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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 2013

Burns are a significant cause of mortality and disability in developing countries, especially in South Asia. Of the more than 300,000 burn fatalities worldwide annually, 90% occur in low- and middle-income countries (LMICs). South Asian countries in particular bear a significant burden of this type of unintentional injury. Estimates of burn injuries in India are between 100,000 and 2 million annually; in Pakistan, burns are the second leading cause of disability and the 11th cause of death. In Sri Lanka, approximately 10,000 burn injuries and 100 deaths are reported annually.

While much has been done in high income countries (HICs) to prevent unintentional burns, including improving information-gathering systems to understand the epidemiology of burn-related injuries—which is fundamental in aiding preventative efforts—such strategies are lacking in many South Asian countries. Additionally, in South Asia, lack of advanced burn care facilities and trained professionals create further obstacles to preventing burn-related injuries.

Recently, a group of researchers from the Johns Hopkins Bloomberg School of Public Health, including JH-IIRU director Adnan Hyder, published the results of a systematic review of burn injuries in four South Asian countries: Pakistan, India, Bangladesh and Sri Lanka. This review provides an analysis of the trends in burn injuries, corroborates the findings of reviewers of burn injuries in other LMICs and indentifies appropriate target groups for intervention, as well as identifies gaps in the literature on burns in South Asia, and highlights the need for better information.

By examining the epidemiology of unintentional burns in South Asia, researchers can identify trends and gaps in information, which will in turn help to both identify appropriate target groups for intervention and identify the most appropriate kind of intervention.

“A Systematic Review of the Epidemiology of Unintentional Burn Injuries in South Asia” appears in the Journal of Public Health.  Find additional information here:

The World Health Organization estimates that road traffic injuries (RTIs) account for approximately 1.2 million deaths annually around the globe, with the majority occurring in low- and middle-income countries. In countries like Cambodia, motorcycles are a common form of transportation. Motorcycle crashes are also the leading source of road traffic fatalities in the country.. However, helmet use in Cambodia remains relatively low, despite the fact that helmet-wearing is a proven injury prevention intervention.

In order to better understand the traffic safety culture in Cambodia, a group of researchers, including JH-IIRU associate director, Abdulgafoor Bachani, recently examined driver and passenger knowledge, attitude and beliefs regarding motorcycle helmets.

Several key findings from the study helped identify barriers to helmet-wearing, including gaps in road safety knowledge and ways to communicate the road safety message more effectively. For example, the study found that there is a need to increase the availability of high-quality, low cost helmets for children, while at the same time addressing the prevailing attitude that children are “too young” to need a helmet. The study also found that many motorcyclists believe helmets are only necessary when driving on highways or high speed motorways.

Results of this study were instrumental in informing the Cambodian Helmet Vaccine Initiative (CHVI) which was established by the Asia Injury Prevention Foundation with support from the FIA Foundation as well as the World Bank, the US Centers for Disease Control and Prevention and others.

“Motorcycle Helmet Attitudes, Behaviours and Beliefs Among Cambodians” appears in the International Journal of Injury Control and Safety Promotion.

To read more, click here:

Burns are the source of a significant number of pediatric injuries, especially in low- and middle-income countries (LMICs). Within developing countries—where 90% of pediatric burn injuries occur—the WHO-defined African region has the highest rate of pediatric burn-related deaths. In the upper-middle income country South Africa, the rate is five-times higher than other upper-middle income countries, with a rate of burns at 2.8 per 100,000 children. The lack of data available on pediatric burns in LMICs, however, is a significant hindrance in efforts to address this burden.

Recently, members of the Johns Hopkins International Injury Research Unit (JH-IIRU), including associate directors Abdulgafoor Bachani and Kent Stevens published study in Injury that examined the trends in injuries over a 15-year period in Cape Town, South Africa.

The study, led by JH-IIRU post-doctoral fellow Hadley K H Wesson, used data collected by Childsafe South Africa from the Red Cross War Memorial Children’s Hospital (RCH) trauma registry in Cape Town between 1995-2009. The data focused on children under the age of 13 who presented in the hospital’s casualty department with burn injuries.

Among the team’s findings, results suggested that attention should be placed on male children under five with scald burns received in the home environment. The significance of this study lies in the ability to use data to support additional studies, inform policy and implement targeted interventions to reduce the burden on childhood burn injuries globally.

“Pediatric Burn Injuries in South Africa: A 15-Year Analysis of Hospital Data,” will appear in the upcoming issue of Injury. More information is available here:

More than 1.2 million people die every year in road traffic crashes around the world, with the majority (90%) of fatalities in low- and middle-income countries (LMICs). This is despite accounting for less than 50 percent of the world’s registered vehicles. And even though the burden of RTIs is greater in LMICs than high income countries, the generation of evidence from the developing world has not kept pace with the rate of injuries. 
Recently, members of the Johns Hopkins International Injury Research (JH-IIRU) team, and colleagues from the Department of International Health at the Johns Hopkins Bloomberg School of Public Health published a paper in Global Public Health that explores the disparity in research and develops a scientific approach for evaluating large-scale road safety programs in LMICs. 
“Large-Scale Road Safety Programmes in Low- and Middle-Income Countries: An Opportunity to Generate Evidence” suggests that what is often missing from road safety initiatives is evidence on the effectiveness of such programs. The paper uses the Road Safety in 10 Countries Project (now referred to at the Bloomberg Philanthropies Global Road Safety Program) as a real-world application of a large-scale multi-country initiative to scientifically test the road safety evaluation approaches used in the project and to generate new knowledge in the field of road safety. The paper also draws on “13 lessons” on large-scale program evaluation, including defining the evaluation scope, selecting study sites, using multiple analytic techniques, continuous monitoring and providing feedback to implementers and policy-makers, among others. 
The paper concludes that new knowledge generated from such real-world, large-scale road safety evaluations is more likely to influence local and national policy makers than externally transported knowledge. 
To find out more, access the paper click here.

The Johns Hopkins Berman Institute of Bioethics will host its first “Global Bioethics Week” June 10-14, designed to launch two unique global research ethics initiatives, in collaboration with colleagues from several African universities.

Global Bioethics Week kicks off with the inaugural meeting of a new bioethics consortium between the Berman Institute and three African universities: University of Zambia, School of Medicine; Makerere University, College of Health Sciences; and University of Botswana, Office of Research & Development. The establishment of the consortium represents a new phase of the Berman Institute’s 13-year-old Johns Hopkins Fogarty African Bioethics Training Program (FABTP), focusing on building self-sustaining capacity for research ethics work within and between African universities. 

“Too often over the past decade, research ethics capacity development work in Africa has involved sending trainees away to well-resourced institutions, only to face major challenges back at home that limited their ability to implement what they had learned,” says co- program director Nancy Kass, the Deputy Director for Public Health at BI. “This consortium will deepen institutional capacity at three strong African universities to support research ethics in ways that allow local experts to build, share and sustain their own research ethics programs,” she says.

Global Bioethics Week will also include a first-of-its-kind workshop, “Ethics of Health Systems Research in Low and Middle Income Countries,” co-sponsored by the BI and the Health Systems Program in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. Representatives from the three African universities will participate, joined by faculty from across Johns Hopkins University and other experts in ethics and health systems research.

Adnan Hyder, director of the Health Systems Program, Associate Director for Global Bioethics at BI, and co-program director of FABTP with Kass, noted that there are unique ethical concerns when reviewing and conducting health systems research in countries where people are already stressed by public health, economic, social, and political instability.

“This workshop is the first such meeting bringing global scholars of varying disciplines together to discuss these challenges, and work toward novel solutions,” Hyder says. “Johns Hopkins is in a unique position to further global dialogue on ethical issues around health systems research due to the university’s strong bioethics expertise and renowned experience in international health systems.”

In addition to the Global Bioethics Week events, six faculty members from the FABTP consortium African universities will spend the month of June in bioethics intensive courses, meetings with Johns Hopkins faculty and Institutional Review Boards, and visits to the National Institutes of Health Department of Bioethics, the Food and Drug Administration and other federal agencies in Washington, DC.

For more information on the Berman Institute’s Global Bioethics Program or intensive courses (open to all) at the Johns Hopkins Berman Institute of Bioethics, contact Joseph Ali at class="MsoHyperlink".

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