They built this city-construction workers injured in Delhi, India: cross-sectional analysis of First Information Reports of the Delhi Police 2016-2018.

BACKGROUND: Construction workers are 3-4 times more likely than other workers to die from accidents at work-however, in the developing world, the risks associated with construction work may be 6 times greater. India does not publish occupational injury statistics, and so little is known about construction workers injured. We aimed to use Indian police records to describe the epidemiology of construction site injuries in Delhi and to thus generate knowledge that may help to control the burden of injuries to construction workers in India and in other developing countries. METHODS: This was a cross-sectional analysis of accident records maintained by the Delhi Police. We included all construction workers reported to have been killed or injured in construction site accidents in Delhi during the period 2016-2018. We used multivariable logistic regression models to investigate associations between injury severity (fatal vs. non-fatal injury) and exposure variables whilst adjusting for a priori risk factors. We also estimated the number of Delhi construction workers in total and by trade to generate estimates of worker injury rates per 100,000 workers per year. RESULTS: There were 929 construction site accidents within the study period, in which 1,217 workers and children were reported to have sustained injuries: 356 (29%) were fatal and 861 (71%) were non-fatal. One-eighth of injuries were sustained by females. Most occurred in the Rainy season; most were sustained during the construction of buildings. The most frequent causes were the collapse of an old building, the collapse of a new building under construction, and electric shocks. Electricians were more likely than unskilled workers to suffer a fatal injury (adjOR 2.5; 95% CI: 0.87-6.97), and there were more electrical shocks than electricians injured. The odds of a fatal injury were statistically significantly lower in Central districts than in the less developed, peripheral districts. CONCLUSIONS: Construction site injuries are an unintended health impact of urbanisation. Women undertake manual work alongside men on construction sites in Delhi, and many suffer injuries as a consequence: an eighth of the injuries were sustained by females. Children accompanying their working parents on construction sites are also at risk. Two main hazards to construction workers in Delhi were building collapses and electrical shocks. Electricians were over twice as likely as unskilled workers to suffer a fatal injury, and electrical work would appear to be undertaken by a multitude of occupations. As the global urban population increases over the coming decades, so too will the burden of injuries to construction workers. The introduction and enforcement of occupational safety, health, and working conditions laws in India and in other rapidly developing countries will be necessary to help to control this injury burden to construction workers.

The incidence of construction site injuries to women in Delhi: capture-recapture study.

BACKGROUND: In India, the construction sector provides the main alternative to agricultural work - seasonal migration to and from construction work is widespread and construction work remains the second-largest employer of women in the country behind agriculture. Occupational injuries, which kill over 300,000 people annually, are a serious public health concern. However, data on construction site injuries to women are lacking, as India does not publish statistics on occupational injuries and illnesses. Our objectives were to: Estimate the number of women injured in construction site accidents in Delhi; and to estimate and compare the annual construction site injury rates per 100,000 workers of males and females in Delhi. METHODS: We conducted a two-sample capture-recapture study using data for accidents reported to the Delhi Police, Employee State Insurance Corporation (ESIC), and Commissioners of Workmen Compensation (CWC) of Delhi Government. The capture-recapture method has been used in epidemiology, to estimate morbidity and mortality using multiple, overlapping, but incomplete data sources. This study is based on the injuries reported from construction site accidents in Delhi in 2017. We linked the data from each of the data sources using the name, gender, and age of each injured person, the date and place of the accident, and the name of the employer. We used the Chapman estimator to estimate the total incidence of construction injuries in Delhi. RESULTS: We estimated that there was a total of 37 female construction site workers injured (17 fatal and 20 non-fatal) in Delhi in 2017. There was a total of 1043 male construction site workers injured (236 fatal and 807 non-fatal). FIRs ascertained two-thirds (68%) of all injuries to females but only one third (34%) of those to males. The annual construction site injury rate per 100,000 workers of females was 82.26 (95%CI: 57.92 to 113.39). The annual construction site injury rate per 100,000 workers of males was 146.5 (95%CI: 137.7 to 155.6). There was strong evidence (p = 0.001) that the overall construction site injury rate per 100,000 workers of females was about one half the rate of males [rate ratio 0.56 (95%CI: 0.40 to 0.78)]. There was no evidence (p = 0.601) that the rates of fatal injuries differed in males and females (rate ratio 1.14 (95%CI: 0.70 to 1.87). CONCLUSIONS: This study is the first to estimate the incidence of injuries to female construction site workers in India. The overall injury rate of female construction workers was over half as great as the rate of males. This implies that female construction workers face a not insignificant risk. Hence, safety measures (e.g., personal protective equipment) that are appropriate and culturally acceptable to Indian women are needed.

Evaluation of first information reports of Delhi police for injury surveillance: Data extraction tool development & validation.

BACKGROUND & OBJECTIVES: : Policymakers and health professionals need to know the distribution, patterns, trends and risk factors of injury occurrence to develop strategies that reduce the incidence of injuries. The first information report (FIR) of Indian police is one potential source of this information. The aims of this study were to identify the minimum data set (MDS) recommended for injury surveillance, to develop a tool for data extraction from FIRs, to evaluate whether FIRs contain this MDS and to assess the inter-rater reliability of the tool. METHODS: : This was a cross-sectional study of incidents reported to Delhi Police in 2017. A systematic literature search was conducted to identify the MDS recommended for injury surveillance. A tool was designed for extraction of data, and its inter-rater reliability was assessed using Cohen's kappa and the percentage availability of each MDS data item in the FIRs, was calculated. RESULTS: : The literature review identified 24 reports that recommended 12 MDS for injury surveillance. The FIRs contained complete information on the following five MDS: sex/gender (100%), date of injury (100%), time of injury (100%), place of injurious event (100%) and intent (100%). For the following seven MDS, information was not complete: name (93.1%), age (67.2%), occupation (32.8%), residence (86.2%), activity of the injured person (86.2%), cause of the injury (93.1%) and nature of the injury (41.4%). The inter-rater reliability of the data extraction tool was found to be almost perfect. INTERPRETATION & CONCLUSIONS: : Information on injuries can be reliably extracted from FIRs. Although FIRs do not always contain complete information on the MDS, if missing data are imputed, these could form the basis of an injury surveillance system. However, use of FIRs for injury surveillance could be limited by the representativeness of injuries ascertained by FIRs to the population. FIRs thus have the potential to become an important component of an integrated injury surveillance system.

Completeness of Ascertainment of Construction Site Injuries Using First Information Reports (FIRs) of Indian Police: Capture-Recapture Study.

BACKGROUND & OBJECTIVES: The construction industry is a leading contributor to occupational injuries. First Information Reports (FIRs) of Indian Police are a potential data source for construction injuries. The aim of this study was to estimate the completeness of ascertainment of construction site injuries by FIRs. METHODS: This was a two-sample capture-recapture study of construction site injuries sustained in the year 2017 in Delhi, India. The first capture sample was data extracted from FIRs. The second capture sample comprised data extracted from the Employee State Insurance Corporation (ESIC) and the Commissioners of Workmen Compensation. The Chapman estimator was used to estimate, with 95% confidence intervals, the total numbers of fatal and non-fatal injuries. RESULTS: FIRs ascertained 374 injuries (110 fatal and 264 non-fatal) while the combined data of ESIC and workmen compensation claims ascertained 80 injuries (48 fatal and 32 non-fatal). The capture-recapture analysis estimated that 1,011 (95% CI: 873 to 1149) injuries: 258 (95% CI: 221 to 295) fatal injuries and 873 (95% CI: 765 to 1053) non-fatal injuries were sustained in Delhi in 2017. INTERPRETATION & CONCLUSIONS: FIRs ascertain approximately one-third of all construction site injuries. In the absence of any other data source, FIRs may be used as the basis of a construction injury surveillance system, recognizing that any estimates made using these data must be adjusted to allow for the approximately two-thirds of injuries not reported to the police. Further research is needed to identify reasons for some injuries not being reported to the police, in order to help to develop a strategy to improve the completeness of ascertainment of construction site injuries for the future.

How Safe Are Industries in India? Ascertaining Industrial Injuries in Dadra and Nagar Haveli, India by Capture-Recapture Method.

CONTEXT: Every year, more than 4 million people die from injuries worldwide. India reported 413,457 deaths due to unintentional injuries in 2015. Manufacturing industry is a major contributor to injury morbidity and mortality. AIMS: This study aims to estimate the burden of industrial injuries in Dadra and Nagar Haveli, India. SETTINGS AND DESIGN: Dadra and Nagar Haveli is a small territory spread over 491 sq. km, having a population of 343,709 as per 2011 population census. METHODS AND MATERIALS: The two-sample capture-recapture method was used for ascertainment of fatal and non-fatal injuries reported from 1st January to 31st December 2017. The first capture was data of injuries extracted from First Information Reports registered by the police. The recapture was data of injuries reported by the government health facilities. STATISTICAL ANALYSIS USED: Chapman estimator was used to derive total fatal and non-fatal injuries. An analysis was done using Microsoft Excel software. RESULTS: According to police records, there were nine fatal and eight non-fatal injuries during the study period. Health facilities reported 21 fatal and 113 non-fatal injuries. Six cases of fatal and 3 cases of non-fatal injuries were found in both the data sources. The capture-recapture analysis estimated 30 fatal (95% CI: 20 to 40) and 225 non-fatal injuries (95% CI: 90 to 420). CONCLUSIONS: Both records of police and government health facilities underestimate fatal and non-fatal injuries with under-reporting more pronounced in police records.

Addressing the social determinants of health through health system strengthening and inter-sectoral convergence: the case of the Indian National Rural Health Mission.

BACKGROUND: At the turn of the 21st century, India was plagued by significant rural-urban, inter-state and inter-district inequities in health. For example, in 2004, the infant mortality rate (IMR) was 24 points higher in rural areas compared to urban areas. To address these inequities, to strengthen the rural health system (a major determinant of health in itself) and to facilitate action on other determinants of health, India launched the National Rural Health Mission (NRHM) in April 2005. METHODS: Under the NRHM, Rs. 666 billion (US$12.1 billion) was invested in rural areas from April 2005 to March 2012. There was also a substantially higher allocation for 18 high-focus states and 264 high-focus districts, identified on the basis of poor health and demographic indicators. Other determinants of health, especially nutrition and decentralized action, were addressed through mechanisms like State/District Health Missions, Village Health, Sanitation and Nutrition Committees, and Village Health and Nutrition Days. RESULTS: Consequently, in bigger high-focus states, rural IMR fell by 15.6 points between 2004 and 2011, as compared to 9 points in urban areas. Similarly, the maternal mortality rate in high-focus states declined by 17.9% between 2004-2006 and 2007-2009 compared to 14.6% in other states. CONCLUSION: The article, on the basis of the above approaches employed under NRHM, proposes the NRHM model to 'reduce health inequities and initiate action on SDH'.