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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: Jun 2014

The results of a recent study led by Johns Hopkins International Injury Research Unit (JH-IIRU) team members suggests that a multi-faceted road safety intervention program is potentially effective in reducing road traffic crashes in a middle-income country setting.

In January 2008, the World Health Organization (WHO) and the Mexican Ministry of Health and the National Center for Accident Prevention (CENAPRA) launched a national multi-faceted road safety intervention program called the Iniciativa Mexicana de Seguridad Vial y Prevención de Lesiones en el Tránsito (Mexican Initiative for Road Safety and Prevention of Road Traffic Injuries) (IMESEVI), funded by the Bloomberg Philanthropies.  The IMESEVI approach utilized a package of evidence-based polices into a comprehensive multipronged effort to reduce the burden of road traffic injuries and deaths in four Mexican cities, including Guadalajara (Jalisco) and León (Guanajuato). The interventions focused on augmenting drink-driving enforcement and seatbelt and child restraint use campaigns.

Two years after the initial launch of IMESEVI, Bloomberg Philanthropies funded the Global Road Safety Program to improve road safety in 10 low- and middle-income countries—including Mexico—which subsequently began the second phase of IMESEVI. In this phase, both Guadalajara and León were included, but the interventions focused on drink-driving enforcement and legislation in the first year, with the addition of seatbelt and child restraint campaigns in the second year.

The study, conducted by JH-IIRU team members in collaboration with local collaborators at the Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, in Cuernavaca, México, used a time series analysis to assess the effectiveness of both phases of the IMESEVI on Mexico’s road traffic crashes, injuries and deaths.

While the study had several limitations, including the lack of information regarding alcohol consumption at a national level and the quality of secondary information available in Mexico, results suggest that such a multi-faceted intervention program appears to be effective in reducing road traffic crashes.

Access “Early Impact of a National Multi-Faceted Road Safety Intervention Program in Mexico: Results of a Time-Series Analysis,” published in PLOS One, here.

Injury severity scores are important and necessary tools for both evaluating care of the injured patient and establishing institutional quality and research practices. In high-income countries (HICs), several injury severity scores have been used to evaluate and study trauma patients; however, despite the fact that more than 90% of the estimated 5.8 million deaths each year caused by injury worldwide occur in low- and middle-income countries (LMICs), few scores have been validated for use in these countries.  The Kampala Trauma Score (KTS) is an injury severity score that was developed specifically for use in low-resource settings.

In the recently published paper, “Is the Kampala Trauma Score an Effective Predictor of Mortality in Low-Resource Settings? A Comparison of Multiple Trauma Severity Scores,” a group of researchers, including Johns Hopkins International Injury Research Unit’s (JH-IIRU) associate director, Kent Stevens and director, Adnan Hyder, compared five trauma severity scores against the ability of KTS to predict mortality of trauma patients in the Central Hospital of Yaounde, Cameroon.

The results suggest that there is potential for the adoption of KTS for injury surveillance and triage in resource-limited settings and that KTS is as effective as other scoring systems in predicting patient mortality. Because the system is simple to administer and record, this makes KTS a potentially valuable tool for low-resource settings, where many hospitals are understaffed and basic record-keeping and data collection is unreliable or incomplete.

To read more about the study, click here.

Emergency care in Pakistan suffers from critical gaps in both essential equipment and provider knowledge necessary for effective emergency and trauma care.  Those are the findings of a recent study undertaken in the country’s Sindh province by the Johns Hopkins International Injury Research Unit (JH-IIRU) in collaboration with colleagues at Aga Khan University’s Department of Emergency Medicine.

The study, “Emergency and trauma care in Pakistan: A cross-sectional study of healthcare levels,” published in Emergency Medicine Journal, used the World Health Organization’s (WHO) assessment protocols—the Guidelines for essential trauma care and the Prehospital care systems—to evaluate emergency and trauma care at different levels of health facilities in Pakistan. The study focused on two specific aspects: 1) infrastructure and essential equipment and supplies and 2): availability and knowledge of physicians providing emergency care.

The findings suggested that both facility-level equipment and supplies and human resource gaps exist in the current emergency care system in the country—gaps that are likely to compromise the level of emergency care—and point to the need for comprehensive reform of the emergency care system in the province of Sindh.  The study also provided a set of recommendations, which include increasing the investment in health provider training for acute care, providing facilities with low-cost commonly-used supplies such as bag valve masks and integrating improved emergency care protocols.

The study was partly supported by the NIH-Fogarty funded Johns Hopkins-Pakistan International Collaborative Trauma and Injury Research Training Program (JHU-Pakistan ICTIRT).

To read more, click here.

On May 21 and 22, 2014, the Johns Hopkins International Injury Research Unit (JH-IIRU), along with the Institute for International Programs (IIP) and USAID co-hosted a meeting on child injury at the Johns Hopkins Bloomberg School of Public Health. The meeting brought together members of the injury prevention field in an effort to reduce the global burden on childhood injuries, with a focus on low- and-middle-income countries (LMICs), where more than 95% of both intentional and unintentional child deaths occur.

International Health professor and director of IIP, Bob Black opened the meeting, which was conducted as part of the Health Research Challenge for Impact Program, funded by the United States Agency for International Development with JH-IIRU director, Adnan Hyder discussing the prospects and challenges of child injuries. Olakunle Alonge, JH-IIRU faculty member who is leading the Unit’s work on Saving of Lives from Drowning in Bangladesh (SoLiD) project, discussed effective interventions for child injury and quality of data sources, as well as provided a summary and next steps for the meeting. Also participating from JH-IIRU was Dr. Ricardo Pérez-Núñez, currently a postdoctoral fellow with the Unit.

Child injury group
JH-IIRU, IIP and USAID child injury meeting participants

Other presenters included Dr. Neal Brandes from USAID and Torine Creppy from SafeKids. Several JH-IIRU collaborators participated in the meeting, including Dr. Junaid Razzak from Aga Khan University, Dr. Olive Kobusingye from Makerere University, Dr. Dr. Shams El Arifeen, from icddr,b as well as current and past Global Road Safety Program collaborators, Martha Hijar, former director of Entornos Foundaçion, Mexico and Marieannette Otero, from the Association for Safe International Road Travel (ASIRT).

The World Health Organization (WHO) reports that the five most common unintentional injuries among children are from road traffic injuries, falls, burns, drowning and poisoning.

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.

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