Suicide Ideation and Depression Quality of Life Ratings in a Reservation-Based Community of Native American Youths and Young Adults.

Suicide among adolescents is a significant public health concern in the U.S., especially within American Indian and Alaska Native (AIAN) communities. Lack of quality of life (QoL) estimates for both suicide ideation and depression specific to the AIAN population hinders the ability to compare interventions in cost-effectiveness analysis. We surveyed 200 AI youth and young adults from the Fort Apache Indian Reservation to estimate utility weights for experiencing suicide ideation and depression. Our results indicate that, on a scale of 0-100, with higher scores indicating better health, the general community rates both suicide ideation and depression at 15.8 and 25.1, respectively. These weights are statistically significantly different and lower than for other cultures. Culturally specific QoL values will allow the comparison and identification of the most effective and feasible interventions to reduce the suicide burden among tribal communities.

Prevalence of drink driving and speeding in China: a time series analysis from two cities.

OBJECTIVES: To confront the public health challenge imposed by road traffic injuries in China. STUDY DESIGN: A consortium of international partners designed and implemented targeted interventions, such as social media campaigns, advocacy for legislative change and law enforcement training, to reduce the percentage of drink driving and speeding in two Chinese cities, Dalian and Suzhou, from 2010 to 2014. METHODS: Time series models were developed to detect changes in the prevalence of drink driving and speeding using data collected through four years of observational studies. RESULTS: This analysis, based on 15 rounds of data, shows that from May 2011 to November 2014, the percentage of vehicles driving above the speed limit decreased from 31.8% (95% confidence interval [CI]: 29.2-34.5) to 7.4% (95% CI: 7.0-7.9) in Dalian and from 13.5% (95% CI: 11.7-15.5) to 6.9% (95% CI: 6.4-7.4) in Suzhou. Drink driving decreased from 1.7% (95% CI: 1.1-2.4) in January 2011 to 0.5% (95% CI: 0.2-0.9) in November 2014 in Dalian and from 6.4% (95% CI: 5.4-7.4) to 0.5% (95% CI: 0.1-2.4) in Suzhou during approximately the same period. Time series models confirmed declining trends in both risk factors in both cities (P-value: 0.06 for speeding prevalence in Suzhou; all other P-values are below 0.05). Disaggregated by vehicle type, saloon cars and SUVs were more likely to exceed the posted speed limit than other types of vehicles in both cities. The speeding rate was higher where the posted speed limit is lower. In Dalian, more drivers were driving above the posted speed limit on weekdays than on weekends (11.4% vs 6.8%); Suzhou had a similar pattern, but the difference was smaller (14.0% vs 12.2%). CONCLUSION: Despite the challenge in accurately attributing the observed changes to one programme, the substantial reduction in the prevalence of the two risk factors suggests that through coordinated actions, internationally recognized best practices in road safety may be effective in improving road traffic safety in China.

Potential gains in life expectancy by improving road safety in China.

OBJECTIVES: Road traffic injuries (RTI) cause a significant number of injuries and deaths in China every year; the World Health Organization estimated 261,367 deaths due to RTI in 2013. As a result of the ongoing growth of China's economy, road construction and motorisation, RTI are expected to impose a heavy health burden in the future. However, the public and policy makers have not widely perceived RTI as a public health issue commensurate with its consequences, in part, due to a lack of intuitive indicator measuring the health impact. STUDY DESIGN: Employs the cause-eliminating life table technique to provide a measure of the burden of RTI based on data from a nationally representative surveillance system in China. METHODS: Previous studies have used indicators such as event counts, rates and disability-adjusted life years to measure the health impact of RTI; but this study uses potential gains in life expectancy to measure this impact. RESULTS: Eliminating RTI could lead to a gain of 0.52 years in life expectancy in 2012, meaning that on average Chinese people could live a half year more than they would in the presence of RTI. Males have a substantially higher RTI death rate and consequently could have a gain in life expectancy more than twice as large as females (male 0.72 years vs female 0.28 years). The gain in rural areas (0.65 years) is twice that in urban areas (0.32 years). CONCLUSIONS: The significant gain in life expectancy signals the urgency for public actions to improve road safety; the disparity in the burden across regions and sexes indicate a great opportunity for targeted interventions to protect health and save lives.

Cost-effectiveness of tuberculosis screening and isoniazid treatment in the TB/HIV in Rio (THRio) Study.

OBJECTIVE: To estimate the incremental cost-effectiveness of tuberculosis (TB) screening and isoniazid preventive therapy (IPT) among human immunodeficiency virus (HIV) infected adults in Rio de Janeiro, Brazil. DESIGN: We used decision analysis, populated by data from a cluster-randomized trial, to project the costs (in 2010 USD) and effectiveness (in disability-adjusted life years [DALYs] averted) of training health care workers to implement the tuberculin skin test (TST), followed by IPT for TST-positive patients with no evidence of active TB. This intervention was compared to a baseline of usual care. We used time horizons of 1 year for the intervention and 20 years for disease outcomes, with all future DALYs and medical costs discounted at 3% per year. RESULTS: Providing this intervention to 100 people would avert 1.14 discounted DALYs (1.57 undiscounted DALYs). The median estimated incremental cost-effectiveness ratio was $2273 (IQR $1779-$3135) per DALY averted, less than Brazil's 2010 per capita gross domestic product (GDP) of $11,700. Results were most sensitive to the cost of providing the training. CONCLUSION: Training health care workers to screen HIV-infected adults with TST and provide IPT to those with latent tuberculous infection can be considered cost-effective relative to the Brazilian GDP per capita.

CAPABLE trial: a randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: rationale and design.

BACKGROUND: As the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect. METHODS: The CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4 months. OUTCOMES: The primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality.

Cost and sustainability of a successful package of interventions to improve vaccination coverage for children in urban slums of Bangladesh.

OBJECTIVE: To estimate the incremental economic costs and explore satisfaction with a highly effective intervention for improving immunization coverage among slum populations in Dhaka, Bangladesh. A package of interventions based on extended clinic hours, vaccinator training, active surveillance, and community participation was piloted in two slum areas of Dhaka, and resulted in an increase in valid fully immunized children (FIC) from 43% pre-intervention to 99% post-intervention. METHODS: Cost data and stakeholder perspectives were collected January-February 2010 via document review and 10 key stakeholders interviews to estimate the financial and opportunity costs of the intervention, including uncompensated time, training and supervision costs. RESULTS: The total economic cost of the 1-year intervention was $18,300, comprised of external management and supervision (73%), training (11%), coordination costs (1%), uncompensated staff time and clinic costs (2%), and communications, supplies and other costs (13%). An estimated 874 additional children were correctly and fully immunized due to the intervention, at an average cost of $20.95 per valid FIC. Key stakeholders ranked extended clinic hours and vaccinator training as the most important components of the intervention. External supervision was viewed as the most important factor for the intervention's success but also the costliest. All stakeholders would like to reinstate the intervention because it was effective, but additional funding would be needed to make the intervention sustainable. CONCLUSION: Targeting slum populations with an intensive immunization intervention was highly effective but would nearly triple the amount spent on immunization per FIC in slum areas. Those committed to increasing vaccination coverage for hard-to-reach children need to be prepared for substantially higher costs to achieve results.

Potential Risk Estimation Drowning Index for Children (PREDIC): a pilot study from Matlab, Bangladesh.

UNLABELLED: Childhood drowning is a major public health problem that has been neglected in many low- and middle-income countries. In Matlab, rural Bangladesh, more than 40% of child deaths aged 1-4 years are due to drowning. AIM: The main objective of this paper was to develop and evaluate a childhood drowning risk prediction index. METHODOLOGY: A literature review was carried out to document risk factors identified for childhood drowning in Bangladesh. The Newacheck model for special health care needs for children was adapted and applied to construct a childhood drowning risk index called "Potential Risk Estimation Drowning Index for Children" (PREDIC). Finally, the proposed PREDIC Index was applied to childhood drowning deaths and compared with the comparison group from children living in Matlab, Bangladesh. This pilot study used t-tests and Receiver Operating Characteristic (ROC) curve to analyze the results. RESULTS: The PREDIC index was applied to 302 drowning deaths and 624 children 0-4 years old living in Matlab. The results of t-test indicate that the drowned children had a statistically (t=-8.58, p=0.0001) significant higher mean PREDIC score (6.01) than those in comparison group (5.26). Drowning cases had a PREDIC score of 6 or more for 68% of the children however, the comparison group had 43% of the children with score of 6 or more which was statistically significant (t=-7.36, p<0.001). The area under the curve for the Receiver Operating Characteristic curve was 0.662. CONCLUSION: Index score construction was scientifically plausible; and the index is relatively complete, fairly accurate, and practical. The risk index can help identify and target high risk children with drowning prevention programs. PREDIC index needs to be further tested for its accuracy, feasibility and effectiveness in drowning risk reduction in Bangladesh and other countries.

Childhood drowning and traditional rescue measures: case study from Matlab, Bangladesh.

Recent mortality data indicate that approximately half a million people drown each year worldwide, with more than 97% of such deaths occurring in low-income and middle-income countries. The purpose of this study was to examine verbal autopsy data on the circumstances of childhood drowning in Matlab, Bangladesh. The study analysed 10 years (1996-2005) of data which reported 489 deaths in children under 5 years and recorded preimmersion, immersion and postimmersion events. The data summarised household characteristics, age, gender and time of drowning event. The study also examined traditional rescue methods performed on children who were removed from the water OR found drowning. Of 489 deaths, 57% were aged 1-2 years and had a drowning mortality rate of 521 per 100 000 children. Most drowning events occurred during the morning (68%), in ponds (69%), and while the mother was busy doing household chores (70%). Traditional rescue methods were attempted in 55% of children and the most frequently reported measure was to spin the child over head (35%). Only 3% of families tried to perform resuscitation. Verbal autopsy data for Matlab is a useful resource for childhood injury research in a low-income country. The study is one of the first to publish data on traditional rescue practices performed on drowning children in rural Bangladesh. The findings suggest that interventions should be designed using locally identified risk factors to reduce childhood drowning incidents. Community-based resuscitation techniques and emergency medical systems are needed to improve postimmersion recovery of the child.

The evolving burden of HIV infection compared with other chronic diseases in northern Italy.

OBJECTIVES: The aim of the study was to estimate the burden and direct costs of diseases in HIV-infected patients (either opportunistic illnesses or other chronic diseases) with respect to the HIV-uninfected population. These estimates will be useful for the projection of future direct costs of HIV care. PATIENTS AND METHODS: A population-based study was conducted in the Brescia Local Health Agency in northern Italy. An administrative database recorded diagnoses, deaths, drug prescriptions and health resource utilization for all medical and surgical patients in the region from 2003 to 2007. The study estimated the prevalence of HIV infection as well as HIV-related mortality and annual cost per patient, and compared mortality and costs related to HIV infection with those for a set of 15 other chronic diseases. The standardized hazard ratio (SHR) and standardized mortality ratio (SMR) were obtained using an indirect standardization method. RESULTS: The prevalence of HIV infection increased from 218 per 100,000 inhabitants in 2003 to 263 per 100,000 in 2007. Although mortality rates decreased markedly (from 24 per 1000 HIV-infected patients in 2003 to 16 per 1000 in 2007), the data show that mortality was still higher in HIV-infected patients compared with the general population in the most recent years (SMR 8.8 in 2007). In each year included in the study, HIV-infected patients had higher rates of care-seeking for chronic diseases, including liver diseases (SHR>8), neuropathy, oesophagus-gastro-duodenum diseases, serious psychiatric disorders and renal failure (SHR approximately 3 for each). Also, the rate of medical attendance for neoplasias, chronic pulmonary disease, diabetes, and cardiovascular disease increased over time in HIV-infected patients compared with the general population. Ranking diseases in order of their total cost to the health system, HIV infection ranked 12th, with total costs of €28.6 million in 2007. Ranking in order of cost per patient, HIV infection ranked third, with a cost per patient of €9894 in 2007. HIV-infected patients with concomitant chronic diseases had higher average costs. The cost per patient in 2007 was €8104 for HIV-infected patients without other chronic diseases, €9908 for HIV infection plus cardiovascular disease, €11,370 for HIV infection plus chronic liver disease and €12,013 for HIV infection plus neoplasias. CONCLUSIONS: The prevalence and population cost of people living with HIV are likely to increase as a result of prolonged survival, aging of HIV-infected patients and increased risk of other chronic diseases. In the near future, HIV infection will rank as one of the most costly chronic diseases. Prevention strategies need to be more widely adopted to control the growing burden of the HIV epidemic and other chronic diseases affecting HIV-infected patients.

Cost-effectiveness of novel diagnostic tools for the diagnosis of tuberculosis.

SETTING: The potential cost-effectiveness of improved diagnostic tests for tuberculosis (TB) in resource-limited settings is unknown. OBJECTIVE: To estimate the incremental cost-effectiveness of a hypothetical new point-of-care TB diagnostic test in South Africa, Brazil and Kenya. DESIGN: Decision-analysis model, adding four diagnostic interventions (sputum smear microscopy, new test, smear plus new test and smear plus TB culture) to a baseline of existing infrastructure without smear. RESULTS: Adding sputum smear was estimated to be more cost-effective (incremental cost per disability-adjusted life year [DALY] of $86 [South Africa], $131 [Brazil], $38 (Kenya]) than a new TB diagnostic with 70% sensitivity, 95% specificity and price of $20 per test ($198 [South Africa], $275 [Brazil], $84 [Kenya]). However, compared to sputum smear, smear plus new test averted 46-49% more DALYs per 1000 TB suspects (321 vs. 215 [South Africa], 243 vs. 166 [Brazil], 790 vs. 531 [Kenya]), at an incremental cost of $170 (Kenya) to $625 (Brazil) per DALY averted. Cost-effectiveness was most sensitive to the specificity and price of the new test, the baseline TB case detection rate and the discount rate. CONCLUSION: Novel diagnostic tests for TB are potentially highly cost-effective. Cost-effectiveness is maximized by high-specificity, low-cost tests deployed to regions with poor infrastructure.

Cost-effectiveness of traffic enforcement: case study from Uganda.

BACKGROUND: In October 2004, the Ugandan Police department deployed enhanced traffic safety patrols on the four major roads to the capital Kampala. OBJECTIVE: To assess the costs and potential effectiveness of increasing traffic enforcement in Uganda. METHODS: Record review and key informant interviews were conducted at 10 police stations along the highways that were patrolled. Monthly data on traffic citations and casualties were reviewed for January 2001 to December 2005; time series (ARIMA) regression was used to assess for a statistically significant change in traffic deaths. Costs were computed from the perspective of the police department in $US 2005. Cost offsets from savings to the health sector were not included. RESULTS: The annual cost of deploying the four squads of traffic patrols (20 officers, four vehicles, equipment, administration) is estimated at $72,000. Since deployment, the number of citations has increased substantially with a value of $327 311 annually. Monthly crash data pre- and post-intervention show a statistically significant 17% drop in road deaths after the intervention. The average cost-effectiveness of better road safety enforcement in Uganda is $603 per death averted or $27 per life year saved discounted at 3% (equivalent to 9% of Uganda's $300 GDP per capita). CONCLUSION: The costs of traffic safety enforcement are low in comparison to the potential number of lives saved and revenue generated. Increasing enforcement of existing traffic safety norms can prove to be an extremely cost-effective public health intervention in low-income countries, even from a government perspective.

The association between cigarette smoking and work status among Egyptian adolescent males.

SETTING: Cigarette consumption has rapidly increased in Egypt and large numbers of young people are now smoking, but little is known about factors influencing smoking behavior in Egyptian adolescents. OBJECTIVE: To determine whether working is associated with cigarette smoking among Egyptian adolescent males. DESIGN: Data were from the nationally representative Adolescence and Social Change in Egypt survey. A total of 4354 boys and 4773 girls aged 10-19 years and one adult in each household were interviewed between March and August 1997. Given the low prevalence of smoking among girls, they were excluded from this analysis. RESULTS: Workers tended to be older, have more smoking peers, be of lower socio-economic status and live in rural regions; these confounders were included in multivariate models. Comparing former and never workers, the OR of ever smoking was 1.57 (95%CI 1.17-2.12), and that of current smoking was 1.46 (95%CI 0.99-2.25); comparing unpaid workers and never workers, the OR for ever smoking was 0.86 (95%CI 0.63-1.19), and for current smoking it was 1.08 (95%CI 0.69-1.67); and comparing paid workers with never workers, the OR for ever smoking was 1.36 (95%CI 1.00-1.85) while for current smoking it was 1.68 (95%CI 1.07-2.65). CONCLUSION: Egyptian boys who do paid work have a higher likelihood of smoking. Policy makers can target youths at high risk for smoking in industries that hire adolescents.

The societal burden of HIV/AIDS in Northern Italy: an analysis of costs and quality of life.

This study aims to measure the direct and indirect costs of HIV/AIDS care and quality of life (QoL) of HIV-infected patients in Northern Italy. We conducted a prospective cohort study over 12 months, enrolling a sample of 121 patients with HIV infection from two cities in Northern Italy. Patients were surveyed at baseline and were followed-up at 6 and 12 months. To assess the relationship between costs and stage of disease, patients were categorized into three groups at baseline: "No HAART" (asymptomatic and never before on highly active antiretroviral therapy (HAART)), "Stable HAART" (HAART with mild HIV infection and no prior opportunistic infections) and "HAART failure" (primary HAART regimen was altered because of severe side effects or immunological failure). Direct medical costs were based on utilization of (day) hospital admissions, diagnostic procedures, laboratory tests, clinic visits, consultations and antiretroviral drug use. Indirect costs included production losses due to absence from work, reduced productivity at work and reduced unpaid labour participation. QoL was assessed by visual analogue scale. Parametric regression was used to estimate the expected value and the standard deviation of annual costs per patient. The expected value of total annual costs was 1818 euros and 9820 euros and 12,332 euros, for groups "No HAART", "Stable HAART" and "HAART failure" respectively. We estimated annual expected earnings as 14,994 euros and 10,811 euros and 9820 euros for the same respective groups. The expected value of QoL on a scale of 0-1 in these same patient groups was 0.80, 0.78 and 0.64. We conclude that indirect costs contribute substantially to total costs and are comparable in magnitude to the direct costs excluding antiretroviral drugs. The costs of inpatient care in our cohort were almost negligible compared to total costs. Despite being in treatment, many patients were still gainfully employed and generated substantial expected annual earnings.

Willingness to pay for drug rehabilitation: implications for cost recovery.

OBJECTIVES: This study estimates the value that clients place on methadone maintenance and how this value varies with the effectiveness of treatment and availability of case management. We provide the first estimate of the price elasticity of the demand for drug treatment. METHODS: We interviewed 241 heroin users who had been referred to, but had not yet entered, methadone maintenance treatment in Baltimore, Maryland. We asked each subject to state a preference among three hypothetical treatment programs that varied across three domains: weekly fee paid by the client out-of-pocket ($5-$100), presence/absence of case management, and time spent heroin-free (3-24 months). Each subject was asked to complete 18 orthogonal comparisons. Subsequently each subject was asked if they likely would enroll in their preferred choice among the set of three. We computed the expected willingness to pay (WTP) as the probability of enrollment times the fee considered in each choice considered from a multivariate logistic model that controlled for product attributes. We also estimated the price elasticity of demand. RESULTS: The median expected fee subjects were willing to pay for a program that offered 3 months of heroin-free time was $7.30 per week, rising to $17.11 per week for programs that offered 24 months of heroin-free time. The availability of case management increased median WTP by $5.64 per week. The price elasticity was -0.39 (S.E. 0.042). CONCLUSIONS: Clients will pay more for higher rates of treatment success and for the presence of case management. Clients are willing to pay for drug treatment but the median willingness to pay falls short of the estimated program costs of $82 per week. Thus a combined approach of user fees and subsidization may be the optimal financing strategy for the drug treatment system.

Cost-effectiveness of misoprostol to control postpartum hemorrhage in low-resource settings.

OBJECTIVE: To test the cost-effectiveness of training traditional birth attendants (TBAs) to recognize postpartum hemorrhage (PPH) and administer a rectal dose of misoprostol in areas with low access to modern delivery facilities. METHOD: A cost-effectiveness analysis, modeling two hypothetical cohorts of 10,000 women each giving birth with TBAs: one under standard treatment (TBA referral to hospital after blood loss >or=500 ml), and one attended by TBAs trained to recognize PPH and to administer 1000 microg of misoprostol at blood loss >or=500 ml. RESULT: The misoprostol strategy could prevent 1647 cases of severe PPH (range: 810-2920) and save $115,335 in costs of referral, IV therapy and transfusions (range: $13,991-$1,563,593) per 10,000 births. By preventing severe disease and saving money, it dominates the standard approach. CONCLUSION: Training TBAs to administer misoprostol to treat PPH has the potential to both save money and improve the health of mothers in low-resource settings.

The cost-effectiveness of DOTS in urban Brazil.

SETTING: Rio de Janeiro, Brazil, is a middle-income setting with an estimated 1% adult human immunodeficiency virus (HIV) seroprevalence. OBJECTIVE: To examine the cost-effectiveness of DOTS in Rio de Janeiro. DESIGN: Cost-effectiveness analysis based on cost data and an epidemiological model based on programmatic outcomes from the Health Department in Rio de Janeiro, cost data from the retail market sector and epidemiological data from published studies. RESULTS: The 10-year cost of a tuberculosis program treating a population of 262 000 based on self-administered therapy (SAT) was estimated to be $580 271 compared to $1047 886 for DOTS. The largest portion of the DOTS budget was for staff costs and costs incurred by patients, both at 28%. For SAT, the largest percentage of the budget was allocated to medication costs, at 34%. Upgrading from SAT to DOTS averted 1558 cases of tuberculosis (TB, uncertainty range [UR] 1418-1704) and 143 TB deaths (UR 131-155). The incremental cost effectiveness ratio (ICER) for DOTS was $300 per case averted (UR $289-$312) and $3270 per death averted (UR $3123-$3435). In terms of disability adjusted life years (DALYs), DOTS saved 5426 DALYs (UR 4908-5961). The ICER for DOTS was $86 per DALY saved (UR $74-$100). CONCLUSIONS: DOTS is a highly cost-effective intervention in Brazil.

Changes in utilization of TB health services in Nepal.

SETTING: Nepal. OBJECTIVE: To assess the impact of community mobilization and health worker training on tuberculosis (TB) health services utilization. DESIGN: Questionnaire. METHODS: The Japan International Cooperation Agency and the Nepal Ministry of Health launched a set of interventions to increase awareness and availability of treatment at government facilities. In 2001 and 2003, a questionnaire was administered to TB patients. RESULTS: In 2001-2002, 77.3% of women and 80.0% of men with TB symptoms consulted at government facilities, compared to 30% of men and 32% of women in 1997-1999. CONCLUSION: In the absence of any secular causes, this change can be attributed to the increasing community awareness of availability and quality of DOTS.

How willing are parents to improve pedestrian safety in their community?

STUDY OBJECTIVE: To determine how likely parents would be to contribute to strategies to reduce pedestrian injury risks and how much they valued such interventions. DESIGN: A single referendum willingness to pay survey. Each parent was randomised to respond to one of five requested contributions towards each of the following activities: constructing speed bumps, volunteering as a crossing guard, attending a neighbourhood meeting, or attending a safety workshop. SETTING: Community survey. PARTICIPANTS: A sample of 723 Baltimore parents from four neighbourhoods stratified by income and child pedestrian injury risk. Eligible parents had a child enrolled in one of four elementary schools in Baltimore City in May 2001. MAIN RESULTS: The more parents were asked to contribute, the less likely they were to do so. Parents were more likely to contribute in neighbourhoods with higher ratings of solidarity. The median willingness to pay money for speed bumps was conservatively estimated at $6.43. The median willingness to contribute time was 2.5 hours for attending workshops, 2.8 hours in community discussion groups, and 30 hours as a volunteer crossing guard. CONCLUSIONS: Parents place a high value on physical and social interventions to improve child pedestrian safety.

Interventions for control of road traffic injuries: review of effectiveness literature.

OBJECTIVE: In 1998, road traffic injuries were estimated to be the 9th leading cause of loss of healthy life globally and are projected to become the 3rd leading cause by 2020. The majority of this burden can be located in the developing world where most of the projected increase will occur. Yet health systems are least prepared to meet this challenge in these countries. At the same time, there are effective interventions for road traffic injuries being implemented in the developed world. An extensive review of the literature reveals more than 16 different interventions in four categories that have been implemented. Renewed testing of these and new interventions will take both time and funds--resources that are scarce in developing countries. As a result, it is imperative to study the effectiveness of those interventions already tested and attempt to evaluate their potential implementation in developing countries. METHOD: Literature review to identify effective interventions and the magnitude of the effects. RESULTS: Four broad classes of interventions can be identified from the literature; health education/awareness, legislation, product design and environmental modifications. CONCLUSION: The issues for the developing countries are affordable, infrastructure and sociocultural in implementation of these strategies. The road traffic injuries are also underreported and hence under represented at the priority setting stage. Road safety should be high on the agenda as it can save a lot of lives and disability. Public health professionals should assess and advocate road safety in developing countries.