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Johns Hopkins International Injury Research Unit

A World Health Organization Collaborating Center for Injuries, Violence and Accident Prevention

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Date: Feb 2014

Every day, more than 32 children between the ages of 1-4 die in Bangladesh due to drowning. That's more than 12,000 children a year. In fact, while the mortality rates of childhood diseases like diarrhea or malaria have decreased, in large part due to disease prevention and nutritional interventions, the rate of child drowning has increased, especially in low-income countries like Bangladesh, because there has not been a similar investment in prevention. It's not surprising, then, that drowning is the leading cause of death for this age group in the country. But drowning, like most unintentional injuries, is a preventable cause of death.

The Johns Hopkins International Injury Research Unit (JH-IIRU) is committed to reducing the burden of child injuries around the world. That's why, on February 27, 2014, JH-IIRU joined Bloomberg Philanthropies in Dhaka, Bangladesh, to launch the Drowning Prevention Project, a $10 million initiative aimed at identifying scalable drowning interventions in this low-lying South Asian country.

As part of this project, JH-IIRU will work in collaboration with the International Center for Diarrhoeal Disease Research, Bangladesh (icddr,b) and the Center for Injury Prevention and Research Bangladesh (CIPRB), to initiate the Saving of Lives from Drowning (SoLiD) in Bangladesh. SoLiD is an implementation study that has been established to test the effectiveness of two interventions to prevent and reduce the burden of childhood drowning in Bangladesh. The interventions will be implemented along with family education and community awareness on drowning prevention.

Adnan A. Hyder, MD, MPH, PhD, director of JH-IIRU, will lead a team that will directly address two major factors in preventable child drowning deaths in a country where 7% of its surface is covered in water-lack of supervision and easy access to water. The project will test two interventions: community daycare centers (sometimes referred to as "crèches" or "anchals") playpens. Attendance in crèches during the period when drowning injury is most likely to occur reduces the risk of drowning by both supervising the child and removing the child from the hazard. Similarly, playpens, which will be locally manufactured, restrict child mobility, thus creating a barrier between the child and the hazard. They are also an aid to adult supervision, which, in turn, minimizes exposure to the risk of drowning.

The goal of the project is to monitor and evaluate the effectiveness of these interventions for 80,000 children, 1-4 years of age over a two-year period.

"The rate of drowning for young children in Bangladesh is alarming," said Hyder. "It is imperative that we explore the feasibility of appropriate and cost-effective drowning prevention interventions for child survival."

"This project represents a tremendous opportunity for continuing to improve child health care in Bangladesh and is a strong commitment to injury research," said Olakunle Alonge, assistant scientist in JH-IIRU and program manager for SoLiD.

Bloomberg Philanthropies is also supporting the World Health Organization (WHO) to publish an evidence-based global report on drowning prevention later this year and provide expert guidance on effective strategies to combat this burgeoning epidemic and save thousands of lives.

More information here

According to the World Health Organization (WHO), unintentional injuries, particularly road traffic injuries, drowning and fire-related burns are among the leading causes of death for children 1-19 years. This translates into more than 2000 child deaths each day as the result of an unintentional injury.

Despite these shocking numbers, child injuries have not received much attention in the public health community. In fact, to date, few studies have examined exclusively the global child injuries of all age groups and even fewer have provided evidence-based solutions for tackling this burden.

The Johns Hopkins International Injury Research Unit (JH-IIRU) is committed to reducing the global burden of childhood unintentional injuries. From our assessment of the potential of child injury prevention in "Saving 1000 children a day: The potential of child and adolescent injury prevention"(accessed here) to our Global Road Safety Program work in low- and middle-income countries that focuses on interventions like seatbelts and child restraints, JH-IIRU is dedicated to using reliable data to assess risks and introduce effective interventions. We have analyzed hospital data on pediatric burn injuries in South Africa, examined child road safety education programs in Malaysia and done extensive home injury risk assessment work in Pakistan.

On February 27th, the Unit will announce an important new project in Bangladesh that will once again focus on reducing the number of childhood fatalities in that country. We'll have more information available here in the coming days.

Until then, follow these links to access information on the unit's extensive work in preventing childhood unintentional injuries:

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301607?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed&

http://adc.bmj.com/content/99/1/62.long

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709307/

http://www.sciencedirect.com/science/article/pii/S0020138312005566

http://qhr.sagepub.com/content/22/11/1476.long

http://www.ncbi.nlm.nih.gov/pubmed/22710788

http://www.tandfonline.com/doi/abs/10.1080/15389588.2011.645382?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed#.UwttpmJdXh4

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337295/

More than 5 million deaths are caused by injuries globally each year, resulting in devastating social and economic costs. These costs are especially high in low- and middle-income countries (LMICs), where health systems are struggling to prioritize injuries as a significant health concern. In LMICs, the economic losses associated with road traffic injuries (RTIs) alone are estimated to be $100 billion annually.

Given the devastating extent of this burden, there is an urgent need to push injury prevention to the forefront of public health initiatives and to understand the costs associated with injury, yet there is a lack of injury-related economic evidence from LMICs.

This is the conclusion JH-IIRU team members, including Hadley KH Wesson and associate director, Abdulgafoor M. Bachani, reached in their recent publication, “The cost of injury and trauma care in low- and middle-income countries: A review of economic evidence,” in the journal Health Policy and Planning.

The goals of the paper are to 1) summarize the body of economic evidence on injury in LMICs; 2) assess the quality of cost-effectiveness studies using standard methods to highlight the role of economic data as a tool for injury-prevention advocacy; and 3) to provide recommendations regarding economic evaluations in LMICs.

The study found that while there are a relatively significant number of studies exploring the costs of injuries or hospitalizations due to injury in LMICs, a small fraction were complete economic studies, making it difficult to generalize costs of injury at regional or global levels. Despite the study’s limitations, the economic burden of injury is unquestionable and low-cost interventions such as traffic enforcement, installation of speed bumps, motorcycle helmet legislation and drowning prevention programs, are possible with support and investment from stakeholders and policy-makers.

Access the full study here:  http://www.ncbi.nlm.nih.gov/pubmed/24097794

On February 12th, as part of the effort to draw attention to the growing burden of road traffic injuries, the Johns Hopkins International Injury Research Unit (JH-IIRU) at the Johns Hopkins Bloomberg School of Public Health will launch “Global Road Safety: Updates from Ten Low- and Middle-Income Countries,” a special issue of Injury. The launch will coincide with a noontime seminar at the Bloomberg School in Baltimore which features panelists from Bloomberg Philanthropies, the Association for Safe International Road Travel (ASIRT) and the Pan American Health Organization (PAHO).

Road traffic injuries (RTIs) account for nearly 1.24 deaths each year, with an additional 20 to 50 million people injured or disabled. In low- and middle-income countries (LMICs), the rate of RTIs is twice as high as in developed nations. Today, RTIs are the 8th leading cause of death globally, and if no action is taken, the World Health Organization (WHO) estimates that they will jump to the 5th leading cause by 2030. Moreover, the economic losses associated with road traffic deaths are just as devastating, costing LMICs an estimated $100 billion every year. While these statistics are shocking, the impact of road traffic crashes is often overlooked as a serious disease burden.

The JH-IIRU is dedicated to reducing those rates of road traffic injuries around the world. Led by Dr. Adnan A. Hyder, in 2010, JH-IIRU joined a consortium of six partners, including the WHO, the Global Road Safety Partnership, ASIRT, EMBARQ and the World Bank, to evaluate and implement road safety solutions in ten countries that account for nearly half (48%) of all traffic deaths globally. The Bloomberg Philanthropies Global Road Safety Program is a five-year undertaking generously funded by Bloomberg Philanthropies and dedicated to evaluating and implementing road safety solutions where they are needed most.  

The goal of the Road Safety Program is to save lives by providing evidence for stronger road safety interventions around the world.  It is equally important, however, to increase awareness of the devastating impact of road traffic injuries.  For this reason, JH-IIRU has published its second special issue.  “Global Road Safety: Updates from Ten Low- and Middle-Income Countries.”  This new supplement features 12 scientific papers jointly authored by nearly 50 JH-IIRU colleagues and collaborators from 30 institutions and organizations within the participating countries. The issue presents findings from the ongoing monitoring and evaluation activities in all ten countries, as well as an examination of the trauma component of the program. It highlights the mixed methods approach of data collection and showcases both the successes as well as the challenges of collecting such data in real-world settings.

“These papers are an important step in building the evidence-base on injury control and road safety in LMICs and demonstrates the promise of mixed-methods research in our understanding of what works in many different contexts for both prevention and treatment of RTIs,” said Hyder.

The supplemental issue is also part of the commitment of the partners in the Global Road Safety Program to share knowledge, provide access to progressive results and stimulate further dialogue on road traffic injury prevention and control in developing countries—something Dr. Hyder sees as vitally important.

“The amount of research done on road safety in LMICs is not proportional to the burden of injury in these countries,” said Hyder. “In the most recent Cochrane review on road safety interventions, only 2.5% of the trails utilized were conducted in LMICs. And all only focused on a single intervention—helmet wearing! It is imperative that we shine a spotlight on the under-recognized burden of road traffic injuries.”

While road safety issues have recently begun garnering more attention, much more work is needed. This special issue brings to light the under-recognized burden of road traffic injuries even as it represents important strides in road safety research.

The Johns Hopkins International Injury Research Unit gratefully acknowledges Bloomberg Philanthropies for their support, as well as that of our in-country collaborators and consortium partners.

For more information on the seminar, click here.

For more information on the Bloomberg Philanthropies Global Road Safety Program, visit the JH-IIRU website: http://www.jhsph.edu/iiru/index.html

To access the special issue, visit the Injury website at http://www.sciencedirect.com/science/journal/00201383/44/supp/S4

Capacity development is a core feature of the Johns Hopkins International Injury Research Unit's (JH-IIRU) efforts to address the global burden of injuries. Our training and capacity development efforts, which span all facets of injury prevention, focus on combining a strong public health approach, scientific principles and examples of challenges and successes from low- and middle-income countries (LMICs).

JH-IIRU faculty cover the basic sciences of public health (epidemiology and biostatistics), social sciences (behavior and communications), health systems analysis (health economics), ethics and issues of cultural sensitivity (equity) and primarily engage with public health professionals, medical and research personnel, as well as graduate students from LMICs.

In the spring of 2013, JH?IIRU extended our training and capacity?building work with the launch of a free, online certificate training program, Road Traffic Injury Prevention and Control in Low- and Middle-Income Countries (RTIP). Through RTIP, participants from around the world may take online courses. Upon successful completion, they earn a certificate issued through the Johns Hopkins Bloomberg School of Public Health (JHSPH).

The program is comprised of seven multimedia educational modules that cover a wide range of topics, from the basics of road traffic injury prevention to setting up injury surveillance systems, evaluating road safety interventions and influencing policy on road traffic injuries (RTIs). The lectures are taught by a variety of instructors, including JH-IIRU faculty as well as experts in the field of injury prevention control and trauma care from around the world. Participants can take the courses at their own pace and each module features pre- and post-knowledge assessments.

This program is available at no cost through the public health workforce training and management system (TRAMS) for the Johns Hopkins Bloomberg School of Public Health. Since its launch in April 2013, nearly 780 people from 105 countries have enrolled in the program. Sixty of them have since successfully completed the program.

The program is open to policy makers, researchers, educators and anyone in the general public interested in learning more about RTIs. We do not offer academic credit, but do provide a certificate for completing course modules.

More information here: http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-international-injury-research-unit/training/courses-in-injury-prevention/free-online-training/index.html

Access RTIP here: http://trams.jhsph.edu/trams/index.cfm?event=training.launch&trainingID=531

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