ABSTRACT
BACKGROUND: Nepal is one of the post-conflict countries affected by violence from explosive devices. We undertook this study to assess the magnitude of injuries due to intentional explosions in Nepal during 2008-2011 and to describe time trends and epidemiologic patterns for these events. METHODS: We analyzed surveillance data on fatal and non-fatal injuries due to intentional explosions in Nepal that occurred between 1 January 2008 and 31 December 2011. The case definition included casualties injured or killed by explosive devices knowingly activated by an individual or a group of individuals with the intent to harm, hurt or terrorize. Data were collected through media-based and active community-based surveillance. RESULTS: Analysis included 437 casualties injured or killed in 131 intentional explosion incidents. A decrease in the number of incidents and casualties between January 2008 and June 2009 was followed by a pronounced increase between July 2010 and June 2011. Eighty-four (19.2%) casualties were among females and 40 (9.2%) were among children under 18 years of age. Fifty-nine (45.3%) incidents involved one casualty, 47 (35.9%) involved 2 to 4 casualties, and 6 involved more than 10 casualties. The overall case-fatality ratio was 7.8%. The highest numbers of incidents occurred in streets or at crossroads, in victims' homes, and in shops or markets. Incidents on buses and near stadiums claimed the highest numbers of casualties per incident. Socket, sutali, and pressure cooker bombs caused the highest numbers of incidents. CONCLUSIONS: Intentional explosion incidents still pose a threat to the civilian population of Nepal. Most incidents are caused by small homemade explosive devices and occur in public places, and males aged 20 to 39 account for a plurality of casualties. Stakeholders addressing the explosive device problem in Nepal should continue to use surveillance data to plan interventions.
ABSTRACT
BACKGROUND: Following more than a decade of civil conflict, Nepal is among the countries affected by landmines, victim-activated improvised explosive devices (IED) and other explosive remnants of war (ERW). OBJECTIVES: To assess the magnitude of injuries due to landmines, victim-activated IED and other ERW in Nepal and to describe epidemiological patterns and risk factors for these events. METHODS: Analysis of surveillance data on civilian injuries due to landmines, victim-activated IED and other ERW between July 2006 and June 2010. Data were collected through active community-based prospective surveillance. RESULTS: Of 307 total casualties, 94 (31%) were female and 169 (55%) were children under 18 years of age. The case-fatality ratio was 14%. The highest number of casualties was in the age group 10-14 years. 233 (76%) injuries were caused by victim-activated IED, 13 (4%) by landmines and 44 (14%) by other ERW. Two types of IED, sutali and socket bombs, caused the majority of injuries (28% and 31%, respectively). 117 (38%) of all injuries occurred in victims' homes and 152 (50%) occurred while victims were tampering with explosive devices. CONCLUSIONS: Substantial numbers of civilians, including women and children, were injured and killed following implementation of the Comprehensive Peace Agreement in 2006. The government of Nepal and humanitarian organisations should continue their efforts to reach communities at highest risk through targeted interventions and nationwide media campaigns to convey the risks of tampering with explosive devices or suspicious objects.
