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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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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.

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.

The Johns Hopkins International Injury Research Unit (JH-IIRU) was recently awarded a grant from the NIH Fogarty International Center as part of the Fogarty Global Health Research and Research Training eCapacity Initiative.  The Johns Hopkins University-Makerere University Electronic Trauma, Injuries and Disability (JHU-MU E-TRIAD) in Uganda will build on the partnership for research and capacity development established between the Johns Hopkins University and Makerere University to study Chronic Consequences of Trauma, Injuries and Disability (Chronic TRIAD) Across the Lifespan in Uganda.

The project, co-led by JH-IIRU director Adnan Hyder and associate director Abdul Bachani, will build on Makerere University (MU) School of Public Health’s demonstrated interest in expanding its teaching and research focused on trauma, injuries and disability by strengthening capacity for information and communication technology (ICT)-supported research and training (e-capacity) at the university.  By training health professionals and academics with new tools to enhance the conduct of research on nationally relevant issues in trauma, injuries and disability, the institutions will work to create a sustainable platform for researchers, faculty, and staff to maintain and plan for further integration of e-capacity in training and research for global health at MU.

The long-term goal of the program is to establish a center at MU dedicated to the appropriate use of ICT in global health research and training.

Fogarty's Global Health Research and Research Training eCapacity Initiative aims to support innovative research education programs to teach researchers at low and middle income country (LMIC) institutions the knowledge and skills necessary to incorporate Information and Communication Technology (ICT) into global health research and research training.

To find out more, click here

From May 1-3, 2014, JH-IIRU technical advisor David Bishai and graduate student Huan He attended the Population Association of America (PAA) annual meeting in Boston.

Dr. Bishai was on hand to present his work on education for children resulting from unwanted pregnancies in Bangladesh as well as to participate in the session, “Maternal, Infant and Child Health and Mortality.” Huan was there to present her work with Dr. Bishai and others on the relationship of economic development to road traffic fatalities and fatalities per crash in 73 Russian federal districts.

Bishai He PAA
Huan He and David Bishai present their work on economic factors and road traffic fatalities. 

The poster, “Economic Development and Road Traffic Fatalities in Russian Federal Districts, 2004-2011” was presented during the poster session, “Economy, Labor Force, Education and Inequality," and had the unique advantage of being the only project on Russia in that session.  Huan received positive feedback, especially in terms of uniqueness of data sources and complexity, rigid methods and the capacity to show the change in road traffic fatalities in Russia. She felt it was helpful to discuss the project with colleagues in the field of demography and to be able to network with potential collaborators. In particular, a participant from suggested using the Russian dash-cam recordings on YouTube to learn about the context and severity of crashes in the country. Other colleagues provided insights on how to explain the time trend we found on Russian RT fatalities, and how to incorporate law enforcement in this study. This project is part of the Bloomberg Philanthropies Global Road Safety Program. Access the abstract here.

Established more than 80 years ago and focused mainly on the topics of death, birth and migration of people, PAA is one of the largest and most prestigious conferences on population science, both in the United States and internationally.  Learn more here.


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