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

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Keyword: pakistan

In Pakistan, injuries and trauma are among the top ten contributors to the burden of disease and disabilities. Other related factors, such as poverty, political instability, and natural disasters as well as the lack of legislation or enforcement of preventative measures contribute to the population’s susceptibility to injuries.

While police and hospital records provide some data on injuries, a recent commentary published in Public Health suggests that it is essential that the public health sector invest in injury prevention by creating a strong, evidence-based strategy, improving national polices, and collaborating with the private sector to promote injury prevention.

In “The challenges of injuries and trauma in Pakistan: An opportunity for concerted action,” JH-IIRU director, Adnan Hyder and Aga Khan University professor, Junaid Razzak, examine the current status of injury prevention and control in Pakistan  as well as the burden and the policy context for interventions in the country.

The commentary goes on to suggest that, because injury prevention and emergency care have been proven to be some of the most cost-effective interventions in the health sector, investing in such measures as traffic enforcement, speed control, helmets, child resistant containers and trained emergency personnel makes sense from both an economic and public health viewpoint.

Drs. Hyder and Razzak are directors of the JHU-Pakistan Fogarty International Collaborative Trauma and Injury Research Training Program (JHU-Pakistan ICIRT). The goal of JHU-Pakistan ICIRT is to build a strong network of professionals and help develop sustainable research capacity on acute care of trauma and injuries and emergency medicine in Pakistan.  For additional information on the program, click here:

http://www.jhsph.edu/faculty/research/map/PK/1227

To access the paper, click here: http://www.sciencedirect.com/science/article/pii/S0033350612004696#

Non-communicable diseases like cardiovascular diseases, cancers, diabetes and injuries have become the major causes of disability and death in Pakistan, according to a report by a group of researchers that included Johns Hopkins Bloomberg School of Public Health professor, Adnan A. Hyder. Furthermore, while rates of death and disability from non-communicable diseases are expected to continue to increase, Pakistan’s health care system is unprepared to handle the rising burden. The report suggests that if current trends continue, nearly 4 million people between the ages of 30-69 will die from cardiovascular disease, cancers and chronic respiratory disease by 2025.

The study, “Non-Communicable Diseases and Injuries in Pakistan: Strategic Priorities,” published as part of The Lancet series on Health Transitions in Pakistan, also examined the prevalence of non-communicable diseases  such as road traffic injuries, noting that enforcement of traffic safety laws is weak. Both seat belt and speeding laws are enforced poorly, as is the helmet law for bicycle and motorcycle riders, where hospital-based surveillance data indicates that more than 90 percent of riders do not wear helmets. No legislation exists for vehicle standards, road safety audits or promotion of safer transportation systems.

“Pakistan is the sixth most populous country in the world. The recognition of injuries as a key component of the national disease burden is an important first step. This issue needs some serious attention from policy makers,” said Hyder, director of the Health Systems program in the Bloomberg School’s Department of International Health and head of the Johns Hopkins International Injury Research Unit.

According to the report, Pakistan was one of the first developing countries to implement an integrated national action plan for non-communicable diseases, but the high-level, government buy-in the plan had initially was withdrawn. The report goes on to explain that the economic effect of non-communicable diseases and injuries is devastating, estimating a cumulative production loss at approximately $3.47 billion.

Hyder and his colleagues recommend several strategies for preventing non-communicable diseases, which includes implementing policy, legislation and programs to support and promote healthy diet and physical activity; directing generated revenue from the increased excise tax on cigarette sales toward prevention initiatives, thereby mitigating the cost of the suggested measures; and re-prioritizing of funds from international donor agencies to fund non-communicable diseases and injuries. The target goal is to reduce the number of premature deaths due to cardiovascular, cancers and respiratory diseases by 20 percent in 2025. The researchers also stress that efforts must also be directed towards prevention of injuries and mental disorders.

The report was published as part of four papers in the Lancet Series which examine the transitions in Pakistan’s health system and focus on the country’s past and present performance in health, specifically after the 18th amendment to the Constitution abolished the federal Ministry of Health. The series also calls for a unified vision for universal and equitable health access across the nation.  Other papers in the Series focus on reproductive and maternal health, non-communicable diseases and injuries, and recommendations for future health reforms.

In a recently published article, Johns Hopkins International Injury Research Unit (JH-IIRU) and collaborators from the Department of Emergency Medicine at Aga Khan University (DEM-AKU) examine unintentional childhood home injuries in Karachi, Pakistan. JH-IIRU director, Adnan Hyder and AKU-DEM director, Junaid Razzak amongst other colleagues participated in this surveillance study.
The article, “Understanding Unintentional Childhood Home Injuries: Pilot Surveillance Data from Karachi, Pakistan,” which appears BMC Research Notes, analyzed results of a previous pilot surveillance study done on unintentional childhood injuries presenting to emergency departments in both public and private hospitals in Karachi. Their findings revealed that of the approximately 400 injuries that occurred in the home, falls made up the majority at 59%, followed by dog bites, burn injuries and road traffic injuries. Most of these injuries occurred during play time. Fifty-four percent of the children were between 5-11 years old and 41% were between 1-4 years old.
This kind of analysis not only helps to define the kinds of unintentional injuries that are most prominent among hospitals in a particular area, but also help researchers concentrate intervention and control strategies, such as defining and adhering to building standards for homes, controlling stray dogs and installing traffic calming measures in residential areas.
Like JH-IIRU, the Department of Emergency Medicine at Aga Khan University (DEM-AKU) is a World Health Organization Collaborating Center for Emergency Medicine and this collaborative project represents collaborating centers working together to better understand the burden of injuries in low income countries.
To access this article, click here:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337295/?tool=pubmed
To find out more about unintentional childhood injuries, contact us at
IIRU@jhsph.edu

Members of the Johns Hopkins International Injury Research Unit (JH-IIRU), including director, Adnan Hyder and associate director, Aruna Chandran, along with colleagues from Aga Khan University (AKU) in Pakistan, recently published a paper in the International Journal of Pediatrics.
The article, titled, “Childhood Unintentional Injuries: Need for a Community-Based Home Injury Risk Assessment in Pakistan,” addresses the dearth of printed materials about home injury prevention in low- and middle-income countries (LMICs) as compared to the availability of comparable information in  high income countries (HICs). The paper also examines the development of two tools for home hazard reduction: an in-home tutorial and an educational pamphlet in preparation for a proposed study, the Global Childhood Unintentional Injury Surveillance-Phase 2, Pakistan (GCUIS-Pak). The GCUIS-Pak would test the implementation and acceptability of the tools in two neighborhoods in Pakistan’s largest city, Karachi. 
Additionally, the GCUIS-Pak is part of ongoing collaborative efforts between the Johns Hopkins Bloomberg School of Public Health/International Injury Research Unit and Aga Khan University/Department of Emergency Medicine in Pakistan. In 2005, JHU-IIRU partnered with Aga Khan University in the development of a child injury surveillance project that resulted in the development of a system with great potential for developing countries, supported by the Department of Violence and Injury Prevention at the World Health Organization, Geneva (published in 2009 –
Hyder AA et al).  The program also hopes to raise awareness about the importance of child injury and trauma research and foster collaboration among health professionals and researchers in Pakistan, while establishing linkages and partnerships with the broader international injury research community.
To access the paper,
click here.
To find out more about the ICTIRT or other JH-IIRU collaborative efforts , contact us at
IIRU@jhsph.edu

Last week, experts from around the world met in Karachi, Pakistan to discuss the country’s system for pre-hospital emergency medical services, as well as the state of trauma care overall.

Organized by Aga Khan University, Johns Hopkins University and the Society of Emergency Physicians of Pakistan, the conference emphasized the need for improving emergency care in the country.

Dr. Adnan Hyder, director of the Johns Hopkins International Injury Research Unit, presented at the conference. He was quoted in the Dawn as saying, “When we think about healthcare, we should think about the emergency medical system as well.” To read the full article, please click here.

For more information about the Johns Hopkins International Research Unit’s work in trauma care and emergency medicine, please contact us.

Dawn_PK

Article in the Pakistani newspaper, the Dawn, from June 23, 2011, reporting on the conference. Quote from Dr. Adnan Hyder is included.

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