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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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On March 10 & 11, members of the Johns Hopkins International Injury Research Unit, including director, Adnan Hyder and assistant scientist, Shivam Gupta, participated in “Capacity Development for Health Policy and Systems Research in Low- and Middle-Income Countries,” held at the Admiral Fell Inn in Baltimore, Maryland.

The goal of the workshop was to explore the current state of capacity development, including methods and metrics, for health policy and systems research (HPSR) in low- and middle-income countries (LMICs) in order to determine innovative models for sustainable capacity development in the future. Examples of capacity development and approaches and methods for build capacity for HPSR were explored as well.

The workshop was sponsored by the World Health Organization (WHO) Alliance for Health Policy and Systems Research and the Health Systems Program at the Johns Hopkins Bloomberg School of Public Health.  Additional participants included both current Health Systems faculty members as well as alumni of the program, Dr. Nhan Tran and Dr. Abdul Ghaffar. Faculty from the American University of Beirut, members of WHO Alliance for Health Policy and Systems Research and the director of the Indian Institute of Health Management Research (IIHMR) were also participants. 

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

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

Over the last 20 years, child deaths from communicable diseases like respiratory infections, diarrheal disease and neonatal disorders have decreased significantly, yet deaths from childhood injuries have remained steady. The global burden of disease studies (GBD) suggest that of the estimated 5.1 million deaths due to injuries in 2010, 12% are attributed to children ages 1-19 years. Despite these high numbers, childhood unintentional injuries have not received much attention.

In a recent publication, JH-IIRU assistant scientist, Olakunle Alonge, MD, PhD, MPH and director, Adnan Hyder, MD, MPH, PhD, use data from GBD 2010 to describe the burden of unintentional childhood injuries, provide an overview of intervention options and examine the policy framework for reducing the burden, especially in low- and middle-income countries (LMICs), where the rate of injuries is disproportionately high.

“Reducing the global burden of childhood unintentional injuries,” published in the November 2013 issue of the Archives of Disease in Childhood, outlines the most common causes of death, including road traffic injuries, drowning and burns, and suggests possible solutions to these childhood injuries. Potential interventions include road traffic injury preventions, such as child restraints and helmet use that have been found effective in high income countries (HICs); barrier methods for drowning prevention, such as playpens fence construction, as well as other engineering methods to reduce water hazards; and safer stoves, lamps and lighting sources as possible short-term solutions for burn injuries.

The paper emphasizes the need for multi-sector cooperation and collaboration, including disciplines of law, engineering, medicine and social sciences for solutions to be truly effective.

To read the entire paper, click here

This is the time of year when many people travel, both near and far, in order to celebrate the holidays with friends and family. The season can be a great time for get-togethers, but it can also be especially dangerous for travelers.

Many of us know someone affected by the tragedy of a road traffic crash. It’s a global epidemic that claims two lives every minute on the world’s roads. That adds up to a staggering 1.3 million people every year. How can you stay safe? Here are a few tips:

1.Always use your seatbelt.

2.Do not mix alcohol or other drugs with driving.

3.Avoid distractions by turning off your mobile device; keep your eyes on the road and your hands on the wheel.

4.Make sure you are well rested and adhere to the speed limit.

5.Keep your vehicle safe with regular car and tire maintenance.

6.If you are a parent of an infant or young child, learn about the proper child restraints by visiting http://www.aap.org/healthtopics/carseatsafety.cfm; if you are the parent of a teenager, visit the CDC’s Parents Are the Key to Safe Teen Drivers campaign at http://www.cdc.gov/ParentsAreTheKey/index.html

While the majority of road traffic fatalities occur in the developing world, road traffic injuries are the top killer of healthy Americans traveling abroad, so these rules don’t change, no matter where you spend your holiday.

For additional information, the Journal of Travel Medicine recently published, “Pre-travel consultation without injury prevention is incomplete,” written by JH-IIRU project coordinator, Shirin Wadhwaniya and director, Adnan Hyder.  Injury Prevention recently published “Rates of intentionally caused and road crash deaths of US citizens abroad,” with contributions by JH-IIRU senior technical advisor, David Bishai and Adnan Hyder.

Access the Journal of Travel Medicine here.

Access Injury Prevention here.

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