factor is drink-driving. While the world’s leading beer, wine, and spirit producers have pledged to combat drink-driving, there is increasing evidence showing the alcohol industry’s promotion of solutions which minimally impact sales. One strategy is forming partnerships with road safety non-governmental organizations (NGOs). Given this, the primary objective of this study is to understand the extent to which the alcohol industry is involved with road safety NGOs around the world. Methods A desk review from July 2020 to March 2021 was conducted to assess the alcohol industry’s involvement with various road safety NGOs (n = 256) in 92 countries. Financial documents press releases, annual reports, social media platforms, and other resources were analyzed to uncover relationships between the alcohol industry and NGOs. Results Out of 256 NGOs, n = 11 (4%) showed direct ties to the alcohol industry, and n = 3 (1%) showed indirect ties. NGOs involved with the alcohol industry were found in five continents and n = 8 of the 11 NGOs (73%) partnered with transnational alcohol manufacturers. Interventions supported by these partnerships were primarily mass media campaigns, free-ride and ride-sharing campaigns, and drink-driving educational events where alcoholic or zero-percent alcoholic beverages were sold or provided. These interventions are largely inconsistent with evidence-based best practice recommendations. Relationships between the alcohol industry and road safety NGOs lacked public transparency on key details such as terms of partnerships and funding amount and terms. Conclusions The study showed a clear effort on behalf of the alcohol industry to partner with road safety NGOs around the world. Findings underscore the need for the road safety community to generate consensus on involvement of the alcohol industry and suggest the need for more transparency on details of partnerships involving road safety. Findings also highlight the importance of local and national government support of road safety initiatives and road safety NGOs to avoid dependence on controversial funding from the alcohol industry.

BACKGROUND: Injuries account for a significant proportion of the health and economic burden for populations in low- and middle-income countries. However, little is known about psychological distress trajectories amongst injury survivors in low- and middle-income countries. METHODS: Adult injury patients (n=644) admitted to Kenyatta National Hospital in Nairobi, Kenya, were enrolled and interviewed in the hospital, and at 1, 2–3, and 4–7 months after hospital discharge through phone to assess depressive and anxiety symptoms and level of disability. Growth mixture modeling was applied to identify latent trajectories of depressive and anxiety symptoms. RESULTS: Elevated depressive and moderate-level anxiety symptoms (13%) and low depressive and anxiety symptoms (87%) trajectories were found between hospitalization and up to seven months after hospital discharge. Being female, prior trauma experience, longer hospitalization, worse self-rated health status while in the hospital, and lack of monetary assistance during hospitalization were associated with the elevated symptoms trajectory. The higher symptoms trajectory associated with higher disability levels after hospital discharge and significantly lower proportion of resuming daily activities and work. CONCLUSION: The persistence of elevated depressive symptoms and associated reduced functioning several months after physical injury underscores the importance of identifying populations at risk for preventive and early interventions.

A cross-sectional survey was conducted to collect primary data prospectively on pre-hospital care time intervals of Road Traffic Crash (RTC) victims that had been rescued by the Uganda police and to determine what factors were related to those intervals. The survey was conducted between 1 May 2015 and 31 May 2015. The Police responses to 96 RTCs were recorded, but only 74 of them were considered serious enough to warrant hospital transfer, and those 74 are the subject of the analysis. Pre-hospital care time ranged between 10 and 220 min. Seventy-two per cent of the calls were completed within 1 h of call initiation. The scene to hospital transport interval was the longest with a mean of 19.07 min (SD 10.11). Activation time was the shortest interval with a mean of 4.58 min (SD 5.67). Key factors for delays included: understaffing, lack of skills and long distances. A toll-free Universal Access Number, a law mandating provision of free basic emergency medical services at every health facility and gazetting of lanes for emergency services and might decrease on pre-hospital care time and could reduce on the notification and transport time interval respectively.

Background Few studies have assessed the child restraint use in Shanghai. We aim to investigate the prevalence of child restraint use and the potential risk factors affecting child restraint practice in Shanghai. Methods A cross-sectional observational study was conducted near the pediatric hospitals, kindergartens, entertainment places, and shopping malls between 2015 and 2019 in Shanghai. Trained field workers observed and recoded the child restraint use in all passing motorized vehicles with children passengers at each site. A logistic regression model was used to examine risk factors on non-restraint use among children, adjusting for potential confounders. Results Eight rounds of data were collected with a total sample size of 12,061 children. The total child restraint use rate was 6.42%. Child restraint use rate rose with fluctuation during the last 5 years, from 5.12% in round 1 to 8.55% in round 8 (p value Conclusion Child restraint use rate was low in Shanghai. Our finding may inform intervention programs among children with those risk factors to promote child restraint use.

Background Road traffic injury remains a leading cause of morbidity and mortality in Southeast Asia. Rear seatbelt use, a key behavioral risk factor, is understudied. We aim to estimate the prevalence and predictors of rear seatbelt use in Bandung, Indonesia and Bangkok, Thailand. Methods Roadside observational studies were conducted across Bandung and Bangkok to provide a representative picture of behavioral risk factor prevalence in each city. Trained observers collected data from stationary vehicles at intersections during the daytime throughout the week. We computed descriptive statistics and conducted multivariable logistic analyses by city. Results Eight rounds of observations were conducted between July 2015 to April 2019. 39,479 and 7,207 rear-seat passengers were observed in Bandung and Bangkok, respectively. Across all rounds, 4.2% of rear seatbelt passengers used seatbelts in Bandung, compared to 8.4% in Bangkok. In both cities, males and adults, as compared to females and adolescents (aged 12–17 years), had higher odds of rear seatbelt use, as did passengers with a belted driver. Additionally, passengers in a light truck (compared to sedan) had higher odds of rear seatbelt use in Bandung, while a belted front passenger was associated with rear seatbelt use in Bangkok. Conclusions Rear seatbelt use was low in Bangkok and even lower in Bandung. Gender, age, and the behavior of other occupants were key predictors of rear seatbelt use. Learning Outcomes Findings highlight the need for rear seatbelt laws in Bandung and improved enforcement of existing rear seatbelt laws in Bangkok.

Background Injury is a great contributor to the Vietnamese disease burden. Road traffic injuries were the leading cause of injury mortality from 2005 to 2013. Our objective was to understand the intricacies of the trauma care system in Hanoi, Vietnam. Methods We aimed to elucidate the trauma care continuum (pre-hospital, hospital and post hospital care) and identify perceptions of system functioning. This was done via in-depth interviews and focus group discussions. Results Ten interviews and two focus groups were conducted. Participants were: community stakeholders, hospital leadership, the Ministry of Health, National Traffic Safety Committee and Hanoi Emergency Response Centre. 59% of respondents were male and there was variation in education level and employment status. Thematic analysis was conducted using the NVivo 12 software. The major theme identified was prehospital care with the relevant issues being communication, transportation and human resources deficits. The minor themes were around hospital care, community education and governance. A common barrier to effective care across multiple themes was the lack of coordination and integration between various institutions. Conclusion The trauma care landscape is multifaceted but there are areas which could potentially benefit with the major one being prehospital care. Specific policies that can arise as a result of this work include improving the logistical coordination of prehospital transportation, a legal framework to protect bystanders providing first aid, and bolstering a non-physician prehospital care workforce. Learning Outcomes The results provide a direction to guide governmental (both local and national) and organizational efforts toward prehospital trauma care.

Background: Globally, there are 1.35 million road traffic deaths annually, with 90% of these deaths occurring in low- and middle-income countries (LMICs). Road traffic injury is now the leading cause of death in children older than five years of age. To achieve the Stockholm Declaration of halving the number of road traffic deaths by 2030, and Sustainable Development Goal 11.7 to provide safe transport systems, particularly for vulnerable individuals, drastic action needs to be taken in LMICs. In 2007, Bloomberg Philanthropies launched the Initiative for Global Road Safety. The …

Introduction There is scarcity of data on children with disabilities living in low-and-middle-income countries, including Uganda. This study describes disability prevalence and explores factors associated with different disability categories. It highlights the value of using a standardized, easy-to-use tool to determine disability in children and contextualizing disability in children in light of their developmental needs. Methods A cross-sectional study was conducted between September 2018–January 2019 at the Iganga-Mayuge Health and Demographic Surveillance Site in Uganda. Respondents were caregivers of children between 5–17 years and were administered an in-depth Child Functioning Module (CFM). The outcome variable, disability, was defined as an ordered categorical variable with three categories–mild, moderate, and severe. Generalized ordered logit model was applied to explore factors associated with disability categories. Results Out of 1,842 caregivers approached for the study, 1,439 (response: 78.1%) agreed to participate in the study. Out of these 1,439, some level of disability was reported by 67.89% (n = 977) of caregivers. Of these 977 children with disability, 48.01% (n = 692) had mild disability and 15.84% (n = 228) had moderate disability, while 3.96% (n = 57) had severe disability. The mean (SD) score for mild disability was 2.22±1.17, with a median of 2. The mean and median for moderate disability was 5.26±3.28 and 4 (IQR:3–6), and for severe disability was 14.23±9.51 and 12 (IQR:6–22). The most common disabilities reported were depression (54.83%) and anxiety (50.87%). Statistically significant association was found for completion of immunization status and school enrollment when controlled for a child’s age, sex, having a primary caregiver, age of mother at child’s birth, family system, family size and household wealth quintile. Conclusion This study suggests association between incomplete immunization status and school enrollment for children with disability. These are areas for further exploration to ensure inclusive health and inclusive education of children with disabilities in Uganda.

Background The UNICEF/Washington Group Child Functioning Module (CFM) assesses child functioning among children between 5 and 17 years of age. This study adapted and validated the CFM at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. Methods This cross-sectional study was conducted between September 2018–January 2019 at the IM-HDSS. Respondents were caregivers of children between 5 and 17 years of age who were administered modified Washington Group short set (mWG-SS) and CFM. The responses were recorded on a 4-point Likert scale. Descriptive analysis was conducted on child and caregiver demographic characteristics. Exploratory factor analysis (EFA) assessed underlying factor structure, dimensionality and factor loadings. Cronbach’s alpha was reported as an assessment of internal consistency. Face validity was assessed during the translation process, and concurrent validity of CFM was assessed through comparison with disability short form. Results Out of 1842 caregivers approached, 1439 (78.1%) participated in the study. Mean age of children was 11.06 ± 3.59 years, 51.4% were males, and 86.1% had a primary caregiver. Based on EFA, vision, hearing, walking, self-care, communication, learning, remembering, concentrating, accepting change, behavior control, and making friends loaded on factor 1 - “Motor and Cognition,” while anxiety and depression loaded on factor 2 - “Mood”. Cronbach’s alpha for the overall CFM was 0.899 (good internal consistency). Cronbach’s alpha for each extracted factor was excellent, motor and cognition (0.904), and mood (0.902). CFM had acceptable face validity. Spearman’s rank correlation between scores of CFM and modified WG short set was 0.51 (p-value Conclusion CFM is a two-factor, valid and reliable scale for assessing disability in Uganda and can be applied to other similar settings to contribute towards disability data from the region. It is an easy-to-administer tool that can help in deeper understanding of context-specific burden and extent of disability in children between 5 and 17 years of age.

Drink-driving is a major cause of global road traffic fatalities, yet few countries have laws that meet international best practices. One possible reason is the alcohol industry’s opposition to meaningful policies that are perceived to directly threaten sales. Our primary objectives are to document alcohol industry involvement in global road safety policies and programmes and to critically evaluate the responses of public health and road safety communities to this involvement. Under the guidance of the Policy Dystopia Model, we used a mixed methods approach in which data were gathered from expert interviews and a mapping review of 11 databases, 5 watchdog websites and 7 alcohol industry-sponsored initiatives. Triangulation was used to identify points of convergence among data sources. A total of 20 expert interviews and 94 documents were analysed. Our study showed that the alcohol industry acknowledges that drink-driving is an issue but argues for solutions that would limit impact on sales, akin to the message ‘drink—but do not drive’. Industry actors have been involved in road safety through: (1) coalition coupling and decoupling, (2) information production and management, (3) direct involvement in policymaking and (4) implementation of interventions. Our study also shed light on the lack of cohesion within and among the public health and road safety communities, particularly with regard to the topics of receiving funding from and partnering with the alcohol industry. These results were subsequently used to adapt the Policy Dystopia Model as a conceptual framework that illustrates the ways in which the alcohol industry has been involved in global road safety. Several implications can be drawn from this study, including the urgent need to increase awareness about the involvement of the alcohol industry in road safety and to build a cohesive transnational alcohol control advocacy alliance to curb injuries and deaths related to drink-driving.

Introduction Empirical data is scare on assessment of concordance between caregiver-child responses on child functioning. Objective To assess correlation and agreement between children (11–17 years old) and their caregivers’ responses to the UNICEF/Washington Group Child Functioning Module (CFM) at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Uganda. Methods CFM with 24-questions corresponding to 13 domains of functioning was administered to children between 11 and 17 years of age and their caregivers. Descriptive analyses of the child/caregiver responses were conducted. Correlation and agreement between caregiver and child responses were assessed. Results Of the 217 caregiver/child pairs eligible for this study, 181 pairs agreed to participate (83.4%). The mean age of children was 13.9 ± 1.9 years, and 56.4% were males. Cronbach’s alpha was 0.892 and 0.886 for the caregiver and child versions of CFM respectively, showing good internal consistency in both. There was a significant overall agreement between mean score of caregiver (5.36 ± 5.63 out of 39) and child (5.45 ± 5.34) pairs. Spearman’s rank correlation between the pairs was 0.806 (strong positive correlation). Bland-Altman plots for CFM scores showed greater agreement between caregiver and child at lower scores. Percentage agreement between the pairs for overall disability was greater for mild (83.53%) and moderate (79.37%) categories as compared to the severe (66.67%) category. There was substantial agreement (kappa 0.623) for overall disability between the pairs. Conclusion This study indicates that there is significant correlation and agreement between self-reported caregiver-child pair responses, opening the way for considering children as CFM respondents, when possible.

Background Roadside observational studies play a fundamental role in designing evidence-informed strategies to address the pressing global health problem of road traffic injuries. Paper-based data collection has been the standard method for such studies, although digital methods are gaining popularity in all types of primary data collection. Objective This study aims to understand the reliability, productivity, and efficiency of paper vs digital data collection based on three different road user behaviors: helmet use, seatbelt use, and speeding. It also aims to understand the cost and time efficiency of each method and to evaluate potential trade-offs among reliability, productivity, and efficiency. Methods A total of 150 observational sessions were conducted simultaneously for each risk factor in Mumbai, India, across two rounds of data collection. We matched the simultaneous digital and paper observation periods by date, time, and location, and compared the reliability by subgroups and the productivity using Pearson correlations (r). We also conducted logistic regressions separately by method to understand how similar results of inferential analyses would be. The time to complete an observation and the time to obtain a complete dataset were also compared, as were the total costs in US dollars for fieldwork, data entry, management, and cleaning. Results Productivity was higher in paper than digital methods in each round for each risk factor. However, the sample sizes across both methods provided a precision of 0.7 percentage points or smaller. The gap between digital and paper data collection productivity narrowed across rounds, with correlations improving from r=0.27-0.49 to 0.89-0.96. Reliability in risk factor proportions was between 0.61 and 0.99, improving between the two rounds for each risk factor. The results of the logistic regressions were also largely comparable between the two methods. Differences in regression results were largely attributable to small sample sizes in some variable levels or random error in variables where the prevalence of the outcome was similar among variable levels. Although data collectors were able to complete an observation using paper more quickly, the digital dataset was available approximately 9 days sooner. Although fixed costs were higher for digital data collection, variable costs were much lower, resulting in a 7.73% (US $3011/38,947) lower overall cost. Conclusions Our study did not face trade-offs among time efficiency, cost efficiency, statistical reliability, and descriptive comparability when deciding between digital and paper, as digital data collection proved equivalent or superior on these domains in the context of our project. As trade-offs among cost, timeliness, and comparability—and the relative importance of each—could be unique to every data collection project, researchers should carefully consider the questionnaire complexity, target sample size, implementation plan, cost and logistical constraints, and geographical contexts when making the decision between digital and paper.

Statement of Purpose Uninsured patients may attempt to cope with the costs of an injury through various financial and non-financial coping mechanisms. Certain coping mechanisms, such as reducing health care utilization, may minimize direct medical costs while increasing indirect costs. Methods/Approach The Health, Economic and Long-term Social Impact of Injuries (HEALS) project was a hospital-based longitudinal study of patients conducted in four countries, including Vietnam and Kenya, in 2015–2016. Using baseline survey data, we compared differences in length of hospital stay by health insurance status using a multivariable linear regression, and conducted a multivariable logistic regression to evaluate the relationship between insurance and foregoing additional health care. Results The sample included 1022 patients in Vietnam and 994 in Kenya. Of these, 56.2% and 68.8% lacked insurance and 21.5% and 3.7% left against medical advice in Vietnam and Kenya, respectively. In Vietnam, uninsured patients left 2.4 days earlier than those with insurance, controlling for injury severity and mechanism; patient demographics; pre-injury household poverty status and the patient’s contribution to household income (β=-2.441, p Conclusions Patients without health insurance may be foregoing health care in order to avoid additional direct health care costs, and in the process increasing indirect costs if leaving against medical advice prolongs a period of disability. Significance and Contributions to Injury and Violence Prevention Science Improving the breadth of health insurance can protect against both direct and indirect costs of injuries.

Objective In Vietnam, motorcycle riders comprise about three-quarters of road traffic fatalities, the most common cause of which is head injuries that can be prevented by wearing a helmet. This study aims to assess helmet-wearing behaviors in Ho Chi Minh City, the largest city in Vietnam. Methods Eight rounds of observational studies were conducted in six randomly selected locations between July 2015 and April 2019. Given the multinomial nature of the outcome measure (not wearing a helmet; wearing a substandard helmet; wearing an unstrapped standard helmet; wearing a strapped standard helmet), a multinomial model was developed to estimate the level and trend of helmet use and identify the related individual and environmental factors. Findings A total of 479,892 motorcycle riders were observed, over 90 % of whom were wearing helmets (range over the eight rounds: 92.5 %–96.0 %). However, the prevalence of correct helmet use (defined as wearing a strapped standard helmet) gradually declined from 80.8 % in round 1–55.6 % in round 8. Results from a multinomial model showed the probability of wearing a strapped standard helmet had declined by 22.4 percentage points from round 3 to round 8 while holding other factors constant (95 % CI: 21.8–23.0). The prevalence of correct use is 11.3 percentage points higher for adults than for children (95 % CI: 10.5–12.1). During the same period, unstrapped standard helmet use increased by 24.5 percentage points (95 % CI: 24.1–24.9); substandard helmet use declined but remained high. Conclusion The upward trend of incorrect helmet wearing behaviors and wearing substandard helmets sends a rallying call for multisectoral interventions.

In urban streets, pedestrians compete with vehicles for right-of-way. In some situations, it may be very challenging for pedestrians to deal with complex, sometimes hostile, traffic conflicts, especially in urban areas. This paper provides an exploratory analysis of pedestrian behavior on four types of mid-blocks crossing facilities in the city of Fortaleza, Brazil. The analysis was based on descriptive statistics and logistic regression models of variables related to signal control, facilities, and pedestrian characteristics and behavior. The models considered the following binary variables: (i) crossing vs no crossing while pedestrian red phase; (ii) driver yielded vs did not yield while pedestrian crossing; (iii) normal vs aggressive/risked pedestrian behavior while crossing. A total of 2,400 crossings were considered in this study. The results showed that, in general, the increase of traffic demand is related to easier crossings. Moreover, the presence of raised crosswalks increased in about 20 times the number of drivers that yielded to pedestrians in comparison to the only-marked site. As well as the implementation of mechanisms that help the performance of crossings, like raised platforms or traffic signals, reduced considerably the number of aggressive/risked crossings.

BACKGROUND Roadside observational studies play a fundamental role in designing evidence-informed strategies to address the pressing global health problem of road traffic injuries. Paper-based data collection has been the standard method for such studies, although digital methods are gaining popularity in all types of primary data collection. OBJECTIVE This study aims to understand the reliability, productivity, and efficiency of paper vs digital data collection based on three different road user behaviors: helmet use, seatbelt use, and speeding. It also aims to understand the cost and time efficiency of each method and to evaluate potential trade-offs among reliability, productivity, and efficiency. METHODS A total of 150 observational sessions were conducted simultaneously for each risk factor in Mumbai, India, across two rounds of data collection. We matched the simultaneous digital and paper observation periods by date, time, and location, and compared the reliability by subgroups and the productivity using Pearson correlations (r). We also conducted logistic regressions separately by method to understand how similar results of inferential analyses would be. The time to complete an observation and the time to obtain a complete dataset were also compared, as were the total costs in US dollars for fieldwork, data entry, management, and cleaning. RESULTS Productivity was higher in paper than digital methods in each round for each risk factor. However, the sample sizes across both methods provided a precision of 0.7 percentage points or smaller. The gap between digital and paper data collection productivity narrowed across rounds, with correlations improving from r=0.27-0.49 to 0.89-0.96. Reliability in risk factor proportions was between 0.61 and 0.99, improving between the two rounds for each risk factor. The results of the logistic regressions were also largely comparable between the two methods. Differences in regression results were largely attributable to small sample sizes in some variable levels or random error in variables where the prevalence of the outcome was similar among variable levels. Although data collectors were able to complete an observation using paper more quickly, the digital dataset was available approximately 9 days sooner. Although fixed costs were higher for digital data collection, variable costs were much lower, resulting in a 7.73% (US $3011/38,947) lower overall cost. CONCLUSIONS Our study did not face trade-offs among time efficiency, cost efficiency, statistical reliability, and descriptive comparability when deciding between digital and paper, as digital data collection proved equivalent or superior on these domains in the context of our project. As trade-offs among cost, timeliness, and comparability—and the relative importance of each—could be unique to every data collection project, researchers should carefully consider the questionnaire complexity, target sample size, implementation plan, cost and logistical constraints, and geographical contexts when making the decision between digital and paper.

The burden of trauma and injuries in Uganda is substantial and growing. Two important gaps that need addressing are the shortage of trained people and a lack of national data on noncommunicable diseases and their risk factors in Uganda.We developed and implemented a new track within an existing master of public health programme, aimed at developing graduate-level capacity and promoting research on key national priorities for trauma and injuries. We also offered training opportunities to a wider audience and set up a high-level national injury forum to foster national dialogue on addressing the burden of trauma, injuries and disability.The Chronic Consequences of Trauma, Injuries and Disability in Uganda programme was implemented in 2012 at Makerere University School of Public Health in Kampala, Uganda, in conjunction with Johns Hopkins Bloomberg School of Public Health in Baltimore, United States of America.Over the years 2012 to 2017 we supported four cohorts of master's students, with a total of 14 students (9 females and 5 males; mean age 30 years). Over 1300 individuals participated in workshops and seminars of the short-term training component of the programme. The forum hosted three research symposia and two national injury forums.Institutional support and collaborative engagement is important for developing and implementing successful capacity development programmes. Integration of training components within existing academic structures is key to sustainability. Appropriate mentorship for highly motivated and talented students is valuable for guiding students through the programme.La charge de morbidité liée aux traumatismes et aux blessures en Ouganda est importante et en augmentation. La pénurie de personnes formées et le manque de données nationales sur les maladies non transmissibles et leurs facteurs de risque en Ouganda constituent deux lacunes importantes qui doivent être comblées.Nous avons élaboré et mis en œuvre un nouveau parcours au sein d'un master de santé publique existant, destiné à développer des capacités de niveau universitaire et à promouvoir la recherche sur les principales priorités nationales relatives aux traumatismes et aux blessures. Nous avons également proposé des possibilités de formation à un plus large public et organisé un forum national de haut niveau sur les blessures pour encourager un dialogue national sur la charge induite par les traumatismes, les blessures et le handicap.Le programme Conséquences chroniques des traumatismes, des blessures et du handicap en Ouganda a été mis en œuvre en 2012 à l'École de santé publique de l'Université Makerere à Kampala, en Ouganda, en collaboration avec l'École de santé publique Bloomberg de l'Université Johns Hopkins à Baltimore, aux États-Unis d'Amérique.Entre 2012 et 2017, nous avons soutenu quatre cohortes d'étudiants en master, pour un total de 14 étudiants (9 femmes et 5 hommes; âge moyen 30 ans). Plus de 1300 personnes ont participé aux ateliers et séminaires du volet formation courte du programme. Le forum a accueilli trois symposiums de recherche et deux forums nationaux sur les blessures.Le soutien institutionnel et l'engagement collaboratif sont importants pour élaborer et mettre en œuvre avec succès des programmes de renforcement des capacités. L'intégration des volets de formation aux structures universitaires existantes est essentielle pour leur viabilité. Un tutorat adapté pour les étudiants motivés et brillants est utile pour les accompagner pendant toute la durée du programme.La carga de traumatismos y lesiones en Uganda es notable y sigue creciendo. Dos deficiencias importantes que deben abordarse son la escasez de personal formado y la falta de datos nacionales sobre las enfermedades no contagiosas y sus factores de riesgo en Uganda.Se ha desarrollado e implementado un nuevo curso dentro de un programa de máster en salud pública existente, destinado a desarrollar la capacidad de nivel de postgrado y promover la investigación sobre prioridades nacionales clave para traumatismos y lesiones. También se ofrecieron oportunidades de formación a un público más amplio y se estableció un foro nacional de alto nivel sobre lesiones para fomentar el diálogo nacional sobre la carga de los traumatismos, las lesiones y la discapacidad.El programa Consecuencias crónicas de los traumatismos, las lesiones y la discapacidad en Uganda se implementó en 2012 en la Escuela de Salud Pública de la Universidad de Makerere en Kampala, Uganda, junto con la Escuela de Salud Pública Johns Hopkins Bloomberg en Baltimore, EE.UU.Entre los años 2012 y 2017 se respaldaron cuatro cohortes de estudiantes de máster, con un total de 14 estudiantes (9 mujeres y 5 hombres, con una edad media de 30 años). Más de 1300 personas participaron en talleres y seminarios del componente de formación a corto plazo del programa. El foro fue sede de tres simposios de investigación y dos foros nacionales sobre lesiones.El apoyo institucional y el compromiso colaborativo son importantes para desarrollar e implementar programas de desarrollo de capacidades de éxito. La integración de los componentes de formación dentro de las estructuras académicas actuales es clave para la sostenibilidad. Una tutoría apropiada para estudiantes muy motivados y con talento es valiosa para guiar a los estudiantes por el programa.هناك عبء ضخم ومتزايد ناتج عن الرضوح والإصابات في أوغندا. وهناك فجوتان ينبغي الالتفات لهما، وهما المتمثلتان في غياب الموارد البشرية المدرّبة، ونقص البيانات الوطنية حول الأمراض غير السارية وعوامل الخطورة الناتجة عنها في أوغندا.قمنا بتطوير وتنفيذ مسار جديد في إطار برنامج حالي لدراسة الماجستير المعني بالصحة العامة، والذي كان موجهًا لتطوير القدرات على مستوى الخريجين، وتشجيع الأبحاث حول الأولويات الوطنية الرئيسية الخاصة بالرضوح والإصابات. كما قدمنا فرصًا للتدريب إلى جمهور أوسع نطاقًا من المتلقين، وقمنا بإعداد منتدى وطني رفيع المستوى للإصابات بغرض تعزيز الحوار الوطني حول التعامل مع عبء الرضوح والإصابات والإعاقة.تم تنفيذ برنامج "التبعات المستديمة للرضوح والإصابات والإعاقة في أوغندا" في عام 2012 في كلية الصحة العامة بجامعة ماكيريري في مدينة كامبالا بأوغندا، وذلك بالتعاون مع كلية الصحة العامة بجامعة جون هوبكنز بلومبرغ في بالتيمور بالولايات المتحدة الأمريكية.خلال المدة ما بين عاميّ 2012 وحتى 2017، قمنا بدعم أربع مجموعات من طلاب الماجستير كانت تضم في مجموعها 14 طالبًا (9 طالبات و5 طلاب، بمتوسط أعمار بلغ 30 عامًا). وقد شارك أكثر من 1300 فرد في حلقات العمل والحلقات الدراسية في إطار الشق الخاص بالتدريب قصير المدى في البرنامج. واستضاف المنتدى ثلاث ندوات بحثية ومنتديين وطنيين حول الإصابات.هناك أهمية كبيرة للدعم من جانب المؤسسات والمشاركة الجماعية لتطوير وتنفيذ البرامج الناجحة لتطوير القدرات. كما أن إدماج عناصر التدريب في الأنظمة الأكاديمية الحالية مهم بدوره لضمان استدامتها. ولذلك فإن التوجيه المناسب للطلاب الموهوبين وذي المستوى المرتفع من الدافعية يمثل عنصرًا قيًما لتوجيه الطلاب في إطار البرنامج.乌干达的创伤和伤害负担巨大且仍在不断增加。乌干达有两个严峻的问题亟需解决，一是缺乏训练有素的人员，二是缺乏国家层面上关于非传染性疾病及其风险因素的数据资料。.我们在现有的公共健康硕士项目中开发并设置了一个新的分支，旨在培养达到硕士级别能力的人才，并促进对创伤和伤害类国家重点优先医疗项目的研究。我们还向更广泛的受众提供培训机会，并成立了一个高水平的国家级伤害论坛，以促进国家对话，并解决创伤、伤害和残疾的负担。.乌干达坎帕拉的马凯雷雷大学公共卫生学院与位于美国巴尔的摩的约翰·霍普金斯大学的布隆博格公共卫生学院合作，于 2012 年实施了一项针对乌干达的创伤、伤害和残疾的慢性后果的项目。.2012 至 2017 年间，我们支持了四批学生获得硕士学位，共计 14 名学生（9 名女生和 5 名男生；平均年龄 30 岁）。超过 1300 人参与了该项目短期培训部分的讲习班和研讨会。该论坛举办了三个研究专题讨论会和两个国家级伤害论坛。.机构支持和协作参与对于成功开发并实施能力发展课程非常重要。在现有的学术体系中纳入培训内容是可持续发展的关键。为积极主动、有天赋的学生提供适当的指导帮助学生完成课程很有价值。.Уганда характеризуется значительным и растущим бременем травматизма. Две важные проблемы, требующие решения, — это нехватка квалифицированных специалистов и отсутствие национальных данных о неинфекционных заболеваниях и их факторах риска в Уганде.В рамках существующей программы магистратуры в области общественного здравоохранения авторы разработали и внедрили новое направление, нацеленное на развитие потенциала на уровне выпускников и продвижение исследований по ключевым национальным приоритетам в области травматизма. Авторами были предложены возможности для обучения, ориентированные на более широкую аудиторию, а также был создан национальный форум высокого уровня по вопросам травматизма для содействия национальному диалогу по устранению бремени травматизма и инвалидности.В 2012 году была создана программа по изучению вопросов хронических последствий травматизма и инвалидности в Уганде на базе Школы общественного здравоохранения Университета Макерере в Кампале, Уганда, совместно с Блумбергской школой общественного здравоохранения Джона Хопкинса в Балтиморе, Соединенные Штаты Америки.В течение 2012–2017 годов авторы оказали поддержку четырем когортам студентов магистратуры, в общей сложности 14 студентов (9 женщин и 5 мужчин, средний возраст которых составлял 30 лет). Более 1300 человек приняли участие в тренингах и семинарах по краткосрочной программе обучения. В рамках форума были проведены три исследовательских симпозиума и два национальных форума по травматизму.Институциональная поддержка и совместные усилия имеют важное значение для разработки и реализации успешных программ по развитию потенциала. Интеграция учебных компонентов в существующие академические структуры играет ключевую роль в обеспечении устойчивого развития. Значительную роль в продвижении высокомотивированных и талантливых студентов играет надлежащее наставничество.

Injury is a growing public health problem worldwide. Deaths due to injuries account for 10% of the world's mortality. More than 90% of the world's injury-related deaths occur in low- and middle-income countries such as Vietnam. The public health burden has been recognized by government; however, there is a need to study and better understand the epidemiology and trends for injuries and injury-related mortality to be able to better address this burden.In this article, we analyze the patterns and trends in injury mortality from 2005 to 2013 in Vietnam.All registered deaths from injuries from January 2005 to December 2013 were extracted from the Ministry of Health death recording system (A6). Mortality rates per 100 000 population per year were calculated. A linear regression model was used to estimate the injury mortality trends.In the 9-year period, 313 101 deaths due to injuries were recorded in the A6 system; this accounts for about 10% of all deaths. The leading causes of injury-related death were road traffic injuries among the entire population, while drowning was the leading cause of death among children. Other unintentional injuries including occupational, fall, poisoning, and exposure to electric current also accounted for a substantial proportion of the burden of injury. There is a significant reduction trend found in drowning among children 0 to 18 years of age and significant increasing trends in intentional injury causes.While injuries have been recognized as a public health problem in Vietnam in the last decade, as seen by our analysis, there is a need for concerted action to reduce their burden. Of particular concern is the increasing prominence of intentional injuries. Improved data systems, increasing the awareness in the community, and making appropriate policies and implementing them, as well as implementing effective, evidence-based interventions are all key to decreasing this burden. This is an important study describing injury mortality in Vietnam for the period 2005-2013. The results of the study show that injury death remains an important public health issue that needs more attention from government and relevant agencies.

Road traffic injuries (RTIs) are commonly under-reported in low-and-medium-income countries. This study aimed to estimate the number of RTIs and determine the magnitude of under-reporting by traffic police and hospital registries. A two-source capture-recapture method was applied to RTI data from police and hospital registries. Seven matching variables; sex of the injured, date, place, time, day of crash and road user type were used to get the matched cases. Police independently reported 46 RTIs and the hospitals reported 206 RTIs. Using the capture-recapture analysis, both sources estimated 313 RTIs (95% CI 273-343). The police registry captured 14.4% of the estimated number of RTIs and the hospitals captured 60.4%. The estimated number of RTIs was higher than reported by either the police or the hospitals alone. Neither the police nor the hospitals provided accurate data on RTIs, calling for the strengthening of both sources of data.

Pediatric injuries are associated with significant morbidity and mortality, especially in low- and middle-income countries. Data to characterize the cause and risk factors associated with childhood injuries in low- and middle-income countries are very scarce. The aim of this study is to describe the cause of pediatric injuries and their possible changes between 2007 and 2011 using hospital-based data in Cape Town, South Africa.Data from injured children13 years of age who presented to the Red Cross War Memorial Children's Hospital's emergency department in 2007 and 2011 were captured in Childsafe South Africa's trauma surveillance system. Poisson regression was used to assess changes in rates of injury between 2007 and 2011 in terms of demographics, geographic location of injury, type of injury mechanism, injury severity, and anatomic region of the sustained injury.In total, 14,915 injured children with 15,414 injuries presented to Red Cross War Memorial Children's Hospital in 2007 and 2011. The mean age was 5.01 ± 3.5 years and 60.3% were male. Common mechanisms of injury included falls (n = 6,036; 40%), road traffic injuries (n = 1,939; 13%), burns (n = 1,885; 12.6%), and assault (n = 640; 4.3%). Comparing 2011 to 2007, the incidence of road traffic injuries has decreased by 7% (P .05) while burn injuries increased 11% (P .05). Seventy-three percent (73%) of injuries that presented to Red Cross War Memorial Children's Hospital occurred in the Cape Flats area of Cape Town, where many informal settlements exist.These epidemiologic findings suggest that while road traffic injuries decreased and burn injuries increased at Red Cross War Memorial Children's Hospital, there is a need for data that are population-based and not hospital based. If we could describe injuries accurately within the pediatric population of a city such as Cape Town, we could in turn use this data to strengthen the need for targeted interventions to address risk factors for pediatric injuries. Despite this, hospital-based data remain a powerful tool to study injuries in low and middle-income countries.

Background Injuries contribute to a substantial proportion of the burden of disease in Kenya. Trauma registries can be a very useful source of data to understand patterns of injuries and serve to provide information about potential improvements in the care of injured patients. In Kenya, health facility-based injury data has been largely administrative. Our aim was to develop and implement a prospective trauma registry at the largest trauma hospital in Kenya, the Kenyatta National Hospital, and to understand the nature of injuries presenting to the hospital, their treatment and care, and their outcomes. Methods An electronic, tablet-based instrument was developed and implemented between January 2014 and June 2015. Data were collected at the emergency department, and patients were followed through disposition from the emergency department or in-patient wards if admitted. Variables included demographics, type of prehospital care received, details of the injury, and initial assessment and disposition from the emergency department or in-patient wards. Bivariate and multiple logistic regressions were used to assess potential risk factors associated with outcomes. Results A total of 8,701 injury patients were included in the registry during the study period. The mean age of the injured patients was 28 years (standard deviation, 26 years). The majority of these patients were males (81.7%). The leading mechanisms of injuries were road traffic injury (41.7%), assault (25.3%), and falls (18.9%). Only 7.4% of patients received prehospital care; 49.6% of injured patients arrived within 1 hour after their injury. Hospital mortality was 4.4% and close to 1% of patients died in the emergency department. The independent predictors of in-hospital death were older age (≥60 years), injury mechanism (burns and road traffic injuries), and admission type (transfer) after controlling for injury severity. Conclusion The establishment of hospital-based trauma registries can be an important tool for injury surveillance. This information will facilitate identifying priority areas for trauma care and quality improvement, as well as guiding the development of injury prevention and control programs.

Background Injury rates in low- and middle-income countries are among the greatest in the world, with >90% of unintentional injury occurring in low- or middle-income countries. The risk of death from injuries is 6 times more in low- and middle-income countries than in high-income countries. This increased rate of injury is partly due to the lack of availability and access to timely and appropriate medical care for injured individuals. Kenya, like most low- and middle-income countries, has seen a 5-fold increase in injury fatalities throughout the past 4 decades, in large part related to the absence of a coordinated, integrated system of trauma care. Methods We aimed to assess the trauma-care system in Kenya and to develop and implement a plan to improve it. A trauma system profile was performed to understand the landscape for the care of the injured patient in Kenya. This process helped identify key gaps in care ranging from prehospital to hospital-based care. Results In response to this observation, a 9-point plan to improve trauma care in Kenya was developed and implemented in close collaboration with local stakeholders. The 9-point plan was centered on engagement of the stakeholders, generation of key data to guide and improve services, capacity development for prehospital and hospital care, and strengthening policy and legislation. Conclusion There is an urgent need for coordinated strategies to provide appropriate and timely medical care to injured individuals in low- or middle-income countries to decrease the burden of injuries and related fatalities. Our work in Kenya shows that such an integrated system of trauma care could be achieved through a step-by-step integrated and multifaceted approach that emphasizes engagement of local stakeholders and evidence-based approaches to ensure effectiveness, efficiency, and sustainability of system-wide improvements. This plan and lessons learned in its development and implementation could be adaptable to other similar settings to improve the care of the injured patient in low- or middle-income countries.