Injuries among children in Karachi, Pakistan—what, where and how

doi:10.1016/S0033-3506(03)00147-1

Public Health

Volume 118, Issue 2, March 2004, Pages 114-120

https://doi.org/10.1016/S0033-3506(03)00147-1 Get rights and content

Abstract

Objectives. To describe the epidemiology of injuries among children in Karachi, Pakistan.

Study design. Retrospective case series.

Methods. Data on children aged ≤15 years who were injured between October 1993 and January 1996 were extracted from the logs of the main provider of emergency medical transportation, and were classified according to the World Health Organization's basic data set for information on injuries.

Results. We identified 1320 cases of injuries in children ≤15 years old. The major causes were: motor vehicle crashes (MVC) (80%), falls other than from vehicles (5%), burns (5%) and drowning (3%). One in six of these children (15%) died either at the scene of the accident or during transportation to the hospital. The majority of deaths were either due to MVCs (67%) or drowning (18%) Large vehicles (buses, minibuses and trucks) were involved in 54% of all childhood road traffic injuries. Almost one-third (33%) of burns took place in the kitchen at home, and half (51%) of all drowning cases occurred in the sea.

Conclusions. The majority of children transported by the ambulance service were male and were victims of MVCs. Prevention efforts aimed at stricter enforcement of driving laws and family/child education geared towards pedestrian safety could potentially reduce morbidity and mortality. This study also highlights the role of the prehospital transport system in injury surveillance.

Introduction

Of all injury-related deaths worldwide, at least two-thirds occur in developing countries.1., 2. It is predicted that over the next two decades, the disease burden from injuries in many populations (especially low- and middle-income countries) will equal or exceed that caused by infectious diseases.³ This increasing burden of injuries in developing countries affects both adults and children.⁴ In 1990, injuries in these countries contributed to 13% of total disability adjusted life years among children. It is expected that by 2020, this share will increase to 22%.⁴ In parts of Africa, injuries are a leading cause of disability and death among children aged more than 5 years,⁵ and caused 8% of all hospital deaths in the 5–19 years age group.⁶ In Bangkok, a prospective, community-based study of childhood mortality showed that 51% of all deaths were due to injuries.⁷

Like other developing countries, mortality and morbidity from preventable causes are major health issues in Pakistan. According to a burden of disease study, injuries are the second leading cause of disability, the 11th leading cause of premature mortality, and the fifth leading cause of overall healthy years of life lost per 1000 people.⁸ The research on injuries in Pakistan has mainly focused on injuries in adults. While children (age <15 years) constitute about 43% of the population, information about injuries in this group remains limited. Without knowledge of the basic epidemiology of injuries, effective injury prevention and acute care cannot be carried out.9., 10. In this study, we present the distribution and determinants of unintentional injuries among children for the city of Karachi.

Section snippets

Methods

We carried out a retrospective study of injured children (defined as age ≤15 years) transported by the Edhi Ambulance Service (EAS) over 26 months in Karachi. Karachi is the largest city in Pakistan, and the hub of economic activity. It has an estimated population of 9.3 million,¹¹ accounting for approximately 10% of the total population and 30% of the urban population of Pakistan. Forty three percent of the city's population is under the age of 15 years.

The Edhi Foundation is a private

Results

We identified 1320 cases of injuries in children aged 15 years or less during the 26-month study period. Common causes of injury in these children were MVCs $(n=1059, 81%),$ falls (excluding falls from vehicles) $(n=67, 5%)$ , burns $(n=64, 5%),$ drowning/near drowning $(n=44, 3%),$ falling objects $(n=32, 2%),$ explosions $(n=21, 2%),$ poisoning $(n=15, 1%),$ contact with electric current $(n=11, 0.8%),$ and bite/sting/envenomations (n=7, 0.5%) (Table 1). The majority of injuries were seen in males $(n=1048, 80%).$ The

Main findings

Our study identified a disproportionately high number of MVCs as the cause of childhood injuries compared with many other settings. Like adults, children in our study were victims of minibus and truck accidents. Also, a large number of children were injured while walking on the streets, particularly in some areas of the city. The distribution of injuries, especially the preponderance of MVCs in Karachi, is considerably higher than in other developing countries such as Trinidad and Tobago¹⁷ and

Conclusions

Despite these limitations, the findings in this study provide important direction to the injury-prevention efforts. More than 80% of injuries in our series involved MVCs, and the majority of these involved pedestrians. Separating pedestrians from motor vehicles, especially commercial vehicles, by building overpasses or crosswalks, beginning with the highest risk intersections, would be a more affordable step forward. While closing doors in a moving vehicle makes inherent sense, minor changes to

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Injuries among children in Karachi, Pakistan—what, where and how

Abstract

Introduction

Section snippets

Methods

Results

Main findings

Conclusions

Injury

Prehosp Emerg Care

Accid Anal Prev

Accid Anal Prev

Accid Anal Prev

Burns

Burns

Burns

Ann Emerg Med

Ann Emerg Med

Unintentional injuries in developing countries: the epidemiology of a neglected problem

Epidemiol Rev

Injury surveillance: should it be a concern to developing countries?

J Public Health Pol

Injuries and noncommunicable diseases: emerging health problems of children in developing countries

Bull World Health Organ

Admissions for injury at a rural hospital in Ghana: implications for prevention in the developing world

Am J Public Health

Causes of death and unintentional injury among schoolchildren in Thailand

SE Asian J Tropic Med Public Health

Applying burden of disease methods in developing countries: a case study from Pakistan

Am J Public Health