Elsevier

Surgery

Volume 157, Issue 5, May 2015, Pages 843-849
Surgery

Lancet Commission
Injury prevalence and causality in developing nations: Results from a countrywide population-based survey in Nepal

https://doi.org/10.1016/j.surg.2014.12.020Get rights and content

Background

Traumatic injury affects nearly 5.8 million people annually and causes 10% of the world's deaths. In this study we aimed to estimate injury prevalence, to describe risk-factors and mechanisms of injury, and to estimate the number of injury-related deaths in Nepal, a low-income South Asian country.

Methods

A cluster randomized, cross-sectional nationwide survey using the Surgeons OverSeas Assessment of Surgical Need tool was conducted in Nepal in 2014. Questions were structured anatomically and designed around a representative spectrum of operative conditions. Two-stage cluster sampling was performed: 15 of 75 districts were chosen randomly proportional to population; within each district, after stratification for urban and rural populations, 3 clusters were randomly chosen. Injury-related results were analyzed.

Results

A total of 1,350 households and 2,695 individuals were surveyed verbally, with a response rate of 97%. A total of 379 injuries were reported in 354 individuals (13.1%, 95% confidence interval 11.9–14.5%), mean age of 32.6. The most common mechanism of injury was falls (37.5%), road traffic injuries (19.8%), and burns (14.2%). The most commonly affected anatomic site was the upper extremity (42.0%). Of the deaths reported in the previous year, 16.3% were injury-related; 10% of total deaths may have been averted with access to operative care.

Conclusion

This study provides baseline data on the epidemiology of traumatic injuries in Nepal and is the first household-based countrywide assessment of injuries in Nepal. These data provide valuable information to help advise policymakers and government officials for allocation of resources toward trauma care.

Section snippets

Methods

The SOSAS survey was executed countrywide in Nepal from May 25 to June 12, 2014. SOSAS is a cluster randomized cross-sectional survey, described in more detail previously.10 The SOSAS survey is divided into 2 sections. The first section collects demographic data regarding the household's access to health care and recent deaths in the household. If a household member died within the past year, further questions regarding health care received, access to operative care, barriers to operative care,

Results

A total of 1,350 households and 2,695 individuals were surveyed, with a response rate of 97%. A total of 379 injuries were reported in 354 individuals (13.1%, 95% CI 11.9–14.5%), with a mean age of 32.6 (95% CI 30.7–34.6). Of these 379 injuries, 76 were reported within the past year (20.1%, 95% CI 16.1–24.4%). Demographic data of respondents and individuals who reported at least 1 injury in his or her lifetime are shown in Table I. Using logistic regression, we found that injuries in Nepal were

Discussion

This study is the first nationwide, population-based assessment of the incidence of injuries in Nepal. We show a nonfatal injury prevalence of 13.1% and a fatal injury prevalence of 16.3% of total deaths. Extrapolating the aforementioned results to the country's population, we estimate the prevalence of nonfatal injuries to be 3.6 million, approximately 31,720 deaths annually are caused by injury, and that 19,460 injury-related deaths could be averted with access to operative care annually.

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