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Unintentional childhood injuries are a growing public health concern, and the home is the most common location for non-fatal injuries in children less than 5 years of age. This study describes the long-term effects of two injury prevention educational interventions for caregivers-an educational pamphlet and an in-home tutorial guide-by comparing the change in the prevalence of home injury hazards before and after the interventions.This was a pre- (June and July 2010) and post-study with short-term follow-up (November-December 2010) and long-term follow-up (November 2012- January 2013). Neighborhood one included households that received only educational pamphlets after completing a baseline assessment; neighborhood two included households that received an in-home tutorial guide after completing the baseline assessment and receiving the educational pamphlet. The main outcome of this study was the reduction in home injury hazards for children under 5 years of age.A total of 312 households participated in the long-term phase to compare the effect of the interventions. Between the short-term to long-term follow-up, injury hazards significantly reduced in neighborhood two compared to neighborhood one. These included fall hazards (walker use) (IRR 0.24 [95% CI 0.08-0.71]), drowning hazards (open bucket of water in the courtyard and uncovered water pool) (IRR 0.45 [95% CI 0.85-0.98] and IRR 0.46 [95% CI 0.76-0.94]), burn hazards (iron, water heater within reach of child) (IRR 0.56 [95% CI 0.33-0.78] and IRR 0.58 [95% CI 0.32-0.91]), poisoning hazards (shampoo/soap and medicine within reach of child) (IRR 0.53 [95% CI 0.44-0.77] and IRR 0.7 [95% CI 0.44-0.98]) and breakable objects within reach of child (IRR 0.62 [95% CI: 0.39-0.99]).An injury prevention tutorial to caretakers of children supplemented with pamphlets could significantly decrease the incidence of falls, drowning, burns, poisoning, and cut injury hazards for children under 5 years of age in their homes in a low-resource setting. This intervention has the potential to be integrated in existing public health programs, such as Lady Health Visitors (LHVs), to disseminate injury prevention information in routine home health visits.

Considerable progress has been made in saving the lives of children younger than 5 years. Nevertheless, these advances have failed to help all children thrive, particularly children with disabilities. We describe the increasing prevalence of disability among children and adolescents. We evaluate the current situation regarding children with disabilities and rehabilitation in the context of health systems, particularly those in low- and middle-income countries. Within the newborn health agenda, congenital anomalies often require early intervention and rehabilitation. We provide Argentina as an example of a country where rehabilitation for congenital anomalies is integrated into the health system. We argue that congenital anomalies that require rehabilitation have the potential to strengthen rehabilitation systems and policies by: strengthening coordination between primary care and rehabilitation; identifying and understanding pathways that allow families to engage with services; providing human resources for rehabilitation; and building systems and resources that support assistive technology and rehabilitation. We propose ways for countries to prioritize and integrate early identification, referral and care for children with congenital anomalies to strengthen health systems for all. We identify opportunities to expand policy and planning and to design service delivery and workforce strategies through World Health Organization guidelines and frameworks for rehabilitation. We argue that the global health community must act to ensure that rehabilitation services to support functioning from birth are well established, accepted and integrated within health systems, and that disability is prioritized within child health. These steps would strengthen health systems, ensure functioning from birth and make rehabilitation accessible to all.Des progrès considérables ont été réalisés pour sauver la vie des enfants de moins de cinq ans. Pourtant, ces avancées n'ont pas permis à tous les enfants de s'épanouir, en particulier lorsqu'ils présentent un handicap. Dans ce document, nous faisons état de la prévalence croissante du handicap chez les enfants et adolescents. Nous évaluons la situation actuelle des enfants porteurs de handicap ainsi que leur réadaptation au sein des systèmes de santé, surtout dans les pays à revenu faible et intermédiaire. Dans le cadre du programme de santé néonatale, les anomalies congénitales nécessitent souvent des interventions et une réadaptation rapides. Nous utilisons l'exemple de l'Argentine, un pays où la réadaptation fait partie intégrante du système de santé en cas d'anomalie congénitale. Nous estimons que les anomalies congénitales impliquant une réadaptation sont susceptibles de renforcer les systèmes et mesures en la matière grâce à: l'amélioration de la coordination entre les soins primaires et la réadaptation; l'identification et la compréhension des parcours qui permettent aux familles d'entrer en contact avec de tels services; la mise à disposition de ressources humaines compétentes dans ce domaine; et enfin, grâce au développement des mécanismes et ressources qui soutiennent les technologies d'assistance et la réadaptation. Nous proposons aux pays des pistes favorisant un diagnostic précoce, un transfert et une prise en charge des enfants souffrant d’anomalies congénitales, afin de consolider le système de santé et d'en faire bénéficier l'ensemble de la population. En outre, nous recensons les moyens d'étoffer les politiques et programmes, mais aussi d'élaborer des stratégies de prestation de services et de gestion des effectifs conformes aux lignes directrices et cadres relatifs à la réadaptation formulés par l'Organisation mondiale de la Santé. Selon nous, la communauté sanitaire internationale doit agir pour faire en sorte que les services de réadaptation soient pris en compte, acceptés et intégrés dans les systèmes de santé afin de contribuer au bon fonctionnement dès la naissance, et que le handicap figure parmi les priorités en ce qui concerne la santé infantile. De telles actions renforceraient les systèmes de soins de santé, assureraient un développement optimal dès la venue au monde et rendraient la réadaptation accessible à toutes et tous.Se han hecho progresos considerables para salvar la vida de los niños menores de 5 años. Sin embargo, estos avances no han permitido que todos los niños prosperen, en particular los niños con discapacidades. En este artículo, se describe la creciente prevalencia de la discapacidad entre los niños y adolescentes. Se evalúa la situación actual de los niños con discapacidad y la rehabilitación en el contexto de los sistemas sanitarios, en particular los de los países de ingresos bajos y medios. Dentro de los programas de salud neonatal, las anomalías congénitas suelen requerir una intervención y rehabilitación tempranas. Se menciona a Argentina como ejemplo de un país en donde la rehabilitación de las anomalías congénitas está integrada en el sistema sanitario. Se argumenta que las anomalías congénitas que requieren rehabilitación tienen el potencial de fortalecer los sistemas y las políticas de rehabilitación mediante: el fortalecimiento de la coordinación entre la atención primaria y la rehabilitación; la identificación y la comprensión de las vías que permiten a las familias participar en los servicios; la provisión de recursos humanos para la rehabilitación; y la creación de sistemas y recursos que apoyen la tecnología de asistencia y la rehabilitación. Asimismo, se proponen mecanismos para que los países den prioridad e integren la identificación, derivación y atención tempranas de los niños con anomalías congénitas, con el fin de fortalecer los sistemas sanitarios para todos. Se identifican las oportunidades para ampliar la política y la planificación y para diseñar estrategias de prestación de servicios y de personal a través de las directrices y los marcos de la Organización Mundial de la Salud para la rehabilitación. Se sostiene que la comunidad sanitaria mundial debe actuar para asegurar que los servicios de rehabilitación para apoyar el funcionamiento desde el nacimiento estén bien establecidos, aceptados e integrados dentro de los sistemas sanitarios, y que se dé prioridad a la discapacidad dentro de la salud infantil. Estas medidas reforzarían los sistemas sanitarios, asegurarían el funcionamiento desde el nacimiento y harían que la rehabilitación fuera accesible para todos.لقد تم إحراز تقدم ملموس في إنقاذ حياة الأطفال دون سن الخامسة. ومع ذلك، فقد فشلت هذه التطورات في مساعدة جميع الأطفال على الازدهار، وبخاصة الأطفال من ذوي الإعاقة. نحن نصف الانتشار المتزايد لحالات الإعاقة بين الأطفال والمراهقين. نحن نقوم بتقييم الوضع الحالي فيما يتعلق بالأطفال من ذوي الإعاقة، وإعادة التأهيل في ظل النظم الصحية، وبخاصة في الدول ذات الدخل المنخفض والدخل المتوسط. في إطار جدول أعمال صحة الأطفال حديثي الولادة، غالبًا ما تتطلب العيوب الخلقية التدخل المبكر وإعادة التأهيل. ونشير إلى الأرجنتين كمثال لدولة تم فيها دمج إعادة تأهيل العيوب الخلقية في النظام الصحي. نحن نناقش موضوع أن العيوب الخلقية التي تتطلب إعادة التأهيل، لديها القدرة على تعزيز أنظمة وسياسات إعادة التأهيل من خلال: تعزيز التنسيق بين الرعاية الأولية وإعادة التأهيل؛ وتحديد وفهم المسارات التي تسمح للأسر بالانخراط في الخدمات؛ وتوفير الموارد البشرية لإعادة التأهيل؛ وبناء النظم والموارد التي تدعم التكنولوجيا المساعدة وإعادة التأهيل. نحن نقترح طرقًا للدول لتساعدها في منح الأولوية وإدماج كل من التحديد المبكر، والإحالة، والرعاية للأطفال الذين يعانون من عيوب خلقية لتعزيز النظم الصحية للجميع. نحن نستكشف الفرص لتوسيع السياسة والتخطيط، وتصميم إستراتيجيات تقديم الخدمات والقوى العاملة، من خلال إرشادات منظمة الصحة العالمية وأطر عمل إعادة التأهيل. نحن نزعم بأن المجتمع الصحي العالمي يجب أن يعمل لضمان أن تكون خدمات إعادة التأهيل لدعم الأداء الوظيفي منذ الولادة، راسخة ومقبولة ومتكاملة في النظم الصحية، وأن يتم منح الأولوية للإعاقة في سياق صحة الأطفال. من شأن هذه الخطوات أن تعزز النظم الصحية، وتضمن الأداء الوظيفي منذ الولادة، وتجعل خدمات إعادة التأهيل في متناول الجميع.挽救 5 岁以下儿童生命的工作已取得巨大进展。尽管如此，但也未能帮助所有儿童茁壮成长，尤其是残疾儿童。我们描述了儿童和青少年致残率升高的情况。我们评估了卫生体系中残疾儿童及其康复治疗的当前状况（特别针对中低收入国家的儿童）。在新生儿健康议程中，先天性发育异常儿童通常需要尽早接受干预和康复治疗。有些国家已将先天性发育异常儿童的康复治疗纳入国家卫生体系，例如阿根廷。我们认为，针对需要接受康复治疗的先天性发育异常情况，可能可以通过以下方式完善康复系统和相关政策：促使初级保健机构和康复治疗机构之间加强协作；了解和确定允许家庭参与服务的途径；加强康复服务人员队伍建设；以及构建支持辅助技术和康复治疗的系统和资源。我们建议各国通过采取一些手段来优先关注和整合先天性发育异常儿童的早期识别、转诊和护理，并加强构建覆盖全人群的卫生体系。我们根据世界卫生组织的康复指南和框架确定可以通过哪些机会来扩大政策和规划范围，并制定服务提供战略和人才战略。我们认为，全球健康社区都必须采取行动，确保在卫生体系中完善、纳入和整合自出生起即可享受的康复服务，并优先考虑儿童健康问题中的残疾问题。这些步骤将完善卫生体系，确保自出生起即可享受服务，并使所有人都能获得康复治疗。.Значительный прогресс достигнут в спасении жизни детей младше 5 лет. Тем не менее эти достижения не способствуют полноценному развитию всех детей, особенно детей с ограниченными возможностями. В статье рассматривается растущая распространенность инвалидности среди детей и подростков. Оценивается текущая ситуация в отношении детей с ограниченными возможностями и реабилитации в контексте систем здравоохранения, особенно в странах с низким и средним уровнем дохода. В рамках программы охраны здоровья новорожденных врожденные аномалии часто требуют раннего вмешательства и реабилитации. Аргентина приведена в качестве примера страны, где реабилитация при врожденных аномалиях интегрирована в систему здравоохранения. По мнению экспертов, врожденные аномалии, требующие реабилитации, могут способствовать укреплению систем и политики реабилитации за счет усиления координации между первичной медико-санитарной помощью и реабилитацией, определения и понимания путей, позволяющих семьям обращаться за услугами, обеспечения кадровых ресурсов для проведения реабилитации, создания систем и ресурсов, поддерживающих использование технических средств и реабилитации. Для укрепления систем здравоохранения во всех странах предлагается определить приоритеты и интегрировать методы раннего выявления, направления к врачу-специалисту и ухода за детьми с врожденными аномалиями. Выявляются возможности для расширения политики и планирования, а также для разработки стратегий предоставления услуг и кадров на основе руководящих принципов и основных положений Всемирной организации здравоохранения по реабилитации. По мнению экспертов, мировое сообщество здравоохранения должно принять меры для того, чтобы реабилитационные услуги для поддержания функционирования с рождения были хорошо налажены, приняты и интегрированы в системы здравоохранения, а инвалидности уделялось особое внимание в рамках охраны здоровья детей. Эти шаги позволят укрепить системы здравоохранения, обеспечить функционирование с самого рождения и сделать реабилитацию доступной для всех.

In Pakistan, data are lacking on the violence experienced by people living with HIV.This study determined the prevalence and risk factors of violence (physical, psychological and sexual) in people living with HIV in Karachi, Pakistan.This was a cross-sectional study in 2016 of people living with HIV attending clinics of Bridge Consultants Foundation, a community-based care provider. Date were collected using an interview-based questionnaire. Multivariate logistic regression analysis was done to assess the risk factors for violence with adjusted odds ratios (aOR) and 95% confidence intervals (CI) presented.The sample included 250 people living with HIV; 183 were men, 60 were women and 7 were transgender. The mean (standard deviation) age of the participants was 30 (6.5) years. The prevalence rates of psychological, sexual and physical violence were 79.6%, 74.8% and 64.4%, respectively. More women experienced physical violence than men (76.2% versus 60.7%). Psychological violence was associated with injecting drug use (aOR = 2.64, 95% CI: 1.27-5.50) and being married (aOR = 0.46, 95% CI: 0.24-0.90). Marriage (aOR = 2.30, 95% CI: 1.27-4.16) and having an HIV-positive partner (aOR = 2.07, 95% CI: 1.09-3.92) were risk factors for sexual violence. Physical violence was associated with young age (aOR = 0.95; 95% CI: 0.91-0.99) and having an HIV-positive partner (aOR = 2.17, 95% CI: 1.10-4.26).Violence is an important public health problem affecting people living with HIV in Pakistan. This issue needs to be addressed by the government and nongovernmental organizations.أنواع العنف التي يعاني منها المتعايشون مع فيروس العَوَز المناعي البشري وعوامل خطر التعرُّض له باكستان: دراسة مقطعية.صفية عوان، نخبة ضياء، فاطمة شريف، شرف علي شاه، بشرى جميل.لا تتوافر في باكستان بيانات حول العنف الذي يعاني منه المتعايشون مع فيروس العَوَز المناعي البشري.هدفت هذه الدراسة إلى تحديد معدل انتشار العنف، وعوامل الخطر المرتبطة به (بدنياً ونفسياً وجنسياً) لدى المتعايشين مع فيروس العَوَز المناعي البشري في كراتشي، باكستان.أُجريت هذه الدراسة المقطعية في عام 2016 على الأشخاص المتعايشين مع فيروس العَوَز المناعي البشري الذين يترددون على عيادات مؤسسة بريدج للاستشارات، وهي أحد مقدمي الرعاية المجتمعية. وجُع التاريخ باستخدام استبيان مستنِد إلى المقابلات. وأُجري تحليل الانحدار اللوجستي المتعدد المتغيرات لتقييم عوامل خطر التعرُّض للعنف باستخدام نسب أرجحية مُصحَّحة وفواصل ثقة بنسبة 95٪.شملت العينة 250 شخصاً من المتعايشين مع فيروس العَوَز المناعي البشري، منهم 183 رجلاً و60 امرأة و7 أشخاص من المتحوّلين جنسياً. وبلغ متوسط عُمر المشاركين (الانحراف المعياري) (6.5) 30 عاماً. وبلغت معدلات انتشار العنف النفسي والجنسي والبدني 79.6٪ و 74.8٪ و 64.4٪ على التوالي. وتعرَّضت النساء للعنف البدني أكثر من الرجال (76.2٪ مقابل 60.7٪). وارتبط العنف النفسي بتعاطي المخدِّرات حَقْناً (نسبة الأرجحية المُصحَّحة = 2.64، بفاصل ثقة 95٪: 1.27-5.50) والزواج (نسبة الأرجحية المُصحَّحة = 0.46، بفاصل ثقة 95٪: 0.24-0.90). وكان من عوامل خطر التعرُّض للعنف الجنسي الزواج (نسبة الأرجحية المُصحَّحة = 2.30، بفاصل ثقة 95٪: 1.27-4.16) ووجود زوج مصاب بفيروس العَوَز المناعي البشري (نسبة الأرجحية المُصحَّحة = 2.07، بفاصل ثقة 95٪: 1.09-3.92). وارتبط العنف البدني بسن الشباب (نسبة الأرجحية المُصحَّحة = 0.95، بفاصل ثقة 95٪: 0.91-0.99) ووجود زوج مصاب بفيروس العَوَز المناعي البشري (نسبة الأرجحية المُصحَّحة = 2.17، بفاصل ثقة 95٪: 1.10-4.26).يُعد العنف أحد مشكلات الصحة العامة المهمة التي تؤثّر على المتعايشين مع فيروس العَوَز المناعي البشري في باكستان. ويتعيّ على الحكومة والمنظمات غير الحكومية التصدّي لهذه المشكلة.Types et facteurs de risque des violences subies par les personnes vivant avec le VIH au Pakistan : étude transversale.Au Pakistan, il n’existe pas de données sur la violence à l’encontre des personnes vivant avec le VIH.La présente étude visait à déterminer la prévalence et les facteurs de risque des violences (physique, psychologique et sexuelle) à l’encontre des personnes vivant avec le VIH à Karachi, au Pakistan.Il s’agissait d’une étude transversale menée en 2016 sur des personnes vivant avec le VIH et fréquentant les cliniques de la Bridge Consultant Foundation, un prestataire de soins communautaire. Les données ont été recueillies à l’aide d’un questionnaire d’entretien. Une analyse de régression logistique multivariée a été réalisée afin d’évaluer les facteurs de risque de violence avec des odds ratios ajustés (ORa) et un intervalle de confiance (IC) à 95 %.L’échantillon incluait 250 personnes vivant avec le VIH, dont 183 hommes, 60 femmes et sept transgenres. L’âge moyen des participants était de 30 ans (ET 6,5). Les taux de prévalence des violences psychologique, sexuelle et physique étaient de 79,6 %, 74,8 % et 64,4 % respectivement. Plus de femmes ont subi de violence que les hommes (76,2 % contre 60,7 %). La violence psychologique était associée à la consommation de drogues par injection (ORa = 2,64, IC à 95 % : 1,27-5,50) et au mariage (ORa = 0,46, IC à 95 % : 0,24-0,90). Le mariage (ORa = 2,30, IC à 95 % : 1,27-4,16) et le fait d’avoir un partenaire séropositif (ORa = 2,07, IC à 95 % : 1,09-3,92) étaient des facteurs de risque de violence sexuelle. La violence physique était liée à un âge jeune (ORa = 0,95, IC à 95 % : 0,91-0,99) et au fait d’avoir un partenaire séropositif (ORa = 2,17, IC à 95 % : 1,10-4,26).La violence est un problème de santé publique majeur qui touche les personnes vivant avec le VIH au Pakistan. Ce problème doit être abordé par le gouvernement et les organisations non gouvernementales.

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.

BackgroundIn Sub-Saharan African countries, the incidence of traumatic brain injury (TBI) is estimated to be many folds higher than the global average and outcome is hugely impacted by access to healthcare services and quality of care. We conducted an analysis of the TBI registry data to determine the disparities and delays in treatment for patients presenting at a tertiary care hospital in Uganda and to identify factors predictive of delayed treatment initiation.MethodsThe study was conducted at the Mulago National Referral Hospital, Kampala. The study included all patients presenting to the emergency department (ED) with suspected or documented TBI. Early treatment was defined as first intervention within 4 hours of ED presentation—a cut-off determined using sensitivity analysis to injury severity. Descriptive statistics were generated and Pearson’s χ2 test was used to assess the sample distribution between treatment time categories. Univariable and multivariable logistic regression models with ResultsOf 3944 patients, only 4.6% (n=182) received an intervention for TBI management within 1 hour of ED presentation, whereas 17.4% of patients (n=708) received some treatment within 4 hours of presentation. 19% of those with one or more serious injuries and 18% of those with moderate to severe head injury received care within 4 hours of arrival. Factors independently associated with early treatment included young age, severe head injury, and no known pre-existing conditions, whereas older or female patients had significantly less odds of receiving early treatment.DiscussionWith the increasing number of patients with TBI, ensuring early and appropriate management must be a priority for Ugandan hospitals. Delay in initiation of treatment may impact survival and functional outcome. Gender-related and age-related disparities in care should receive attention and targeted interventions.Level of evidencePrognostic and epidemiological study; level II evidence.

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.

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.

Objective Lack of data on traumatic brain injuries (TBI) hinders the appreciation of the true magnitude of the TBI burden. This paper describes a scientific approach for hospital based systematic data collection in a low-income country. The registry is based on the evaluation framework for injury surveillance systems which comprises a four-step approach: (1) identifying characteristics that assess a surveillance system, (2) review of the identified variables based on adopted specific, measurable, assignable, realistic, and time-related criteria, (3) assessment of the proposed variables and system characteristics by an expert panel, and (4) development and application of a rating system. Results The electronic hospital-based TBI registry is designed through a collaborative approach to capture comprehensive, yet context specific, information on each TBI case, from the time of injury until death or discharge from the hospital. It includes patients’ demographics, pre-hospital and hospital assessment and care, TBI causes, injury severity, and patient outcomes. The registry in Uganda will open the opportunity to replicate the process in other similar context and contribute to a better understanding of TBI in these settings, and feed into the global agenda of reducing deaths and disabilities from TBI in low-and middle-income countries. Electronic supplementary material The online version of this article (10.1186/s13104-018-3419-1) contains supplementary material, which is available to authorized users.

Background Road traffic injuries (RTIs) commonly affect the younger population in low- and-middle-income countries. School children may be educated about road safety using storybooks with colorful pictures, which tends to increase the child’s interest in the text. Therefore, this study assessed the use of bilingual pictorial storybooks to improve RTI prevention knowledge among school children. Methods This pretest-posttest study was conducted in eight public and nine private schools of Karachi, Pakistan, between February to May 2015. Children in grades four and five were enrolled at baseline (n = 410). The intervention was an interactive discussion about RTI prevention using a bilingual (Urdu and English) pictorial storybook. A baseline test was conducted to assess children’s pre-existing knowledge about RTI prevention followed by administration of the intervention. Two posttests were conducted: first immediately after the intervention, and second after 2 months. Test scores were analyzed using McNemar test and paired sample t-test. Results There were 57% girls and 55% public school students; age range 8–16 years. Compared to the overall baseline score (5.1 ± 1.4), the number of correct answers increased in both subsequent tests (5.9 ± 1.2 and 6.1 ± 1.1 respectively, p-value

The global increase in COVID-19 cases in 2021 has primarily been due to an uncontrolled surge in South Asia. It is estimated that by 1 September 2021, approximately 1.4 million in South Asians will die due to COVID-19 alone.1 The total number of excess deaths will be much higher—including non-COVID causes, as health systems are on the brink of collapse.2 With 33.4% of South Asians being extremely poor3 and the large-scale loss of livelihood being reported, the region faces a potentially catastrophic future for the ongoing decade.4 However, countries in South Asia continue to remain divisive. This differs from other geographic ‘blocs’ that frequently cooperate on mutual interest issues.5 Tensions in South Asia are shaped by complex domestic, bilateral, intra-regional and international geopolitical factors, despite the region’s obvious geographic, economic and cultural interdependence. A key lesson from the current pandemic is that countries need to share lessons and actively coordinate, complement and supplement each other’s public health responses, especially between neighbours. We present a pragmatic ‘Stronger Together’ agenda (table 1) on critical areas of concern for political, social, medical and public health leaders in South Asia to consider and build on. View this table: Table 1 Key recommendations of a new ‘Stronger Together’ pandemic agenda for South Asia The uncontrolled spread of COVID-19 in many parts of South Asia implies that newer variants will continue to emerge. Some variants will inherently display increased transmissibility, infectivity and vaccine/antigenic escape capability, making it difficult for us to track and intelligently act on them.6 Rapidly scaling up capacity for genomics and rolling out …

BackgroundTraumatic brain injury (TBI) is an important cause of morbidity and mortality in low/middle-income countries. The objective was to assess causes and outcomes of unintentional and intentional TBI among patients presenting to a tertiary care hospital in Uganda.MethodsThis study was conducted at Mulago National Referral Hospital, Kampala, Uganda, for 15 months in 2016–2017. Patients of all ages, males and females, presenting to the emergency department with suspected or documented TBI were enrolled. Patient demographics, TBI causes and outcomes were recorded. The outcome of interest was unintentional and intentional TBI.ResultsIntent was known for 3749 patients, of these 69.7% were unintentional TBI and 30.3% were intentional TBI. The average age of patients in both groups was similar (28±14 years) with over 70% of patients between 19 and 45 years age group. About 80% were males in both groups. The main causes of unintentional TBI were road traffic injuries (RTI) (88.9%) and falls (11.1%). Pedestrians (42.1%) and motorcycle drivers (28.1%) were the most common road users. Among patients with unintentional TBI, about 43.6% were admitted, 34.0% were sent home. There were 73 deaths: 63 were patients with RTI and 10 had a fall. Although assault (97.1%) was the main cause of intentional TBI, those patients with self-harm were likely to be in severe Glasgow Coma Scale range (39.4%) compared with victims of assault (14.2%). Among patients with intentional TBI, 42.6% were admitted and 37.1% were sent home. There were 30 deaths: 29 were assault victims and 1 of self-harm.DiscussionUnintentional TBI caused by RTI and intentional TBI caused by assault are common among young males attending Mulago Hospital in Kampala.Level of evidenceProspective observational study, level III.

Additional file 1: Table S1. Participating organizations.

Objective South Asia has the highest mortality rate from burns in the world. Application of quality improvement methods to burn care can help identify health system gaps. Our overall aim is to introduce a sustainable hospital-based burn registry for resource-constrained settings to assess health outcomes of burn injury patients presenting to dedicated burn injury centers in South Asia. Results The South Asia Burn Registry (SABR) is implemented through collaborative approach in selected burn centers in Bangladesh and Pakistan. Th registry collects data on burn injury events, the care provided, and the functional status of patients at discharge from burn centers. It covers the entire spectrum of care provision for burn injury patients from the actual event through their discharge from the healthcare system. SABR investigates locally relevant contextual factors associated with burn injury and health-system requirements for burn patients receiving emergency and inpatient care in resource-constrained settings. It also explores factors associated with burn injury and care provision. SABR will inform better prevention and management efforts in South Asia and help to address healthcare needs of burn injury patients. Electronic supplementary material The online version of this article (10.1186/s13104-019-4063-0) contains supplementary material, which is available to authorized users.

Lack of data on traumatic brain injuries (TBI) hinders the appreciation of the true magnitude of the burden, and poses a barrier to defining risks, vulnerable groups, and the impact of potential interventions. This work describes a scientific approach for hospital based systematic data collection in a low-income country (LIC), and details the steps of developing an internet-based TBI registry in Uganda. The registry is developed and implemented based on the evaluation framework for injury surveillance systems (EFISS) which comprises a four-step approach: (1) identifying characteristics that assess a surveillance system, (2) a thorough review of the identified characteristics(variables) based on adopted Specific, Measurable, Achievable, Realistic, Time-bound (SMART) criteria, (3) assessment of the proposed variables and system characteristics by an expert panel, and (4) development and application of a rating system. After extensive literature review on TBI surveillance and management, variables and implementation strategy were finalized by a peer review panel and an mHealth platform was developed for data collection in Mulago Hospital, Kampala. The TBI registry is designed to capture comprehensive, yet context-specific, information on each case, from the time of injury until death or discharge from the hospital, with a cut off at 30 days if the patient was still admitted. It included patients’ demographic information, pre-hospital and hospital assessment and care, causes of TBI, injury severity, and patient outcomes in terms of survival and disability. This was the first mHealth based TBI registry to be pilot tested in a tertiary care hospital of Uganda. An mHealth-based TBI registry in Uganda will open the opportunity to replicate the process in similar context and thus contribute to a better understanding of TBI in these settings, and feed into the global agenda of reducing deaths and disabilities from TBI in low-and middle-income countries.

In low-and-middle-income-countries (LMICs), families are often tasked with taking care of individuals who are disabled because of injuries. The extent of this burden is, however, not well understood. The objective was to examine the type and severity of disability among individuals with non-fatal injuries, and type of caregiving assistance available to individuals with disability in Uganda. Data was collected for adults (≥18 years) with injury-related physical disability living in the Iganga-Mayuge health and demographic surveillance site (IM-HDSS) in Uganda. Disability was assessed using the WHO Disability Assessment Schedule 2.0. Logistic regression analyses examined factors associated with caregiver availability and included sex, age groups, marital status, education, occupation, wealth quintile and disability severity. Overall, 70% of individuals with injury-related disability reported having a caregiver, mostly family. Among these, 60% were head of household; 65% were females; 40% were married; 40% were not educated; 65% were self-employed, 24% belonged to households in the lowest socioeconomic quintile, and 51% had mild disability. Common types of disability were related to legs (74%) and arms (63%). Logistic regression results showed that compared to females, males were 54% less likely to have a caregiver(p 80 years were 2.5 times more likely to have a caregiver compared 18–29 years (p=0.033). Those in the highest wealth quintile were 1.76 times more likely to have a caregiver (p=0.023). Our results highlight that this burden often falls immediate family imposing an undue burden with life-long implications. In LMICs like Uganda, non-fatal injuries can have consequences that extend beyond the individual. Health and economic impact of injury-related disability is documented but less so for caregiving for these individuals. It is important to better understand the needs of disabled individuals and their caregivers and design more effective strategies to address this burden.

Pedestrian road traffic crashes are responsible for a substantial number of injuries and deaths in Pakistan. There is a need to better understand the situations faced by pedestrians especially children. The objective of this study was to develop and pilot observation tool for pedestrian’s behavior and road practices of school children in Karachi. The survey was conducted from March to June 2013. Initially 175 schools were approached out of which (n=107, 61.1%) agreed to participate. The observations were made on school children as pedestrians (coming to and going from school) by trained data collectors. The observations were made during morning (starting time of school) and afternoon (off time of school). Three hundred and forty-four pedestrian observations were made in 107 schools. Of the 107 schools, 50.47% were private (n=54), 44.86% were public (n=48), and the rest were non-governmental organization run (n=5, 4.67%) schools. Most of the schools (n=227, 66.6%) lacked a zebra crossing. None of the observed children used zebra crossing, when present. Only a quarter of the children looked right and left while crossing the road (n=85, 24.7%). Almost one third of the children had their back towards oncoming traffic while walking on road (n=109, 31.7%). About 10.5% (n=36) children ran to cross the road. About 36.3% (n=125) children did not look out for traffic before stepping on to the road. This was the first time that safety behaviors of children in school as pedestrians were measured in Pakistan. There is need for improved safety for child pedestrians while promoting the health and environmental benefits of walking.

Traumatic brain injury (TBI) is an important cause of morbidity and mortality especially in low-and-middle income countries (LMICs). The study objective was to assess causes and outcomes of intentional TBI among patients presenting to a tertiary-care hospital in Uganda. The study site was Mulago National Referral Hospital, Kampala, Uganda. Data was collected from May 2016-July 2017. Patients of all age groups presenting to emergency department of the hospital with suspected or documented TBI were enrolled. Patient demographics, TBI causes and outcomes were recorded. TBI was grouped into mild (13–15), moderate (9–12) and severe (≤8) categories based on Glasgow Coma Scale (GCS). Ethical approval was taken from Johns Hopkins School of Public Health and Makerere University. Out of 3749 patients with known intent, 30.3% (n=1135) had intentional TBI. Majority were males (84.5%); mean age was 28.5±14.5 years. Assault (97.1%) was the main cause, however, there were 33 (2.9%) cases of self-harm. Common assault methods were use of bodily force (33.7%), iron bar (24.2%) and hammer (12%). Gun was used in 3 cases. About 60.9% of these victims were breadwinners. 62.8% were in mild GCS category, 22.4% in moderate and 14.9% were in severe category. About 42.6% of the patients were admitted to ward, 37.1% were sent home. There were 30 deaths; 29 were assault victims and 1 of self-harm. Intentional TBI is common among young males in Kampala with assault being the main cause of TBI. TBI resulting from assault among young males in Kampala is an important cause of mortality and morbidity. This has consequences for LMICs like Uganda which has a young population contributing to a broad population pyramid. There is need for further exploration of intentional injuries among youth in the country and to develop programs to engage youth in productive activities for contribution towards country’s economic development.

Speeding is a major risk factors for road traffic injuries in Bangkok. The objective was to understand speeding prevalence, and examine associated factors in Bangkok, Thailand. Five rounds of cross-sectional data were collected between July 2015–September 2017 using standardized protocols. Observation locations were selected through systematic sampling. Speed was measured using a microwave radar gun on weekdays/weekends, and five times during each day. The speeding prevalence was calculated based on established speed-limits in Bangkok. Descriptive analysis estimated city-wide, and area/road specific-speed prevalence. Regression analysis examined key factors associated with speeding. Over 700 000 vehicles were observed across the five rounds. The speeding prevalence ranged from 32%–47% across the five rounds. Speeding was common during weekdays (round 1:67%; round 2:69%; round 3:70%; round 4:75% and round 5:61%) and during evenings (21% in rounds 1–3 and 22% in rounds 4–5). Larger vehicles were more likely to speed. Speeding was more likely on arterial roads (round 1:84%; round 2:79%; round 3:81%; round 4:74% and round 5:86%) as compared to collector roads. Overall, 46% of speeding vehicles were at ≤10 km/hour above the posted speed limit while 30% were between 11–20 km/hour. Multivariate regression analysis revealed that minibuses were nine times more likely to speed than motorcycles (aOR: 9.20), and commercial vehicles were 16% less likely to speed compared to private vehicles. Our results highlight the increased susceptibility of motorcyclists and other vulnerable road users due to larger speeding vehicles on the roads in Bangkok. Speeding was also highest during weekends and evenings. Considering the limited resources, these findings could be invaluable to design more efficient and targeted road safety programs including but not limited to appropriate messaging and data-led enforcement of legislation. Such an approach would be key to reducing the burden of road traffic injuries in cities like Bangkok.

Studies from low- income countries have shown that 7% of all childhood injuries occur in schools; however little is known about the injury hazards present in the school environment. The objective of this study was to develop and pilot injury risk assessment tool in the schools in Karachi. The study was conducted from March – June 2013. These risk observations in school environment were done by trained data collectors. The injury risk assessment was done in 107 schools. About a quarter (26%) of classrooms had broken furniture. In 50.9% of schools the playground surface was of concrete. About 28.3% schools had low height of corridor walls, while 60.4% schools had open wires in electrical switches. In 14.2% of schools there were cleaning chemicals in toilets within the reach of children. There were stray dogs within schools (22.4%). This was the first time that injury school environment risks tool was developed and piloted in the context of Pakistan. There was a significant burden of hazards present in the school environment representing an important opportunity for injury prevention.

Clinical characteristics of traumatic brain injuries (TBIs) depend on severity of injury. The objective was to assesses clinical characteristics of TBI patients presenting to a tertiary-care hospital in Uganda. This prospective study was conducted at Mulago National Referral Hospital, Kampala, Uganda from May 2016-July 2017. Patients of all age groups presenting to emergency department (ED) of the Mulago Hospital with suspected or documented TBI were followed-up till discharge. Patient demographics, TBI characteristics, and outcomes were recorded. TBI was grouped into mild, moderate and severe categories based on Glasgow Coma Scale (GCS). Of the 3944 patients enrolled, 84.7% were males. Mean age was 28.5±14.2 years. Road traffic injury (58.9%) and assault (27.9%) were the common mechanisms. Headache (67.3%), scalp wound (65%) were common presenting complains. Most patients had closed TBI (62.9%). Common modes of arrival were police vehicle (33.9%), private vehicle (29%) and ambulance (26.8%). Alcohol use was suspected in 30.1% and drugs in 8.6% of the TBI patients at the time of initial presentation. Mean heart rate was 85.6±20.47 beats/minute, respiratory rate was 22.8±7.6/minute, systolic blood pressure was 120.0±18.6 mmHg. About 61.6% had mild TBI, 22.1% had moderate and 16.4% had severe TBI at the time of ED presentation. CT scan was done in 48.5% patients. 33.8% patients were sent home while 40% patients were admitted to wards. There were 109 deaths in the ED; 65 among mild TBI patients, 25 in moderate group and 19 in severe TBI group. Young male patients, with road traffic crash or assault are the most common victims of TBI. Majority patients had mild TBI but poor outcomes like ED death were observed within all categories of TBI patients. Understanding clinical parameters and causes of TBI patients is crucial to developing preventive strategies for prevention of TBI.

Additional file 1. Patient and data flow for KiTBIR.

BackgroundPrehospital airway management (AM) is the first priority in the care of emergency and trauma victims as it has shown to improve survival in these patients.ObjectiveThe aim of this study was to assess training and knowledge of ambulance staff and availability of AM equipment in ambulances of Karachi, Pakistan.MethodsThis cross-sectional study was conducted from June through September 2014. Interviews were conducted with management of six ambulance service providers and 165 ambulance staff. Data from the management included availability of AM equipment in the ambulances, number and designation of staff sent for emergency calls, and AM training of staff. Ambulance staff were assessed for their awareness, knowledge, and training pertaining to AM.ResultsAll the ambulance services (A through F) had basic equipment for AM but lacked qualified and trained staff. All services had solo drivers (98.3%) for emergency calls; however, Ambulance Service A also had doctors and paramedics. Only 35.7% (59/165) of ambulance staff had awareness regarding AM, out of which 77.9% (46/59) belonged to Ambulance Service A. Of these 59 staff, 81.4% received some form of AM training. Staff with AM awareness, when assessed for knowledge pertaining to AM steps and AM equipment, had a mean score of 4.7/5 and 8.4/12, respectively.ConclusionEven though ambulances are equipped with basic equipment, due to lack of trained staff, these ambulances only serve the mere purpose of transportation. There is a need to train ambulance staff and increase ambulance to staff ratio to improve prehospital AM and patient survival.IsmailS, ZiaN, SamadK, NaeemR, AhmadH, RazaA, BaqirM, KhanUR. Prehospital airway management in emergency and trauma patients: a cross-sectional study of ambulance service providers and staff in a low- and middle-income country. Prehosp Disaster Med. 2015;30(6):606–612.

Background Disability is highly prevalent in low-and-middle-income countries (LMICs), but there is a relative dearth of disability and caregiving research from LMICs. Objective To examine type and severity of disability experienced by individuals 60 years and older, caregivers and type of caregiving assistance, and the interrelationships between sociodemographic factors involved in Uganda. Methods Data was collected from two Eastern Ugandan districts using the WHO Disability Assessment Schedule 2.0. Data on availability of caregiver was analyzed for 816 participants with disability. Group comparisons and regression analyses examined differences based on caregiver availability. Results Approximately 66% of individuals with disability had a caregiver. The mean age of those with a caregiver (74.7 ± 8.9 years) was statistically significantly (p = .0004) higher than that of individuals without caregiver (72.4 ± 8.2 years). Significant differences based on caregiver availability were found relative to sex (p = .009), age (p≤.001), education level (p≤.001), occupation (p≤.001) and head of household status (p≤.001). The most frequent types of disability were related to vision (78.4%) and ambulation (71.7%). Caregiving most often fell to family members. Logistic regression results showed that individuals over the age of 80 years were 2.51 times more likely to have a caregiver compared to those 60–69 years (p≤.001). Those in the highest wealth quintile were 1.77 times more likely to have a caregiver. Conclusions Findings demonstrate gaps in caring for aging individuals with disabilities in LMICs and highlight the importance of understanding caregiver access in generating effective healthy aging initiatives and long-term care systems.

BackgroundTraumatic brain injuries (TBIs) are a common cause of emergency department (ED) visits and hospital admissions in Kampala, Uganda. The objective of this study was to assess determinants of ED discharge disposition based on patient demographic and injury characteristics. Four ED outcomes were considered: discharge home, hospital admission, death, and others.MethodsThis prospective study was conducted at Mulago National Referral Hospital, Kampala, Uganda, from May 2016 to July 2017. Patients of all age groups presenting with TBI were included. Patient demographics, external causes of injury, TBI characteristics, and disposition from EDs were noted. Injury severity was estimated using the Glasgow Coma Scale (GCS), Kampala Trauma Score (KTS), and the Revised Trauma Score (RTS). A multinomial logistic regression model was used to estimate conditional ORs of hospital admission, death, and other dispositions compared with the reference category “discharged home”.ResultsA total of 3944 patients were included in the study with a male versus female ratio of 5.5:1 and a mean age of 28.5 years (SD=14.2). Patients had closed head injuries in 62.9% of cases. The leading causes of TBIs were road traffic crashes (58.8%) and intentional injuries (28.7%). There was no significant difference between the four discharge categories with respect to age, sex, mode of arrival, cause of TBI, place of injury, type of head injury, transport time, and RTS (p>0.05). There were statistically significant differences between the four discharge categories for a number of serious injuries, GCS on arrival, change in GCS, and KTS. In a multinomial logistic regression model, change in GCS, area of residence, number of serious injuries, and KTS were significant predictors of ED disposition.DiscussionThis study provides evidence that ED disposition of patients with TBI is differentially affected by injury characteristics and is largely dependent on injury severity and change in GCS during ED stay.Level of evidenceLevel II.

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.

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.

To determine the frequency, site and time to relapse from diagnosis, and to see the relationship of relapse with important prognostic factors.The prospective descriptive observational study was conducted at the National Institute of Child Health, Karachi, June 2005 to May 2007, and comprised newly-diagnosed cases of acute lymphoblastic leukaemia. Bone marrow aspiration was done on reappearance of blast cells in peripheral smear and cerebrospinal fluid. Detailed report was done each time when intra-thecal chemotherapy was given or there were signs and symptoms suggestive of central nervous system relapse. SPSS 12 was used for data analysis.Of the 60 patients enrolled, 4(6.6%) expired and 1(1.7%) was lost to follow-up. Of the 55(91.6%) who comprised the study sample, 35(58%) were males and 25(42%) females. Mean age of relapse was 6.8±3.27 years. Mean time to relapse from diagnosis was 1.3±0.54 years; 12(20%) patients suffered relapse, and of them 5(14%) were boys. Central nervous system relapse in 8(67%) patients was the most common site, with 3(25%) bone-marrow relapses. Out of 12 patient with relapses, 9(75%) had white blood cell count less than 50,000/cm.Relapse in acute lymphoblastic leukaemia was common, although treatment modalities are improving day by day.