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Pediatric injury research - what we know & what we need to know

Pediatric injury research - what we know & what we need to know. Olive Kobusingye, MD, M.Med ( Surg ), MPH Makerere University School of Public Health. Uganda summary demographics 2012 mid-yr projections. Source: Uganda Bureau of Statistics. Burden of child injury.

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Pediatric injury research - what we know & what we need to know

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  1. Pediatric injury research - what we know & what we need to know Olive Kobusingye, MD, M.Med (Surg), MPH Makerere University School of Public Health

  2. Uganda summary demographics 2012 mid-yr projections Source: Uganda Bureau of Statistics

  3. Burden of child injury • How do we know what we know? • Health facility data (routine & other) • Community data • Routine Police data • NGOs

  4. Top 10 causes of hosp based deaths, all ages 2012/13, HMIS

  5. Top 10 causes of hosp based deaths, Under 5, 2012/13, HMIS

  6. Hospital injury surveillance • Injury Control Center – Uganda has been conducting surveillance since 1997. Recently this effort has been patchy. Data from 07/2004 – 08/2005 were analyzed to determine the pattern of injuries in children. Hsia, R., Ozgediz, D., Jayaraman, S., Kyamanywa P, Mutto M, & Kobusingye O. Epidemiology of child injuries in Uganda: challenges for health policy. Journal of Public Health in Africa. 2011;2:e15

  7. Most common causes of injury 2004/5

  8. Mechanism of violent injury in children

  9. Most common causes of injury 2009 (ICCU)

  10. Other child focused research • Motto et al. Intentional injuries. Among Uganda youth: a trauma registry analysis. InjPrev 2010 • Hodges, Wilson & Hodges. Plastic and re obstructive surgery in Ug 10yrs experience Pead anesthesia 2009 • Onongeetal. Clinical presentation and management of alleged sexually assaulted females at Mulago hops. Afr Health Scio 2005

  11. Community / non-hospital based sources

  12. African Network for Prevention and Protection against Child Abuse and Neglect (ANPPCAN) Uganda 2011 study • The specific objectives were to; • 1. Provide information about the nature, magnitude, causes and consequences of child abuse and neglect in Uganda. • 2. Provide an updated situation of child abuse and neglect in Uganda • 3. Provide a comprehensive analysis on problems and challenges of child abuse and neglect in Uganda.

  13. ANPPCAN study scope • 8 districts drawn from Central, Western, Eastern and Northern regions to have a representative sample of the whole country at 11.5% of the 122 districts in Uganda

  14. African Network for Prevention and Protection against Child Abuse and Neglect (ANPPCAN) Uganda • Primary data was generated from interviews with victims of abuse, perpetrators of child abuse, parents/caregivers as well as other duty bearers including teachers, health workers, and relevant technical staff both at the district and sub county level. • Secondary data from Annual Police Crime Report as well as media publications by the New Vision, Daily Monitor, & Bukedde papers.

  15. Child Abuse Cases Reported to Police in 2011 & 2012

  16. Child focused community research • Amone P'Olak . Torture against children in rebel captivity in Northern Uganda. Torture 2009; 19(2):102-17. • Lee etal. Pedestrian injuries in school-attending children: a comparison of injury data sources in a low income country. Inj Prev 2009

  17. Northern Uganda – a community in armed conflict • Survey done covering period 1 January 2005 to July 2005. • Complete demographic information was available for 30 304 individuals who had been present in the 3830 households surveyed

  18. Northern Uganda – a community in armed conflict • Northern Uganda has recorded highest injury rate so far, with 770 injury deaths per 100,000 persons per year (1999). • Survey found violence third most frequent cause of death (9.4%) • occurring mostly outside of Internally Displaced People’s camps (68.8%) and health facilities (93.5%) • Persons killed mostly adult males (70.1%) • 16.9% were children under 15.

  19. Northern Uganda in conflict • Of the 77 deaths due to violence recorded throughout Acholi region, 70.1% (54/77) occurred among older (15 years or above) males, 13.0% (10/77) among older females. • 16.9% (13/77) among children below 15 years. • The violence-specific mortality rate was 0.17 persons per 10 000 per day (95% CI 0.12 to 0.21), corresponding to 3971 persons (95% CI 2803 to 4905) estimated killed between January and mid-July 2005.

  20. African Child Policy Forum • Commissioned retrospective surveys in Ethiopia, Kenya and Uganda on young women's experiences of violence before they were 18 years old. • Presented at the Second International Policy Conference on the African Child 2003

  21. African Child Policy Forum • surveyed 500 young women (ages 18 to 24) • selected through random social groups in the city of Kampala. • Half of the young women questioned grew up in rural areas, now residing in the capital. • Only one third of the girls were still living with their parents at the time of the survey, • 4% of the girls had never had any schooling, yet most (70%) had completed or quit studies at the time of the survey.

  22. Age at which violence occurred A retrospective survey in Ethiopia, Kenya, and Uganda

  23. Physical violence resulting in seeking med care / missing school / work

  24. Student health survey • The 2003 Uganda GSHS was a school-based survey of secondary school students in yrs 1, 2, and 3. A two-stage cluster sample design. Data representative of all students in standards 1, 2, and 3 in Uganda. At the first stage, • 1st stage: Schools were selected with probability proportional to enrollment size. 2nd: Classes randomly selected, all students in selected classes eligible. A total of 3,215 students participated • Students self-reported their responses to each question on a computer scannable answer sheet. • Only students aged 13-15 years are included in the analyses for the presented results.

  25. Global Student Health Survey 2003

  26. Global Student Health Survey 2003

  27. Global Student Health Survey 2003 RURAL

  28. Summary: what we know • Ugandan children face a high burden of injuries - morbidity, mortality • The very young at risk of burns, falls, violence • The older children – road traffic, falls, violence • Adolescents into young adulthood – road traffic, violence • Most injuries happen at home or on the road • Violence – takes various forms

  29. What we need to know • What is the true burden to the communities? (most datasets lack denominator data) • Mechanisms, circumstances of injury • Access to health care, barriers to access • Economic cost of child injuries • Burden of Injuries which are rapidly fatal, such as drowning – they do not show up in hosp

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