Experience from community based childhood burn prevention programme in Bangladesh: implication for low resource setting.

A comprehensive community-based burn prevention framework was developed for rural Bangladesh taking into consideration the magnitude, consequences of burns, risk factors of childhood burn, health seeking behaviour of parents after a burn injury of a child and the perception of community people. This paper explains the comprehensive framework of the childhood burn prevention programme and describes its acceptability, feasibility and sustainability. A number of methodologies were adopted in developing the framework, such as, (i) building up relevant information on childhood burn and prevention methods, (ii) arranging workshops and consultation meetings with experts and related stakeholders and (iii) piloting components of the framework on a small scale. Lack of supervision of the children, hazardous environment at home and the low level awareness about childhood burn and other injuries were identified as the major attributes of childhood burn in Bangladesh. To address these factors "Triple S" strategies were identified for the prevention framework. These strategies are: Safe environment. Supervision. Skill development. According to these strategies, home safety, community crèche, school safety, formation of community groups and general awareness activities were identified as the different components of the childhood burn prevention framework in rural Bangladesh. The framework was piloted in a small scale to explore its feasibility acceptability and sustainability. The framework was found to be acceptable by the community. It is also expected to be feasible and sustainable as very low cost and locally available technology and resources were utilized in the framework. Large scale piloting is necessary to explore its effectiveness and ability to scale up all over the whole country.

Burn mortality in Bangladesh: findings of national health and injury survey.

OBJECTIVE: The study was designed to explore the epidemiology of burn mortality in Bangladesh. METHODS: A population-based cross-sectional survey was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. RESULTS: Overall mortality burn rate was 2.2 per 100,000 populations per year. The rate was higher amongst females. Most of the deaths were accidental in nature, only 5% of deaths were from self-inflected burn. The rate was higher amongst the rural population compared to the urban population. About 90% of the burn incidences were at home with the kitchen the most frequent place at home for burn incidence to occur. A majority, 89%, of the deaths were caused by flame burn. Cooking fire, heating fire and fire from kerosene lamps were the major sources of flames. The majority of burn deaths occurred during winter season. CONCLUSION: Burn is a considerable cause of death in Bangladesh. Females, rural dwellers and populations of low socioeconomic condition are more vulnerable to burn injury. With simple intervention many of the deaths due to burn can be prevented. Considering the magnitude of the problem it is very important to address it as a public health problem and develop a national burn prevention program.

Health care providers' readiness to screen for intimate partner violence in Northern Nigeria.

Research on screening for intimate partner violence (IPV) within health care in a sub-Saharan African context is rare. This paper assessed factors associated with the readiness to screen for IPV among care providers (HCP, n = 274) at Kano hospital, Nigeria. Readiness was measured using the Domestic Violence Health Care Providers' survey instrument, which measures grade of perceived self-efficacy in screening for IPV, fear for victim/provider safety, access to system support to refer IPV victims, professional roles resistant/ fear of offending clients, and blaming the victim for being abused victim. Social workers perceived a higher self-efficacy and better access to system support networks to refer victims than peers in other occupation categories. Female care providers and doctors were less likely to blame the victim than males and social workers, respectively. Younger care providers of Yoruba ethnicity and social workers were less likely to perceive conflicting professional roles related to screening than older providers of Hausa ethnicity and doctors, respectively. Implications of our findings for interventions and further research are discussed.

Epidemiology of childhood electrocution in Bangladesh: findings of national injury survey.

To explore the epidemiology of childhood electrocution in Bangladesh, a population-based cross-sectional survey was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. The average incidence rate of non-fatal childhood electrocution was 53.2 per 100,000 population-year. The rate was found to be significantly higher (p=.000) among male children compared to the females which was 66.7 and 39.2 per 100,000 population-year, respectively. A significantly higher rate of electrocution was found in rural areas compared to urban (p=0.000). The average child death rate due to electrocution was 1.42 per 100,000 population-year. More than two-thirds of the total childhood electrocution took place at home and 69% electrocution cases were from a domestic source of electricity. Younger children, specifically males are more vulnerable to electrocution. Rural children are at higher risk compared to urban. Home is the most common place of childhood electrocution. A national strategy and prevention program is necessary to address morbidity and mortality of children due to electrocution.

Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

OBJECTIVE: To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. STUDY DESIGN: Cross-sectional study. METHODS: The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). RESULTS: Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). CONCLUSION: RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact.

Health seeking behaviour of parents of burned children in Bangladesh is related to family socioeconomics.

OBJECTIVE: The study was design to explore the health seeking behaviour of Bangladeshi parents for their children during burn injuries. METHODS: A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171,366 rural and urban households comprising of a total population of 819,429, including 351,651 children of 0-18 years. Mothers or heads of households were interviewed with a structured questionnaire in obtaining the information. RESULTS: About sixty percent parents seek health care from unqualified service providers for their children during a childhood burn injury. Educated and the higher income groups parents choose qualified service provider at significantly higher rate compared to illiterate and poor. Higher proportion of parents of urban residence chooses qualified service provider compared to rural. No significant difference of health seeking behaviour of parent in choosing care provider was found in relation to sex of the children. CONCLUSION: Education, economic condition and place of residence were found as the contributory factors in choosing service provider. Education to the parents can contribute in changes in health seeking behaviour which ultimately contribute in reducing morbidity and mortality from childhood burn injuries. Including parent's education a national burn prevention program needs to be developed to combat the devastating child injury, burn.

Non-fatal burn is a major cause of illness: findings from the largest community-based national survey in Bangladesh.

OBJECTIVE: To examine the incidence and characteristics of non-fatal burn injury in Bangladesh. METHODS: A population-based cross-sectional survey was conducted between January and December 2003 in Bangladesh. Nationally representative data were collected from 171 366 rural and urban households, with a total sample size of 819,429. RESULTS: The incidence of non-fatal burns was 166.3 per 100,000 per year. The rate was higher in females than in males (RR 1.15; 95% CI 1.03 to 1.27). Children less than 5 years of age were at much higher risk of burn injury than those older than 5 years (RR 7.05; 95% CI 6.35 to 7.8). Rural people were at more than three times higher risk of burn. The average number of days absent from school due to burn injury was 21.64 (SD 19.64); the average number of workdays lost was 22.96 (SD 35.94). The average duration of assistance required in daily living activities was 17.26 (SD 20.34) days. The hospitalisation rate was 12.6 per 100,000 population per year. The mean duration of hospital stay was 15.88 (SD 20.47) days. The rate of permanent disability was 2.6 per 100,000 population-years. CONCLUSION: Burn is a major cause of morbidity, disability, school absence, and workday loss. Young children, females, and rural dwellers are at highest risk. Home is the most risky place for children and females in terms of burn injury risk. To halt this devastating health issue, a national strategy and programme for burn prevention must be developed.

Perceptions of rural people about childhood burns and their prevention: a basis for developing a childhood burn prevention programme in Bangladesh.

OBJECTIVES: This study was conducted to gain an in-depth understanding of people's perceptions of childhood burns and their prevention in rural areas of Bangladesh. STUDY DESIGN: Qualitative study. METHODS: Five focus group discussions were conducted in this study. Eight to twelve members were present in each group. Groups were composed of mothers of children under 5 years of age, adolescent male and female students in Grades IX and X, fathers and local leaders such as school teachers and religious leaders. The study was conducted in a rural community of Bangladesh in 2003. RESULTS: Focus group participants were aware of the devastating consequences of childhood burn injuries. They reported that younger boys and older girls are at higher risk of burn injuries. They identified home as the most common place for childhood burn injuries, and stated that occurrence was more common in winter. They held the household members or caregivers responsible because of their lack of supervision and carelessness. The focus group participants suggested that people should supervise their children more carefully, and should take initiatives to modify their homes and premises as necessary so that children would not have access to fires and heat sources. Regarding first aid, the focus group participants reported prevailing harmful practices which are likely to make injuries worse. CONCLUSIONS: A safety education programme could be an effective intervention to improve knowledge and practices of rural people in Bangladesh with regard to prevention of burns injuries in children.

The horizon of unintentional injuries among children in low-income setting: an overview from Bangladesh Health and Injury Survey.

INTRODUCTION: The paper aims to explore the magnitude and distribution of unintentional injuries among Bangladeshi children (<18 years). METHODOLOGY: A cross sectional survey was conducted during 2003 (January to December) in 12 randomly selected districts and Dhaka Metropolitan City of Bangladesh. Nationally representative data were collected from 171 366 households comprising of 351 651 children of under 18 years. Information includes the number of deaths and illness at the household in the preceding year. Verbal autopsy and verbal diagnosis form was used to determine the cause of mortality and morbidity respectively. RESULTS: There were 351651 children in the study, of which 5577 had one or more injuries in the past one year. Drowning and falls was the leading cause of injury mortality and morbidity in children over 1 year of age respectively. Incidence of unintentional injuries was significantly higher among boys (95% CI = -2157.8) than girls (95% CI = 968.7 - 1085.8) while rural children were the most vulnerable group. Home and its premises was the most common place for the injury incidence. CONCLUSION: The result of the study could be an insight to the policy makers to develop realistic and effective strategies to address the issue.

Burn injury: economic and social impact on a family.

OBJECTIVE: To assess the burden of burn injury in primary and secondary hospitals in Bangladesh, and how these costs are reflected as social and economic burdens in the community. STUDY DESIGN: Cross-sectional study. METHODS: A direct method was adopted to estimate the cost of burn injury, which involved interviewing patients or their attendants. Patient discharge records from 16 district hospitals and 45 Upazila (lower political units) health complexes were used as the main data sources in this study. Discharge records for December 2000 were reviewed for all types (injury and non-injury) of hospital admissions, and discharge records for January to December 2000 were reviewed for injury admissions. Hospital emergency departments' records for December 2000 were reviewed to study emergency injury cases. Patient interviews were conducted between February and March 2001 in selected primary and secondary hospitals in Bangladesh. RESULTS: Seven hundred and ninety-one burn patients were admitted in 2000, which constituted 2% of total injury admissions. Hospital records of all types of admission in December 2000 revealed that burn patients represented 1% of the total admissions. The duration of hospital stay was significantly longer for patients with burn injury compared with patients with other injuries or illnesses. The longest hospital stay due to burn injury was 17.34 days, found for children aged 1-4 years. The average patient cost for burn injury was higher than that for other injuries and illnesses. CONCLUSION: Burn injuries were associated with a longer hospital stay compared with other injuries and illnesses. The management costs of burn injury, even using very incomplete data, were found to be very high in Bangladesh. To reduce this economic burden on families, an effective burn prevention programme should be developed.

Consequences of childhood burn: findings from the largest community-based injury survey in Bangladesh.

In terms of morbidity and disability, burn is a major public health problem throughout the world, especially in low-income countries. It causes long-term disability and remains as a health, social and economic burden. A population-based survey was conducted in Bangladesh between January and December 2003. Nationally representative data were collected from 171,366 rural and urban households comprising of a total 819,429 population, which included 351,651 children under 18 years of age. Mothers/head of households were interviewed with a structured instrument. The objective of this paper is to determine the consequences of childhood burn at social and economic levels in Bangladesh. In the survey, 1013 children were found with different degrees of burn in the preceding 1 year. Among them 20 children were permanently disabled. The rate of permanent disability was found to be 5.7 per 100,000. The average loss of school days was found to be about 21 days. More than two-thirds of the burn victims required assistance in their daily activities for different durations of time. More than 7% of the children required hospitalisation for their burns. The rate of hospitalisation was 21.9 per 100,000; the average duration of hospital stay was 13.4 days. The highest duration (40 days) of hospital stay was found among girls 10-14 years old. The highest expenditure for the treatment was also found in this age group. The average direct expenditure incurred by a family for treatment of severe burn was determined to be $462. In this study it was found that more than 61% of the families earn less than $50 a month. Burn is a devastating injury among all childhood injuries with significant additional economic consequences beyond the medical, pain, and suffering issues. Developing a national prevention program should be an immediate public health priority.

Epidemiology of childhood burn: yield of largest community based injury survey in Bangladesh.

In terms of mortality, morbidity and disability, burns are emerging as a major child health problem in Bangladesh. This trend is similar to many other developing countries. To develop effective burn prevention programmes, information on its magnitude and determinants is necessary. The purpose of this study was to document the magnitude and determinant of childhood burns in Bangladesh, based on a population-based survey which was conducted between January and December 2003. Nationally representative data was collected from 171,366 rural and urban households, comprising of a total population of 819,429. To facilitate data collection, face-to-face interviews were conducted. The rate of non-fatal burn among children under 18 years of age was calculated as 288.1 per 100,000 children-year. The highest incidence (782.1/100,000 children-year) was found among the 1-4 years age group. About 46% of non-fatal burn injuries occurred between 9 a.m. and 3 p.m. The incidence of childhood burn was found to be more than four times higher in rural children than urban children. Ninety percent (90%) of the childhood burns occurred at homes and the kitchen was the most common place. The rate of disability due to burn was 5.7 per 100,000 children per year. The rate of fatal burn was 0.6 per 100,000 per year among all children. The study findings confirmed that childhood burn was a major childhood illness in Bangladesh. An urgent and appropriate prevention programme is required to prevent these unwanted morbidities, disabilities and deaths due to burn.

Drowning--a major but neglected child health problem in rural Bangladesh: implications for low income countries.

This study was intended to estimate the magnitude and explore the determinants of childhood drowning in rural Bangladesh. A cross-sectional survey as well as a population-based case - control study was conducted. By multistage cluster sampling 51 147 children aged 1 - 4 years were identified from 108 827 rural households. All drownings in children aged 1 - 4 years in the preceding 5 years were identified and recruited as cases and two living children of the same age group were selected from the same localities as controls. Socio-economic, demographic, environmental and other related information was collected from mothers of both cases and controls by face-to-face interview with the help of structured questionnaires. The incidence of drowning among children aged 1 - 4 years old was 156.4 per 100 000 children-year. The highest rate (328.1 per 100 000; 95% CI 254.8 - 421.7) was observed in 1 year old male children. The proportional mortality due to drowning in the children was 27.9%. Mothers' age and literacy and family income were identified as risk factors. Drowning is one of the major causes of 1 - 4 years childhood mortality in Bangladesh. One-year-old male children from poor families were at great risk of drowning in rural Bangladesh.

Rationales for home safety promotion in the Iranian primary healthcare system: results from a pilot study.

OBJECTIVE: To analyse the prerequisites for a nationwide primary healthcare (PHC) home safety promotion programme in Iran. BACKGROUND: Injury is a major public health problem throughout the world, currently accounting for one-seventh of all premature deaths and disabilities. Within 20 years, it is estimated that the proportion will increase to one-fifth. The present healthcare system in Iran was started in 1979, with a major focus on easy access to services and prevention. The system is based on the 'health house', which is run by community health workers. A survey shows that 36% of injuries occur in the home environment. A pilot phase of the Home Safety Promotion Programme was initiated in 1994, and included safety checking at home for fences, kitchens, drugs and poisons, heaters, electricity, and stairs and ladders. The pilot study covered 478,551 households out of the 12 million (approximately) in Iran. Sixty-nine supervisors were involved individually, assembled into eight focus groups. RESULTS: Household safety increased by 10-20% over the 4 years of the study. The frequency of home visits changed from annual to seasonal, since all participants agreed that there were seasonal differences in safety problems. The supervisors showed a high level of knowledge of injury as a public health problem, and also positive attitudes towards doing something about safety on the basis of a PHC scheme. The role of a surveillance system was highlighted, and it was suggested that such a system should be added to the programme. DISCUSSION AND CONCLUSION: Based on our preliminary findings, there were reasons to obtain a policy decision concerning a national programme for safety promotion before extending the pilot scheme to the whole country. A national safety programme was decided upon following completion of the pilot study. It includes a home-related-injury surveillance system that is mandatory in rural areas and voluntary in some cities.

Unintentional home-related injuries in the Islamic Republic of Iran: findings from the first year of a national programme.

BACKGROUND: As elsewhere, unintentional injuries are a leading cause of death in Iran, but non-fatal injuries occurring in the home environment have not been analysed. OBJECTIVES: The primary purposes of this study were to describe the pattern of home-related injuries and to obtain incidence rates for their determinants in order to monitor intervention programmes for preventive purposes. METHODS: A surveillance system for home-related injuries in selected rural and urban areas was established for the systematic collection of data. The information obtained covers emergency department visits and health services provided between March 1998 and March 1999. RESULTS: In total, 79,723 unintentional home-related injuries were reported, primarily burns (49%, incidence of 19/10,000 rural and 13/10,000 urban inhabitants) and lacerations/cuts caused by contact with sharp instruments (30%, incidence of 8.4/10,000 rural and 11/10,000 urban inhabitants). Injury rates were highest among children aged 0--4 years and lowest among the elderly (60 years or over). Rates varied between the sexes; among children under 15 years of age, most patients were male, but the opposite applied to all groups >15 years of age. Leading causes of death were burns, falls and poisoning among 628 people who died because of home-related injuries. CONCLUSIONS: The injury pattern found in this study is generally similar to that of many other countries, with the striking exception of burns. Other reports focus on the same problem, particularly with regard to Iran. The prevention of burns should be an important feature of any national injury prevention programme. Due to the varied causes of home-related injuries in Iran, interventions should be targeted at people at the greatest risk, namely children. Home visitation as a tool for face-to-face training with a sharper focus on burns, falls and poisoning prevention can be recommended as a part of primary health care policy. Greater investment in surveillance also provides a way of reducing the threat of injury in the community.

Temporal trends, gender, and geographic distributions in child and youth injury rates in Sweden.

OBJECTIVE: Sweden has the lowest child injury mortality rate in the world, 5.2/100 000 for children under 15. This paper describes temporal trends in Sweden, as well as gender related and geographic differences. DESIGN: The Swedish Cause-of-Death Register (1987-2001) and the Hospital Patient Register (1987-2002) were used to compare rates for the country as a whole and for discharges aged 0-20 by municipality, using the SEATS time series analysis program. RESULTS: There was a decrease in the rate of fatal unintentional injuries from 7 to 4 per 100 000 for girls and from 16 to 10 per 100 000 for boys since 1987. The gap between girls and boys was reduced and boys now have almost the same mortality rate as girls for violence related deaths. Road and other unintentional injuries show a general decrease whereas the pattern for falls varies by age and sex. Self inflicted injuries increased for both sexes, but more for girls. Substantial differences in injury rates between municipalities were also found-up to six times for girls and eight times for boys. CONCLUSION: Substantial declines in injury fatalities over time were found, but these were different for boys and girls. There remain substantial differences between municipalities. These data, published in a child injury atlas, have prompted substantial interest among media and the authorities.

Bicycle-related injuries among the elderly--a new epidemic?

Bicycling in Sweden has almost doubled between 1980 and 1992/3 among persons aged 25-64 y. The upward trend is continuing. For the elderly (65 or older) the bicycle is a common means of transport, in both Sweden and a number of other countries. Almost one-third of the Swedish population aged 65 or older bike at some time during the year. The objectives of this study are to describe the pattern of, and trend in, bicycle-related injuries among the elderly in Sweden and to discuss possible means of injury prevention. Mortality data come from official death certificates (1967-96). Hospital-discharge data (1985-96) are also employed, divided into three age groups (-14, 15-64 and 65-), by external cause according to the ICD-9, and also into 'all diagnoses' and 'head injuries'. Number of cases and days of hospital care for persons aged 65 or more, on aggregate and by gender, are reported for 1996. The whole of Sweden and its northern and southern parts separately were investigated. 2830 bicyclists were killed over the period 1967-96, of which 47% were 65 or older. The risk of dying due to bicycling was about 3.7 times greater among the elderly than among children aged 14 or under. There were significant changes in injury trends for all age groups between 1985 and 1996 with regard to hospital care. Annual average decreases for children, of 2.2% for all diagnoses and of 3.4% for head injuries, were observed. For the other two age groups there were increases in all injuries of 3.4% (15-64) and of 2.9% (65-), and increases in head injuries of 4.6% (15-64) and 2.7% (65-). For the elderly living in the southern part of Sweden, there was an increase on average of 2.2% per year over the period, compared with 4.2% for those in the northern part. Males showed a higher incidence of injuries and received longer periods of care than females. Do we have an epidemic of bicycle injuries among the elderly? They face a greater risk of being injured or killed than his/her younger counterpart. For all ages the risk is 7.4 times higher for a bicyclist than for a car driver. The risk for the elderly is about 3 times greater than for the average bicyclist, and as much as 6 times higher for the age group 75-84 y. With some few exceptions, there is no doubt that society has neglected the problem. Decision-makers have a tendency to focus on the relatively young. But people are living longer today and the elderly are healthier, which indicates the need for greater interest and more intervention. We have signs of an epidemic, but one that can be ameliorated or prevented. Just waiting for injury to occur leads only to premature death or lifelong disability.

Development of a national injury prevention/safe community programme in Vietnam.

The aim of this study is to describe the initiation of a national programme on injury prevention/safe community (IP/SC). Market economy, Doi Moi, was introduced in Vietnam in 1986, and since then the injury pattern has been reported to have changed. The number of traffic injury deaths has increased three-fold from 1980 to 1996 and traffic injuries more than four-fold. Injuries are now the leading cause of mortality in hospitals. There are difficulties in obtaining a comprehensive picture of the injury pattern from official statistics and, in conjunction with the work initiated by the Ministry of Health, a number of local reporting systems have already been developed. Remarkable results have been achieved within the IP/SC in a very short time, based on 20 years of experience. An organizational construction system has been built from province to local community areas. Management is based on administrative and legislative documents. IP/SC implementation is considered the duty of the whole community, local authorities and people committees, and should be incorporated into local action plans. The programme is a significant contribution towards creating a safe environment in which everybody may live and work, allowing the stability for society to develop. Implementation of the programme in schools is a special characteristic. The programme will be developed in 800 schools with a large number of pupils (25% of the population). This model for safer schools is considerably concerned and is a good experience to disseminate. The recommendations are that more pilot models of IP/SC should be conducted in other localities and that the programme should be expanded to a national scale. Furthermore, co-operation between sectors and mass organizations should be encouraged and professional skills of key SC members at all levels should be raised.

Cigarette smoking, oral moist snuff use and glucose intolerance.

OBJECTIVE: To investigate the association between cigarette smoking and use of oral moist snuff and impaired glucose tolerance and type 2 diabetes. DESIGN: We performed a population-based cross-sectional study of glucose intolerance and tobacco use in Stockholm during 1992-94. The sample consisted of 3128 men, aged 35-56 years, of whom 52% had a family history of diabetes. In an oral glucose tolerance test, we detected 55 men with type 2 diabetes and 172 with impaired glucose tolerance. Information on cigarette smoking and oral moist snuff use was collected by a questionnaire. RESULTS: The odds ratio of type 2 diabetes was increased for smokers of 25+ cigarettes day-1 (odds ratio = 2.6, 95% confidence interval = 1.1-5.9) as well as for moist snuff dippers of 3+ boxes week-1 (odds ratio = 2.7, 95% confidence interval = 1.3-5.5). The odds ratio of relatively high (highest tertile) fasting insulin levels in subjects with impaired glucose tolerance associated with cigarette smoking of 25+ cigarettes day-1 was 1.5 (95% confidence interval = 0.7-3.6). The corresponding estimate of a relatively low (lowest tertile) 2 h insulin response was 2.5 (95% confidence interval = 0.9-7.1). CONCLUSIONS: These results indicate that heavy users of cigarettes or moist snuff have an increased risk of type 2 diabetes. The results could suggest that tobacco use is associated with a low insulin response.

Potential of using existing injury information for injury surveillance at the local level in developing countries: experiences from Bangladesh.

Although injury is a major public health problem in Bangladesh, as in other low income countries in the world, it has gained very little attention from policy makers, or even health professionals, mainly due to the lack of valid injury information in these countries. To address the injury problem, there is an urgent need to develop injury surveillance activities, based on existing sources of potential interest for obtaining injury information. This study is an evaluation of existing injury data sources in terms of prevention orientation representativeness, and sustainability with respect to the use of these sources in injury surveillance at the local level in Bangladesh. The regular injury information sources that have been used in this study include hospital records, post-mortem reports, newspaper reports, and police reports. In addition, 60 health practitioners in the area, representing various categories, were interviewed according to questionnaire, and ten others were interviewed in-depth about their opinions regarding their participation in the injury surveillance system. The information sources were then assessed for their potential to be included in the surveillance system. The validity was estimated by means of comparisons of the different sources. All the existing sources of injury information suffer from certain deficiencies such as, lack of representativeness, low prevention orientation and poor sustainability. Post-mortem reports and police reports have been found to be potential sources of mortality data but not morbidity data. Hospital records can be seen as potential sustainable sources of injury morbidity data but suffer from low prevention orientation and representativeness. The injury information was not consistent from source to source and failed to depict the true picture of injury in the area. To develop an injury surveillance system, a combination of data obtained from several different sources is necessary to compensate for inadequacies in the individual sources and to improve the overall usefulness of the system. Updated with E-codes, hospital discharge records could be used for injury morbidity surveillance, and updated police and post-mortem data can be used for mortality data in injury surveillance systems at the local level in developing countries.