Fall injuries in Baghdad from 2003 to 2014: Results of a randomised household cluster survey |
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| Institution: | 1. Department of Surgery, University of Washington, Seattle, WA, USA;2. School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;3. Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana;4. Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq;5. Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq;6. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA;7. Department of Global Health, University of Washington, Seattle, WA, USA;8. Institute for Health Metrics and Evaluation, Seattle, WA, USA;9. Department of Health Services, University of Washington, Seattle, WA, USA;10. Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;11. Surgeons OverSeas (SOS), New York, NY, USA;12. Department of Surgery, Columbia University, New York, NY, USA;13. Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa;1. Division of Traumatology, Surgical Critical Care and Emergency Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;3. The Leonard Davis Institute, Wharton School of Business at the University of Pennsylvania, Philadelphia, PA, United States;4. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;5. Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States;6. Department of Emergency Medicine, Jefferson University School of Philadelphia Medicine, PA, United States;1. Department of Trauma, Division of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands;2. The Royal Netherlands Navy (R) and Department of Traumatology, Division of Surgery, Medical Center Haaglanden – Bronovo, The Hague, The Netherlands;3. Royal Netherlands Army and Department of Surgery-Trauma, Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands;4. United States Air Force and The Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Science, Bethesda, United States;5. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands;1. Department of Surgery, Kern Medical Center, USA;2. Department of Radiology, Kern Medical Center, USA;1. Interuniversity Centre for Health Economics Research, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium;2. Emergency and Disaster Medicine, Department Emergency Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium;3. Medical Registration, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium;1. Division of Pulmonary and Critical Care Medicine, Loyola University Health Sciences, Maywood, IL, United States;2. Department of Public Health Sciences, Loyola University School of Medicine, Maywood, IL, United States;3. Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD, United States;4. Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, United States;5. Heartland Health Outreach, Chicago, IL, United States;6. Program in Trauma, R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, United States;7. Shock Trauma and Anesthesiology Research (STAR)—Organized Research Center, University of Maryland, Baltimore, MD, United States |
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| Abstract: | IntroductionFalls incur nearly 35 million disability-adjusted life-years annually; 75% of which occur in low- and middle-income countries. The epidemiology of civilian injuries during conflict is relatively unknown, yet important for planning prevention initiatives, health policy and humanitarian assistance. This study aimed to determine the death and disability and household consequences of fall injuries in post-invasion Baghdad.MethodsA two-stage, cluster randomised, community-based household survey was performed in May of 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding injury specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship.ResultsNine hundred households totaling 5148 individuals were interviewed. There were 138 fall injuries (25% of all injuries reported); fall was the most common mechanism of civilian injury in Baghdad. The rate of serious fall injuries increased from 78 to 466 per 100,000 persons in 2003 and 2013, respectively. Fall was the most common mechanism among the injured elderly (i.e. ≥65 years; 15/24 elderly unintentional injuries; 63%). However, 46 fall injuries were children aged <15 years (49% of unintentional injuries) and 77 were respondents aged 15–64 years (36%). Respondents who spent significant time within the home (i.e. unemployed, retired, homemaker) had three times greater odds of having suffered a fall injury than student referents (aOR 3.34; 95%CI 1.30–8.60). Almost 80% of fall injured were left with life-limiting disability. Affected households often borrowed substantial sums of money (34 households; 30% of affected households) and/or suffered food insecurity after a family member's fall (52; 46%).ConclusionFalls were the most common cause of civilian injury in Baghdad. In part due to the effect of prolonged insecurity on a fragile health system, many injuries resulted in life-limiting disabilities. In turn, households shouldered much of the burden after fall injury due to loss of income and/or medical expenditure, often resulting in food insecurity. Given ongoing conflict, civilian injury control initiatives, trauma care strengthening efforts and support for households of the injured is urgently needed. |
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| Keywords: | Fall Aging Iraq Conflict War Epidemiology Community assessment Global surgery |
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