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Johns Hopkins International Injury Research Unit


Keyword: lmics

Johns Hopkins International Injury Research Unit Leadership Leads Session on Emergency Medical Services

Johns Hopkins International Injury Research Unit Associate Director Dr. Amber Mehmood and Senior Technical Advisor Dr. Junaid Razzak led an Explore-Connect-Create session, “Emergency Medical Services: an integral part of health systems strengthening,” on Wednesday, February 27, 2019 at the Johns Hopkins Bloomberg School of Public Health.

The session – which is part of a larger series designed to create opportunities for the Health Systems Program faculty, staff and doctoral students to interact with other related disciplines– addressed the cross-cutting role of emergency medical services in improving health outcomes of acute illnesses.

Drs. Mehmood and Razzak began the session with presentations before facilitating a larger group conversation on emergency medical services and its role within health systems. The following in-depth discussion was about the intersectionality of emergency and primary care, accessibility of emergency care system in LMICs and challenges of conducting research focusing on emergency care outcomes.


JH-IIRU Associate Director Dr. Amber Mehmood presents during the February 27th session on emergency medical services.

JH-IIRU Publish Results of Pilot Study on Childhood Injury in Pakistan

Targeted home injury prevention information can result in decreased childhood unintentional injury hazards in low-income community homes, according to a new study by researchers in the Johns Hopkins International Injury Research Unit (JH-IIRU) at the Johns Hopkins Bloomberg School of Public Health.  The study examined results from a pilot study of home hazard information dissemination tools used in a low-income neighborhood in Karachi, Pakistan. The researchers pilot-tested and compared the effectiveness of two tools—an educational pamphlet and an in-home tutorial—which were previously developed by the team specifically for the location.

Unintentional injuries result in more than 875,000 deaths in children under the age of 18, with 80% of those taking place in low- and middle-income countries (LMICs). In Pakistan, approximately one million unintentional injuries occur each year in children under five years of age. Young children spend a significant amount of time in the home, and as a result, a substantial amount of injuries occur in that setting. Often, challenging living conditions—like lack of barriers to cooking and washing areas, use of open fires and lack of safe storage for harmful substances—contribute to injuries as well.

Little is known about the best methods for dissemination of home safety information in LIMCs, despite the availability of a variety of proven effective methods for promoting home injury prevention to caretakers of young children in high income countries (HICs). This dearth of information in LMICs has resulted in limited ways for health professionals to share potential prevention knowledge with parents. The JH-IIRU study is one of only a very few to look at developing home injury prevention information dissemination tools targeted for a developing country.

"Unlike in the developed world, healthcare providers and public health educators in low- and middle-income countries don't have tailored targeted materials to share with parents of young children about how to prevent/reduce unintentional injury hazards in the home,” said JH-IIRU associated faculty, Aruna Chandran, the lead investigator on the study.  Other researchers included JH-IIRU research assistant Nukhba Zia, JH-IIRU director, Adnan Hyder and Junaid Razzak, from Aga Khan University Department of Emergency Medicine.

The study showed an overall significant decrease in potential home hazards after the introduction of either an educational pamphlet or an in-home tutorial. Additionally, in the immediate four-to-five months following the intervention, there were fewer childhood hazards present in the homes in the targeted community. The study also suggests that the use of an in-home tutorial may be a more effective method for the dissemination of childhood hazard prevention information.

 “This study showed that using newly developed tools, sharing such information can be effective at changing the home environment in a low-income urban setting, and that the use of a community-health worker going into the home might be the optimal way to do so.  We hope this will spur additional such studies to explore these issues further in Pakistan and other settings," said Dr. Chandran.

This pilot project demonstrates the potential utility of using home-visit tutorials to decrease home-hazards in a low-income neighborhood in Pakistan.

“Disseminating Childhood Home Injury Risk Reduction Information in Pakistan: Results from a Community-Based Pilot Study,” appears in the current issue of the International Journal of Environmental Research and Public Health.


Gains in Motorcycle Helmet Use Undermined by Use of Poor Quality Helmets

About 50% of the motorcycle helmets being worn in many low and middle-income countries (LMICs) are not likely to provide the protection needed to prevent injury and death, according to the findings of a study undertaken in nine LMICs in Africa, Asia and the Americas, coordinated by the Road Traffic Injuries Research Network (RTIRN), and supported by the World Bank Global Road Safety Facility and the World Health Organization (WHO) Department of Violence and Injury Prevention.  More than 5,000 motorcyclists were included in the study, which showed that about half the helmets being worn by these motorcyclists did not conform to national and international standards.
Those purchasing lower cost helmets were most likely to be wearing poor quality helmets. Market surveys of retailers in each of these nine countries uniformly showed that these poor quality helmets sell for about a third of the price of high quality helmets.  The study also showed that legislation prohibiting the use, sale and manufacture of these helmets was absent in many of these countries and where such legislation existed, it was not supported by enforcement strategies.
 “Many governments around the world, supported by the WHO, are recognizing the importance of implementing helmet wearing campaigns, given the proven effectiveness of helmets in reducing deaths and serious head injuries.  However these findings are very concerning.” said Professor Robyn Norton, RTIRN Chair Emeritus and Principal Director of The George Institute for Global Health.

The results suggest that the introduction of helmet wearing campaigns need to also focus on strategies aimed at reducing the costs of “standard” helmets, as well as both legislation and enforcement to ensure that poor quality helmets are not being used. 
“This multi-country study has provided very useful evidence base for policy and decision makers in order to strengthen their national strategies and their work aimed at preventing injuries in these vulnerable road users” said Dr. Adnan Hyder, RTIRN board chair and director of the Johns Hopkins International Injury Research Unit (JH-IIRU).

The RTIRN has supported research and research capacity in LMICs for a decade, thanks to the funds received by different partners, such as the Global Road Safety Facility of the World Bank, as well as the Global Forum for Health Research, the World Health Organization and the George Institute for Global Health, among others.
During the past decade, the RTIRN has developed strategic activities that contribute significantly to both capacity development and research promotion in the field of RTIs. In the past five years, RTIRN supported nine young researchers in their work on road safety and funded four sabbaticals for senior researchers. The RTIRN also supported nine research centers that participated in this multi-country research study.

“The Use of Non-Standard Motorcycle Helmets in Low- and Middle-Income Countries: A Multi-Centre Study,” is published online first on the Injury Prevention website.

Access the full paper here:

JH-IIRU Team Members Publish Paper on Childhood Injury Patterns in Journal of Trauma

More than 626,000 children under the age of 15 die each year due to injuries, with more than 95% of those fatalities occurring in low- and middle-income countries (LMICs).  In sub-Saharan Africa, injuries are especially high and result in approximately 43 deaths per 100,000 children each year. Yet despite this high burden of pediatric injury, there is little data to explain the epidemiology of injury in LMICs. And without proper understanding of the etiology of injuries, researchers cannot adequately address the risk factors for injury and implement injury prevention interventions.

Recently, members of the JH-IIRU team, including  trauma specialist Hadley K. Herbert, associate directors Kent A. Stevens and Abdulgafoor M. Bachani and director, Adnan A. Hyder, along with their colleagues at Childsafe South Africa and Red Cross War Memorial Hospital in Cape Town and the Virginia Commonwealth University Medical Center’s Department of Surgery, address this issue in “Patterns of Pediatric Injury in South Africa: An Analysis of Hospital Data Between 1997-2006,” published in the Journal of Trauma. The paper looks at the patterns of childhood injuries using hospital-based surveillance system in Cape Town, South Africa.

The results indicated that, between 1997-2006, more than 62,000 children presented to the Trauma Unit of the Red Cross War Memorial Children’s Hospital’s (RCH) Casualty Department with almost 69,000 injuries. The majority of injured were males and injuries included falls, road traffic injuries, burns and assaults.

To read more, you can access the paper

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Focus on Road Traffic Injuries in China: Selections from the Traffic Injury Prevention Special Issue

As part of the Road Safety in 10 Countries project (RS-10), in 2012, the Johns Hopkins International Injury Research Unit (JH-IIRU) published “Public Health Burden of Road Traffic Injuries: An Assessment from Ten Low- and Middle-Income Countries,” a special issue of Traffic Injury Prevention. This landmark publication includes 11 scientific papers jointly authored with 50 colleagues from JH-IIRU and their in-country collaborators that contribute much-needed new knowledge to the burgeoning issue of road traffic injuries in low- and middle- income countries.

In China, though road traffic injuries have become a leading cause of death, the reported numbers of road traffic deaths are often inconsistent. JH-IIRU team members, including  associate director, Sai Ma and senior technical advisor, David Bishai, along with colleagues from the Chinese Center for Disease Control and Prevention (CCDC), addressed this issue in their publication, “Road Traffic Injury in China: A Review of National Data Sources.”  The team reviewed and compared four national-level data sources: The Ministry of Health-Vital Registration (MOH-VR) system, Chinese CDC-Disease Surveillance Points (DSP), Chinese CDC-National Injury Surveillance System (NISS) and police reports. The team found that, while each system had a number of strengths, no one system provided a complete epidemiological profile of road traffic injuries in China, and some information, such as long-term disability or hospitalization data, is not measured at all. The study does, however, establish a framework for researchers and policy makers to strengthen the existing surveillance systems in order to better track road traffic injuries. This, in turn, will help to develop evidence-based long-term road safety interventions

For more information on the Road Safety in 10 Countries project, visit our website:

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