Dataset Information

Child transport injuries and deaths in Lebanon: a multicentre retrospective study.

ABSTRACT: INTRODUCTION:Road traffic injury (RTI) constitutes the leading cause of deaths and disabilities for individuals aged 5-29 years globally. Lebanon suffers from a high toll of transport mortality and morbidity, though accurate and reliable RTI data are limited. The aim of this study is to assess the prevalence and the characteristics of child transport injuries and deaths in Lebanon and to determine their outcomes and associated risk factors. METHODS:We conducted a multicentre retrospective study to analyse data on transport injuries and deaths for children aged 0-17 years over a 3-year period (2015-2017). Data were captured from multiple sources, including police reports and the emergency departments of 30 hospitals across the country . We performed logistic regression models to examine the effects and test the association of multiple simultaneous factors on the child injury outcome and severity. RESULTS:A total of 3,033 cases of child transport injuries and 237 fatalities were collected. The majority of the cases were males (73%) (mean (SD) age=11 (±5) years). Transport victims were Lebanese (66.5%) and Syrian refugees (27.9%). The most commonly reported factor contributing to child's RTI was a child riding in high-speed vehicles (25%) and the most affected body regions were upper and lower extremities (29.9%), followed by head injuries (26.1%). Pedestrians had higher odds of sustaining fatal injuries compared to four-wheel vehicle occupants (OR=1.6; 95% CI: 1.17 to 2.27). Older age groups of 6-14 years (OR=0.51; 95% CI: 0.79 to 0.69) and 15-17 years (OR=0.41; 95% CI: 0.30 to 0.61) had lower odds of dying from transport injuries compared to the younger age group of 0-5 years. CONCLUSION:Child transport injury is a major public health problem in Lebanon. Findings from this study urge policy-makers and health professionals to implement evidence-based child transport safety policies and behaviour change programs to reduce child transport injuries and deaths.

SUBMITTER: Al-Hajj S

PROVIDER: S-EPMC7592305 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Child transport injuries and deaths in Lebanon: a multicentre retrospective study.

Al-Hajj Samar S Arjinian Sebouh S Hamadeh Zahraa Z Al-Zaghrini Elie E El Asmar Khalil K

BMJ open 20201026 10

<h4>Introduction</h4>Road traffic injury (RTI) constitutes the leading cause of deaths and disabilities for individuals aged 5-29 years globally. Lebanon suffers from a high toll of transport mortality and morbidity, though accurate and reliable RTI data are limited. The aim of this study is to assess the prevalence and the characteristics of child transport injuries and deaths in Lebanon and to determine their outcomes and associated risk factors.<h4>Methods</h4>We conducted a multicentre retro ...[more]

PMID: 33109652

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Project description:Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies. Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa. Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals. A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the 'three delays framework' (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs-a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care. Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems. A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.

Project description:BackgroundInjuries result in substantial number of deaths among children globally. The burden across many settings is largely unknown. We estimated global and regional child deaths due to injuries from publicly available evidence.MethodsWe searched for community-based studies and nationally representative data reporting on child injury deaths published after year 1990 from CINAHL, EMBASE, IndMed, LILACS, Global Health, MEDLINE, SCOPUS, and Web of Science. Specific and all-cause mortality due to injuries were extracted for three age groups (0-11 months, 1-4 years, and 0-4 years). We conducted random-effects meta-analysis on extracted crude estimates, and developed a meta-regression model to determine the number of deaths due to injuries among children aged 0-4 years globally and across the World Health Organization (WHO) regions.ResultsTwenty-nine studies from 16 countries met the selection criteria. A total of 230 data-points on 15 causes of injury deaths were retrieved from all studies. Eighteen studies were rated as high quality, although heterogeneity was high (I2 = 99.7%, P < 0.001) reflecting variable data sources and study designs. For children aged 0-11 months, the pooled crude injury mortality rate was 29.6 (95% confidence interval (CI) = 21.1-38.1) per 100 000 child population, with asphyxiation being the leading cause of death (neonatal) at 189.1 (95% CI = 142.7-235.4) per 100 000 followed by suffocation (post-neonatal) at 18.7 (95% CI = 11.8-25.7) per 100 000. Among children aged 1-4 years, the pooled crude injury mortality rate was 32.7 (95% CI = 27.3-38.1) per 100 000, with traffic injuries and drowning the leading causes of deaths at 10.8 (95% CI = 8.9-12.8) and 8.8 (95% CI = 7.5-10.2) per 100 000, respectively. Among children under five years, the pooled injury mortality rate was 37.7 (95% CI = 32.7-42.7) per 100 000, with traffic injuries and drowning also the leading causes of deaths at 10.3 (95% CI = 8.8-11.8) and 8.9 (95% CI = 7.8-9.9) per 100 000 respectively. When crude mortality changes over age, WHO regions, and study period were accounted for in our model, we estimated that in 2015 there were 522 167 (95% CI = 395 823-648 630) deaths among children aged 0-4 years, with South East Asia (SEARO) recording the highest number of deaths at 195 084 (95% CI = 159476-230502), closely followed by the Africa region (AFRO) with 176523 (95% CI = 115 040-237 831) deaths. Globally, traffic injuries and drowning were the leading causes of under-five injury fatalities in 2015 with 142 661 (22.0/100 000) and 123 270 (19.0/100 000) child deaths, respectively. The exception being burns in AFRO with 57 784 deaths (38.6/100 000).ConclusionsVarying study designs, case definitions, and particularly limited country representation from Africa and South-East Asia (where we reported higher estimates), imply a need for more studies for better population representative estimates. This study may have however provided improved understanding on child injury death profiles needed to guide further research, policy reforms and relevant strategies globally.

Project description:BackgroundSyrian refugees in Lebanon have endured increasing hardships since the onset of the Syrian war in 2011, with many resorting to child labor. Working refugee children endure socioeconomic deprivation and harsh working conditions. This study explores the relationship between working conditions and the reporting of injuries among male and female Syrian refugee children in Lebanon and the related gender differences.Methods and findingsA cross-sectional survey of Syrian refugee children working in the Bekaa Valley of Lebanon was conducted in 2017. Face-to-face interviews with children (8 to 18 years) collected sociodemographic information and testimonies of their work experiences. Logistic regression tested the association between reporting of injuries and risk factors including school enrolment, field of work, means of transportation to work, age started working, number of working hours, multiple jobs, work pressure and hazards, and abuse. Analyses were stratified by gender. Of the 4090 surveyed working children, the majority reported working in agriculture (75.8%). Around a third (31.4%) reported being injured at work with a higher proportion in males. The most common reported injuries were cuts and wounds (44.9%), with males showing a higher proportion for all types of injuries compared to females. Nearly one fifth of reported injuries (19.8%) required medical attention in a hospital, with males reporting higher proportions than females for most types of injuries. The study findings revealed the association of multiple risk factors with an increased odds of reporting an injury, which included working in more than one job (AOR, 1.71; CI, 1.20-2.43; p = 0.003), working under pressure (AOR, 1.64; CI, 1.36-1.97; p<0.001), the use of sharp or heavy objects (AOR, 1.88; CI, 1.58-2.24; p<0.001), and experiencing physical abuse at work (AOR, 2.46; CI, 1.97-3.08; p<0.001). The odds of reporting an injury increased with every additional hour of work per day (AOR 1.08; CI, 1.02-1.14; p = 0.006). Most of these findings persisted in the male and female stratified models, with few exceptions. Males who went to work in a pickup truck had significantly lower odds of being injured than those who walked (AOR, 0.65; CI, 0.51-0.83; p = 0.001); this finding did not reach significance for females. Having longer work hours per day was significantly linked to higher odds of injury for females (AOR, 1.07; CI, 1.02-1.12; p = 0.008); but not for males. The main limitations of this study were its cross-sectional design and the use of self-reported variables.ConclusionsThis study is the first to obtain direct testimony on work-related injuries and working conditions, exploring gender differences, among Syrian refugee children in Lebanon. Results demonstrated the association between the occurrence of injury and multiple risk factors highlighting their strenuous working conditions, with some differences detected between males and females. Many injuries can be prevented through direct safety interventions and proper implementation of child labor policies. Multidimensional interventions are essential to address the complex evolving challenges facing refugees.

Dataset Information

Child transport injuries and deaths in Lebanon: a multicentre retrospective study.

Publications

Child transport injuries and deaths in Lebanon: a multicentre retrospective study.

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